This study used multilocus sequence typing (MLST) of total DNA extracted from faecal specimens to genotype Helicobacter pylori to analyse intra-familial transmission. Faecal DNA was extracted and amplified by nested PCR. The products were analysed by direct sequencing and the allele type was determined using an MLST website. Mother-to-child transmission was suspected in at least two of three families, and father-to-child transmission was suspected in one family.
INTRODUCTIONInfection by the Gram-negative microaerophilic rod Helicobacter pylori is associated with the development of chronic gastritis, peptic ulcers and gastric adenocarcinoma in humans (Kusters et al., 2006). It is thought that one of the modes of transmission of H. pylori is between family members, and therefore the presence of infected family members is an important risk factor in children (Konno et al., 2008). However, there have been few studies that have proven intra-familial infection using isolated family strains (Konno et al., 2005;Nahar et al., 2009). It is difficult to isolate H. pylori from the gastric mucosa of children, as endoscopic analysis is not often undertaken. Therefore, the genotypes of paediatric H. pylori strains have not been analysed fully in comparison with those of other adult family members.Multilocus sequence typing (MLST) analysis has become the most common method for genetic analysis of bacterial strains. MLST has been applied previously for the root causal analysis of outbreaks (Chalmers et al., 2008), hospital infections (Walker et al., 2012) and intra-familial infections (Staples et al., 2012). An H. pylori MLST database is available online, consisting of seven housekeeping genes (http://pubmlst.org/helicobacter/), with over 2000 alleles detected at each locus. The genetic identity of various pathogenic strains can be analysed by MLST, which is tied in with information on the geographical sources of H. pylori, exposing major events in the history of human settlement (Achtman et al., 1999;Falush et al., 2001Falush et al., , 2003Linz et al., 2007;Moodley et al., 2009;Wirth et al., 2004).After H. pylori organisms reach the anaerobic environment of the intestine, the micro-organisms are unable to grow and change morphology to their coccoid forms, which are non-culturable (Shirai et al., 2000). However, the DNA of H. pylori has been reported to be detected by PCR using faecal specimens from infected patients (Scaletsky et al., 2011) and animals (Oshio et al., 2009). Here, we compared the MLST of faecal DNA specimens for the detection of intra-familial H. pylori infection.
METHODSParticipants. Children aged 0-12 years attending seven elementary schools, three nursery schools and six kindergartens in Sasayama city, Hyogo, Japan, were recruited into an epidemiological study. The Sasayama Study, for H. pylori infection in children, was carried out from November 2010 to March 2011. Stool samples were collected from 783 children, and 15 samples gave positive results. Family members of the 15 stool antigen-positive children ...