Helicobacter pylori and Clostridium difficile in Cystic Fibrosis Patients

Abstract

We describe the prevalence of H. pylori and toxigenic Clostridium difficile (CD) infection and its relationship with gastrointestinal symptoms and pancreatic sufficiency (PS) or insufficiency (PI) in cystic fibrosis (CF) patients. Stool specimens from 30 consecutive patients with CF, aged 1-44, and from 30 healthy similarly aged subjects were tested for the H. pylori antigen by specific monoclonal antibodies and for CD toxins by Tox A/B assay and Tox A assay. CF patients were assessed clinically and tested for specific H. pylori serum antibodies and for mutations. In CF patients, the prevalence of H. pylori antigen was 16.6% (5/30), compared to 30% (9/30) in controls. Of the 26 CF patients with PI, only 2 (7.6%) were infected by H. pylori, compared with 3 of the 4 (75%) patients with PS (P=0.001). H. pylori infection was diagnosed in 3 of 5 (60%) CF patients carrying mild mutations, compared to 1 of 25 (4%) CF patients carrying severe mutations (P=0.01). Fourteen of 30 (46.6%) stool specimens from CF patients tested positive in the ToxA/B assay, and 3 of 14 tested positive for ToxA. No significant differences in antibiotic use, severity of lung disease, PI, chronic abdominal pain, or genotype were found between the two groups. None of the controls was positive for CD toxins. Prevalence of H. pylori infection in CF patients was lower than in similarly aged non-CF controls. CF patients with PI or a history of distal intestinal obstruction syndrome and those carrying mutations associated with a severe phenotype were protected against H. pylori infection. Almost half of the CF patients were asymptomatic carriers of CD producing mostly toxin B. More studies are needed to confirm our results in a larger group of CF patients.

Clostridium difficile in Children: A Review of Existing and Recently Uncovered Evidence

“…Carriage rates of C. difficile in patients with cystic fibrosis have been reported to be 22-46 %, double that of control patients receiving antibiotics [85][86][87]. These high carriage rates were described in older patients (median age 18.5, youngest 15 years) in the absence of symptoms of diarrhoea or abdominal pain, despite the presence of toxigenic strains [87].…”

The Cystic Fibrosis Intestine

“…Patients with CF are at increased risk of hyperoxaluria and formation of calcium-oxalate kidney stones. Conversely, an example of a pathogen acquired in CF is Clostridium difficile, which can be detected in fecal samples of .50% of CF patients (Yahav et al 2006).…”

<i>Helicobacter pylori</i> Infection and the Respiratory System: A Systematic Review of the Literature

“…Only a small number of publications can be found addressing H. pylori and CF [84,85,86,87]. A study by Israel et al [85] is the only study addressing the prevalence of H. pylori infection in CF patients; it shows a lower prevalence than in similarly aged non-CF controls [87].…”

“…A study by Israel et al [85] is the only study addressing the prevalence of H. pylori infection in CF patients; it shows a lower prevalence than in similarly aged non-CF controls [87]. …”