Multiple and mixed Helicobacter pylori infections: Comparison of two epidemiological situations in Tunisia and France

Epidemiology of Helicobacter pylori infection

“…They are difficult to detect but should impact the effectiveness of eradication treatment. Multiple infections are very often suspected when virulence genes are characterized . Three articles focused on multiple infections this year.…”

“…Ben Mansour et al . compared the prevalence of multiple and mixed H. pylori infection in a developing country, Tunisia, and in a developed country, France, including 42 H. pylori ‐culture positive‐infected patients (21 Tunisian and 21 French).…”

Low‐level primary clarithromycin resistance of Helicobacter pylori in Burkina Faso: A prospective molecular study

“…Nine percent of resistance to clarithromycin is largely under the 15%-20% threshold put forward by the Maastricht V consensus report as a reason to abandon the clarithromycin-based first-line treatment. 6 In conclusion, we report a low level of primary clarithromycin resistance in H pylori isolates from the Burkinabe population (9.1%), which leads us to still recommend the standard clarithromycin-based triple therapy as a first-line treatment in Burkina Faso. [3][4][5] We report a distribution of mutations with a predominance of the A2143G mutation, while A2142G predominates in Morocco, A2143G predominates in Algeria and Tunisia, thereby confirming the local emergence of this resistance under selection pressure by macrolide consumption rather than the epidemic spread of resistance genes.…”

Direct Detection of Helicobacter Pylori in Biopsy Specimens using a High-Throughput Multiple Genetic Detection System

“…Interestingly, besides single resistance genotype, dHMGS could also detect mixed resistance genotype (both wild-type and mutant genotypes) simultaneously from same biopsy specimens by appearing in two distinct peaks (Figure 5A), which indicated that these patients may have mixed infection with the heteroresistant strains. Several studies showed that the mixed infection rate in some regions could reach around 20%, which seriously increased the complex and difficulty in clinical diagnosis and treatment [6,28,29]. Therefore, the resistance analysis using biopsy specimens would be more accurate and objective than using isolated strains.…”

“…While only some H. pylori infected patients eventually develop these severe gastroduodenal diseases pathologies, it is still not clear to what degree the magnitude of bacterial burden and/or expression of virulence genes contributes to the development of these complications [2,3]. Furthermore, the H. pylori drug resistance and the mixed infection rate seriously increased the complexity and difficulty in clinical diagnosis and treatment [4–6]. Incorporation of these readouts into the rapid, routine diagnostic method would not only inform the physician and patients about the potential risks, but in retrospect, allow the medical community to study and more accurately ascribe risks of specific gastroduodenal diseases.…”