Revista de SIDA e investigación clínica

Role of H. pylori Infection (Serology, PCR) in Chronic Idiopathic Thrombocytopenic Purpura in an Endemic Country: A Case Control Study, Tehran, IRAN

Abstract

Mohammad Faranoush, Samileh Noorbakhsh, Azim Mehrvar and zardokht Tabatabae

Background: A practical guideline for detection and managements of some common infectious agents in cases with chronic ITP (Idiopathic Thrombocytopenic Purpura) is so important. Objectives: to investigate the role of H. pylori infection in children with chronic ITP in an endemic area. Materials and methods: A case control study done in pediatric ward Rasul Hospital, Tehran, Iran (2009-2010). 51 chronic ITP cases and 25 controls were assessed. H. pylori IgG & IgA ELISA (LDN -Germany) assesses in all cases and controls. All cases undergoing Bone Marrow Aspiration. H. pylori -PCR evaluated (QIAquickP® QIAGEN; Germany). P-value <0.05 was considered statistically significant. Results: cases were between 1- 20 years (mean 13.3.5 ± 7.6 y). Platelet count varied between 5000-1330000 (mean 63621 ± 37369.9) Positive H. pylori- IgA observed in 70% (36/51) of cases and 4% (1/25) of controls; p-value=0.00. H. pylori (IgG) was not significantly difference between cases and controls. [51% (26/51) vs. 32% (8/25), p-value=0.09] .Poor agreement observed between H. pylori –IgA and H. pylori - IgG antibodies and severity of thrombocytopenia in ITP cases (Kappa=-0.11; 0.04). Positive PCR results was % 5.9% (3/51) in ITP cases without significant difference in age between positive and negative PCR results (mean age 9.3 ± 9.7 years vs. 13.5 ± 7.52 years; p-value =0.3) Poor agreement between positive PCR and positivity of IgA (actual agreement=47.062%; p-value =0.5; Kappa=- 0.04), and IgG antibodies (actual agreement=40.91%; p-value =0.6; Kappa=- 0.04 respectively) were observed in ITP cases. Conclusion: We concluded that H. pylori infection (serologically) is high in young Iranian population. In chronic ITP, the H. pylori infection can be considered as an additional disorder which aggravates the main disease. The management of mild-to-moderate chronic ITP in Iranian patients, especially those with a recent onset of disease, should include an investigation for and eradication of infection with H. pylori.