pptnya jurnal anak

8/10/2019 pptnya jurnal anak

1/11

Preceptors :

Dr. Rahmat Gumelar, SpADr. Manan Affandi, SpA

Dr. Tina Ramayanti, SpA

Dr.Mustakim, SpA, Mkes

Oleh :

Wulandari Pawestri H.

1102008322


2/11

Helicobacter pylori (H. pylori) is one of the mostimportant factors in the gastroduodenaldiseases.

H. pylori has been shown to playamajor role inthe pathogenesis of gastric atrophy, chronicdiarrhea, and growth retardation in children,intestinal metaplasia, dysplasia, and the

development of gastric carcinoma andlymphoma subsequently.


3/11

Besides, some benefits are also noted such asreducing prevalence of esophageal

adenocarcinoma by decreasing the periods ofgastroesophageal reflux disease.

Fecal-oral or oral-oral routes are the maincandidate ways of its transmission, although

much is unknown in this regard. Gastroenteritis is another important disease in

children caused by a variety of bacterial andviral agents and the exact responsible

organisms are different from one area toanother but generally, E. coli, Shigella, andSalmonella are the most common enteric bacterialpathogens


4/11

The study is a case control study performed during20092011 in the Children Medical Center Hospital, themajor childrens hospital of Iran affiliated to TehranUniversity of Medical Sciences, Tehran, Iran.

Twomatched groups were studied as follows: (1)

group of children with acute bacterial gastroenteritisdue to Salmonella or Shigella consisted of 122 consecutivechildren (55 females and 67 males), aged 2472 monthsold, 68 with Shigellosis and 54 with Salmonellosis; (2)control group consisted of two hundred and fourhealthy children (100 males and 104 females) with nohistory of diarrhea and no bacterial growth in theirstool cultures. Age parameter was matched betweenboth genders (> 0.05).


5/11

Healthy children with history of diarrhea within 2weeks before sampling and any child in each groupwith history of antibiotic therapy within 4 weeks priorto stool collection were excluded from study. None of

the participants were treated with a proton-pumpinhibitor or bismuth preparations. No underlyingmedical disease or immunodeficiency was detected inenrolled groups.

Personal data including age (13 years and 36 years),gender, and address was also obtained from parentsusing a structured questionnaire. Cases were fromurban area but parents defer to get information aboutthe exact socioeconomic level but as the hospital is

governmental and located in the middle part of the cityand the admitted children were from nearby areas, onecan conclude that cases belonged to mediumsocioeconomic level.The study was approved by theTehran University of Medical Sciences Ethics

Committee.


6/11

Stool samples were collected in thehospital andimmediately frozenand stored at 70C. Solidand semisolid stool specimens were tested for

H.pylori antigen by the GA Generic Assays GmbHkit, H. Pylori sandwich enzyme immunoassay(Germany), in accordancewith themanufacturers instructions.


7/11

Bacteria from stool samples were cultivated oneight different selective agar plates in order toisolate the microorganisms. Mac-Conkey agar

was used for the detection of E. coli, Salmonella,and Shigella species.

Thiosulfate-citrate-bile salts-sucrose (TCBS)agar was used for the detection of Vibrio

species, mannitol-malt agar (MSA) forStaphylococcus aureus, and SS and XLD forShigella and Salmonella


8/11

Among 112 patients enrolled in this study, 68 hadShigella infection and 54 had Salmonella infection. The prevalence of H. pylori infection in control group

was significantly higher than in acute bacterialdiarrhea group (= 0.007), in which two of fifty-

four cases of Samonella infection and three of sixty-eight cases of Shigellosis were infected by H. pyloriwhile 27 out of 204 control children were infected.

The risk of positive H. pylori infection in controlgroup was 3.6 (odds ratio =3.6, 95% CI: 1.339.5, =

0.007) times higher than bacterial infection group(Table 1). There was no statistical difference inprevalence of H. pylori infection in variable age

groups in control versus patients groups (data notshown).


9/11

The cause of diarrhea differs fromone country toanother and generally one can expect higher ratesof bacterial infections in underdeveloped anddeveloping countries in comparison with

developed countries. Several pathogenic microorganisms are

incriminated as the etiologic agents of acutediarrhea such as rotavirus, adenoviruses,caliciviruses, and astroviruses, Salmonella, Shigella,

enteropathogenic and enterotoxigenic E. coli (EPECand ETEC, resp.), Aeromonas, Plesiomonas spp.Campylobacter jejuni, Yersinia enterocolitica,Vibriocholerae, protozoa, and helminthes


10/11

Our results revealed that the prevalence of H.Pylori infection in healthy children was higherthan in patients with bacterial diarrheaindicating that bacterial infected patients areless infected with H. pylori.These findings are inline with other studies showing protective roleof H. pylori infection and reporting a reduced

frequency of diarrheal illness in H.pylori infectedchildren.

It can be due to either increase in gastric acidproduction in individuals infected by H. Pylori

which leads to bacterial pathogens damage [19]or activation of immune system as a result ofH. pylori infection and increased IgAproduction,which is fatal for enteric pathogens


11/11

There are many studies showing associationorprotective role of H. pylori infection in differentdisease groups, for example, reducing Barrettsesophagitis, decreasing risk of esophageal cancer ,decreasing risk of gastric cardiac cancer , ordecreasing the bleeding risk of esophageal varicesin cirrhotic patients.

According to our findings, H. pylori infectionmay be

candidate agent which plays a protective role ingastroenteritis in children. So it is important toconsider all of the positive and negative aspects ofH. pylori infection before its eradication; however,because of the current debate and considering the

fact that knowledge about H. pylori life cycle and itspathogenesis is not explicitly definedmorecomprehensive research is recommended.

Searching for viral gastroenteritis and determiningthe Cag A status of H. pylori by means of PCR

method are also suggested.

pptnya jurnal anak

Documents

Transcript of pptnya jurnal anak