Prevalence of Typhoid fever and Helicobacter pylori infection in local population of Faisalabad, Pakistan


 BackgroundTyphoid fever and Helicobacter pylori infection increases the secretion of gastric acid that leads to gastric carcinoma. In this research, we have tried to investigate the prevalence of typhoid and H. pylori in Faisalabad, Pakistan.MethodIn the present study, we collected the laboratory reports from different hospital of Faisalabad, Punjab, Pakistan. Statistical Package for Social Sciences (SPSS) (Chicago, IL), version 25 was used for data processing.ResultOur results demonstrated that H. pylori was most frequent in male at the age of 41–50-year-old and typhoid in female having 21-30 age.ConclusionConclusively, mostly female in typhoid and male in H. pylori were infected. People having 21-30 age were greatly infected by typhoid. The patients owing the 41-50 age were more susceptible for H. pylori infections. By comparing the co-infection rate, we found that typhoid is most common in over all age group than H. pylori.


Introduction
Typhoid fever is a major health issue in developing countries such as Pakistan [1]. According to WHO, the global burden of typhoid fever is about 21 million cases per year, with rate of mortality 1-4% 30170987. In Asia, the morbidity of typhoid fever is with 93% of global episodes occurring in this region. It is estimated that the incidence rate in Southeast Asia about 110 cases/100,000 population [2]. The sources of infections is certain foods such as ice, unbranded ice cream, chilled food, and contaminated water [1,3].
However, typhoid fever has been detected in the months of September, October and after monsoon rains in July to August [2].
Salmonella enterica serotype typhi is a rod shaped, agellated, gram-negative bacterium that causes typhoid fever. In 1829, Pierre Louis was the rst scientist that identi ed the lesions in the abdominal lymph nodes of gastric fever patient and coin the term "typhoid fever". The term "typhus" is a Greek word which meant "smoky" that is used to narrate the delirium that patient would exhibit with the disease [4].
In 2000, it has been estimated that there were about 21.7 million cases of typhoid fever and 216,000 death rates globally [5]. Typhoid fever is more commonly present in children as well as in young adults and associated with low-income countries in which poor sanitation is prevalent [6][7][8]. In 2010, International Vaccine Institute estimated about 11.9 million cases and 129,000 death cases of typhoid fever in middle-income countries [9]. In USA, about 200 to 300 cases of Salmonella enterica serotype typhi a gram-negative bacterium, are reported every year, and about 80% cases are from travelers returning from endemic areas [10,11].
In the pre-antibiotic period, it has been estimated that the mortality rate was 15% or more. Hence, mortality rates have been decreases to less than 1% via introduction of antibiotics [7,12]. Many other complications have been occurred in 10-15% of the patients that were infected from typhoid fever.
Although, many complications have been investigated in the literature, but the most common complications comprise intestinal perforation, relapse, typhoid encephalopathy, and gastrointestinal hemorrhage [6,7].
Chloramphenicol is the rst antibiotic that has been used to treat the infections cause by Salmonella enterica serotype typhi is a gram-negative bacterium [7]. After 2 years later, resistant form of typhi bacterium were discovered in the community [7]. Recently, cipro oxacin or o oxacin antibiotics have become the mainstay of treatment [6,7,13]. Instead of signi cant efforts in medical and research eld, typhoid fever is still a major, globally, public health concern.
Helicobacter pylori is also a gram-negative spiral bacterium that is the major cause of chronic human gastritis. H. pylori infection is also associated with many other diseases such as gastric cancer and peptic ulcer [14]. In 1994, the international Agency for Research on Cancer categorized H. Pylori infection as a group I carcinogen. Hence, the incident rate of gastric cancer is decreases and it remain the 4th common cancer and 2nd leading cause of cancer related deaths worldwide [15].
H. Pylori is linked to various other gastroduodenal diseases; hence, about 20% of infected individual develop sever diseases [16]. Prevalence of H. pylori antibiotic resistance is upsurge globally and is the main aspect affecting potential of current therapeutic regimens [17].
Additionally, environmental, dietary factors, contamination, another possible factor for the varying outcomes of H. pylori infection relates to differences in the virulence of H. pylori strains. Various virulence factors of H. pylori including cagA, vacA, oipA, babA, homA/B and hopQ have been explored to be predictors of gastric atrophy, intestinal metaplasia, and various other clinical outcomes [18][19][20].
Our aim of study to review the recent data on H. Pylori and Salmonella enterica resistance towards prevalence rate at different age group of individuals in district Faisalabad, Punjab, Pakistan.

Material And Method
Study Area: Faisalabad, Pakistan's third largest city, is situated between latitudes 31.41°N and 73.11°E and has a population of more than 2.6 million, is recognized an industrial engine of Pakistan. This study was conducted in the private laboratories of district Faisalabad, Pakistan.

Data Collection for typhoid and H-Pylori:
Data collection was based on sex, age, and test result. For this study, 323 samples (n=323) were collected from suspected subjects of typhoid from both male (n= 129) and female (n=194) comprises of eight age group ranges viz >01-10 (n=8), 11-20 (n=58), 21 Statistical Package for Social Sciences (SPSS) (Chicago, IL), version 25 was used for data entry, processing, and statistical analysis. p value was calculated by χ2 test was used for categorical variables.
A 2-tailed p ≤ 0.05 was statistically signi cant. Table 1: represents the prevalence of typhoid in different age groups. It was proved that highest prevalence observed between 21-30 age group. Our study revealed that Salmonella enterica serotype typhi infected the 67.2% people. It was also noticed that there was no effect of gender in the incidence of typhoid infection because our chi-square value (0.872) was greater than 0.05.   Studies have showed that the major risk factors for endemic typhoid are unhygienic environment, not washing hands before and after eating, ice-creams and avored ice [21]. The low socioeconomic status has been a major reported effect on H. pylori infection in a major population [22,23]. The association of virulent factors such as cagA, cagB, homA/B etc., with gastritis, duodenal ulcer has also been reported.

Results
The ndings of this study explain that people from age 21-30 are more suspected of typhoid and H. pylori infection (41-50). Mostly are females in the case of typhoid and males in the point of H. pylori [18]. Typhoid cases are more positive, and H. pylori cases are primarily negative, indicating that typhoid is more common than H. pylori infection.
The data were analyzed statistically using the software "Statistical Package for Social Sciences (SPSS) (Chicago, IL), version 25". A Chi-square test was performed, and results were obtained.
The p-value of typhoid fever and H. pylori infection is .006 and .002, respectively, less than 0.05. If the pvalue is less than 0.05, it is statistically signi cant and indicates strong evidence against the null hypothesis as there is less than a 5% probability the null is correct. So, we reject the null hypothesis and accept the alternative idea.

Conclusion
Typhoid is most common infection than Helicobacter pylori in the population Faisalabad due to industrialization. We found that Helicobacter pylori and typhoid was common at the age of 41-50, 21-30 respectively. We must adopt systematic preventive measure for curing disease.