HELICOBACTER PYLORI INFECTION IN SIBLINGS: A CASE REPORT: A case report

Helicobacter pylori infection is still prevalent worldwide. A study on H. pylori infection in 12 countries in Asia and the Middle East showed a wide range of prevalence, with the highest found in Australia (African refugees). Indonesia is a country with a thousand islands and a variety of ethnic groups. A study in the five biggest islands of Indonesia revealed that the prevalence of H. pylori infection was 22.1%. Although the predominant ethnic group in Indonesia is Javanese, the most commonly affected ethnic groups are Papuan, Batak, and Buginese. Another study in urban areas found a higher prevalence of 68%. The mode of transmission of H. pylori infection is not well known. It is assumed that the major mode of transmission within a family is direct person-to-person contact. Here, we present the case of four siblings who had H. pylori infection. The patients were from a family originating from the Bataks tribe (North Sumatra). They complained of dyspepsia. Endoscopic examination revealed that three of them had gastritis, while one had normal gastric tissue. In addition, histopathological examination of three siblings showed that they had chronic active gastritis. One sibling's histopathology report was not available. Further laboratory evaluation of gastric biopsy specimens from all siblings confirmed the presence of H. pylori infection. Real-time polymerase chain reaction followed by DNA sequencing was then performed, and it was found that all siblings had almost similar patterns of H. pylori gene sequences. Phylogenetic analysis indicated the relationship among the siblings. Further genotyping studies are required to understand the mode of transmission in these cases. In addition, follow-up samples of the two siblings showed the presence of Clarithromycin's gene mutation. In summary, molecular biology techniques support the evidence of intra-familial H. pylori infection and may help physicians in patients' management. The management of intra-familial infection due to H. pylori should be done comprehensively. Individuals should pay more attention to oral and hand hygiene to prevent H. pylori infection and the spreading of its resistance against antibiotic.