1. Department: Microbiology
Helicobacter pylori
Dr.ruaa Elias
College of Medicine
Department: Microbiology

2. List of Contents: Objectives Introduction Important properties
Source and Transmission
Diagnosis
Diseases
Treatment

3. Objectives:
-H. pylori has a great ability to resist destruction by stomach acid.
-Human GI tract is the only reservoir for H. pylori
-H. pylori causing Chronic Gastritis and Duodenal Peptic Ulcer .This ulceration is most often chronic and recurrent and may lead to complication such as bleeding, anemia, and perforation
-The students must learn all detail about the virulence factors,pathogenicity and diagnosis, treatment of these very important bacteria

4. Introduction
-H. pylori is a genus of Gram-negative bacilli , bacteria in the Enterobacteriaceae family.
-Transmission occurs via the fecal oral route.

5. Important properties:
- Gram negative S-shape or comma shape rods
- Microaerophilic, fastidious, non-spore forming, non- capsulated, motile bacteria.

6. Source and Transmission
-Human GI tract is the only reservoir for H. pylori.
-Transmission occurs via the fecal oral route.
-There is a direct relationship between increased age and increased likelihood of H. pylori infection

7. Virulence factors 1- Endotoxin (lipopolysaccharide)
2- H. pylori has a great ability to resist destruction by stomach acid.
3- Flagella enables movement into and within the protective mucus layer of the stomach.
4- Urease enzyme generates ammonium ions to buffer gastric acid; this enables survival within the hostile acidic environment.

8. Diagnosis
- Diagnosis of infection is usually made by checking for dyspeptic symptoms and by tests which can indicate H. pylori infection.
-One can test non invasively for H. plori infection with a blood antibody test, stool antigen test

9. Diagnosis
-or with the carbon urea breath test (in which the patient drinks 14C- or 13C-labelledurea, which the bacterium metabolizes, producing labeled carbon dioxide that can be detected in the breath).  

10. Diagnosis
-However, the most reliable method for detecting H. pylori infection is a biopsy check during endoscopy with a rapid urease test, histological examination, and microbial culture.
-There is also a urine ELISA test with a 96% sensitivity and 79% specificity.

11. Diagnosis
-None of the test methods is completely failsafe. Even biopsy is dependent on the location of the biopsy. Blood antibody tests, for example, range from 76% to 84% sensitivity.
-Some drugs can affect H. pylori urease activity and give false negatives with the urea-based tests.

12. Electron micrograph of Helicobacter pylori possessing
multiple flagella (negative staining). The spiral
morphology of Helicobacter pylori 

13. Diseases Chronic Gastritis-
Symptoms: causes some nausea or upper abdominal discomfort, but in many cases the patient is asymptomatic.
-Duodenal Peptic Ulcer: (H. pylori is No. 1 causative agent).
Symptoms: burning upper abdominal pain; occurs 1-3 hours after meals; pain is worse at night but relieved by eating or use of anti-acids.

14. Diseases
-This ulceration is most often chronic and recurrent and may lead to complication such as bleeding, anemia, and perforation.
-Gastric Peptic Ulcer: similar to duodenal ulcer Gastric
-Carcinoma: occurs in the setting of H. pylori

15. under the stomach mucus layer

17. Treatment: -Combination of the following :
-Ranitidine (H2 blocker) + Bismuth salts + Amoxycillin +Metronidazole.
-Tetracycline can be substituted for amoxycillin in penicillin allergy.
-Alternative combination: Clarithromycin metronidazole.

18. Summary
H. pylori is a genus of Gram-negative bacilli , bacteria in the Enterobacteriaceae family. Human GI tract is the only reservoir for H. pylori. -Transmission occurs via the fecal oral route. Has Virulence factors: Endotoxin (lipopolysaccharide), H. pylori has a great ability to resist destruction by stomach acid, Flagella , Urease enzyme generates ammonium ions to buffer gastric acid; this enables survival within the hostile acidic environment. One can test non invasively for H. plori infection with a blood antibody test, stool antigen test the most reliable method for detecting H. pylori infection is a biopsy check during endoscopy with a rapid urease test , histological examination, and microbial culture. Chronic Gastritis ,Duodenal Peptic Ulcer, Gastric Peptic Ulcer: similar to duodenal ulcer Gastric ,Carcinoma .treatment by Combination of the following Ranitidine (H2 blocker) + Bismuth salts + Amoxycillin +Metronidazole

19. References
Medical Microbiology, edited by Jawetz,E., Brooks,G.F.; Carroll,K.C.;Butet,J.S.; Mores,S.A.and Mietzner,T.A th ed.
Medical Microbiology, edited by Jawetz,E., Brooks,G.F.; Butet,J.S and Mores,S.A th ed.
Internet access .

20. Question?

21. Thanks a lot