In young children, the significance of stool samples transiently positive for Helicobacter pylori antigen is unknown. As part of a larger prospective study on enteric infections, stool samples were obtained from 323 children at two time points 3 months apart and tested for H. pylori antigen using a commercially available enzymelinked immunosorbent assay (ELISA) test. Seminested PCR for a Helicobacter-specific 16S rRNA gene was performed on all 26 pairs reverting from positive to negative ( Helicobacter pylori chronically colonizes the human stomach. Little is know about the transmission of H. pylori, although most cases appear to be acquired in childhood. Because the date of acquisition of H. pylori is rarely known, most clinical and epidemiological studies have focused on chronic infection. Some data do indicate, however, that transient H. pylori infection can occur. For example, among patients who have been infected experimentally (10, 14) or endoscopically (12), the majority with reported follow-up had spontaneous resolution of infection. In children, transiently positive breath, serum, and stool antigen tests for H. pylori infections have been reported (17,21,24). The validity of these findings, however, has been uncertain due to the lack of standardization of these diagnostic tests in young children.In a cohort study designed to identify risk factors for H. pylori transmission, we collected two sequential stool samples from 323 children. Among these children, 26 reversions (i.e., transient stool positives) were discovered. We conducted a study to determine whether these transiently positive stool samples represent true transient infections or false-positive stool antigen tests.
MATERIALS AND METHODSStudy participants. As part of a large cohort study on transmission of enteric infections (20), households with an index case of gastroenteritis, with at least one additional participating member, were recruited through cooperating community health care settings as well as community outreach. An index case was defined as a case of diarrhea with or without vomiting characterized by at least five stools per day and lasting no more than 14 days. There was no age restriction for index cases. Episodes of possible noninfectious etiology, such as pregnancy, poisoning, or drug effects, were excluded. This source population is predominately lowincome and Hispanic, including a large percentage of foreign-born people. A brief telephone interview confirming study eligibility was followed by a home visit within 14 days of the index case of gastroenteritis reported in the home. Visits were conducted by trained research staff fluent in the primary language of the home. After providing informed consent, a structured questionnaire was administered regarding household demographics, socioeconomic markers, risk factors for H. pylori infection, household composition, and family relationships. Blood samples were obtained from all consenting household members. Because of concerns about the accuracy of H. pylori serologic testing in you...