alexa Meanders of an Atypical Research Work on Helicobacter pylori in the Democratic Republic of Congo: Influence of HIV and other Factors and Study of some Interesting Cases

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Journal of Pharmacogenomics & Pharmacoproteomics

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Meanders of an Atypical Research Work on Helicobacter pylori in the Democratic Republic of Congo: Influence of HIV and other Factors and Study of some Interesting Cases

J. Ndelo-di-Phanzu1*, Mputu Malolo1, P. Ndelo Matondo1, Y. Nuapia1, Tsomba Hondo Bin Salum2 and S. Mbendi Nsukini3
1Laboratory of Toxicology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
2Forensic Medicine Institute, General Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
3Department Of Gastroenterology, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
*Corresponding Author: J. Ndelo-di-Phanzu, Laboratory of Toxicology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, Tel: + 243 81 026 57 00, Email: [email protected]

Received Date: Dec 29, 2017 / Accepted Date: Jan 08, 2018 / Published Date: Jan 12, 2018

Abstract

During the 3rd Euro case reports in Valencia, Spain, a strange medical case taking place in the DRC has been presented. Indeed, while the Congolese population is, until now, convinced of the existence of massive criminal poisonings, throughout the national area, originating from the East region of the country, we incredibly observed and demonstrated that actually, the phenomenon is a silent, surprising and unexpected Helicobacter pylori epidemic with numerous extra-digestive pathologies. The present subject will deal with picturesque meanders by which our research work passed, lengthening it to more than twenty years before getting appropriate results. The presentation will start by a brief summary of the DRC Helicobacter pylori phenomenon described in Valencia and hypothesis raised for better knowledge of Helicobacter pylori infection, at the international level. In a second time, it will focus on the influence and consequences of some followed factors in our study: HIV infection, political situation in DRC, lack of equipment and financial means, population ignorance, traditional practitioners’ cupidity, deficiency of south-North collaboration, and so on. Afterwards, two interesting incredible extra-digestive DRC Helicobacter pylori cases observed in our study will be discussed. Finally a brief conclusion will present some useful propositions drawn from the experience of this DRC Helicobacter pylori research work.

Keywords: Helicobacter pylori; Extra-gastric pathologies; RD Congo; Euro case reports; Karoo phenomenon; HIV influence

Introduction

In 1990, in the Democratic Republic of the Congo, Mobutu’s regime was at its end and political, social, cultural country environment was very bad. The country was under general international embargo for political reasons. All partners of education of Congolese universities left the country and all of our laboratories lacked of equipment. Medical situation was also bad because of the HIV general infection which was at its top in the country.

It’s in that period of time that we started at the Laboratory of Toxicology of the University of Kinshasa a cross-sectional study of a strange disease present in DR Congo since a few decades, characterized by huge digestive and extra-digestive pathologies, considered by Congolese population as a result of massive criminal poisonings throughout the country. Internal heat, suffocation, mental confusion, heart pain, intense tiredness and loose of weight were the principal symptoms of that phenomenon.

During the 3rd Euro case reports in Valencia Spain, in 2016, the strange medical case taking place in DR Congo has been presented. Indeed, contrary to the conviction of the Congolese population about the existence of massive criminal poisonings, throughout the country, we incredibly observed and demonstrated, in 2010, a surprising and unexpected Helicobacter pylori epidemic with numerous extra-digestive pathologies.

This paper deals with the presentation made during the 5th Clinical and Medical Euro case reports held in Paris, France in 2017 September 07 to 08, explaining picturesque meanders by which our research work passed, before getting appropriate results. According to the presentation, it will focus first on a brief summary of Helicobacter pylori phenomenon described in Valencia and hypothesis raised for the better knowledge of Helicobacter pylori infection, at the international level. Afterwards the influence and consequences of some delaying factors will be presented. Finally, two extra-digestive Helicobacter pylori cases observed in our study will be discussed.

Methods

Study design and sample

This paper is based on a cross-sectional study conducted on Karoo patients received at the Laboratory of Toxicology of the University of Kinshasa from January 2005 to June 2016. The study protocol has been submitted to the Internal Review Board of the Faculty of Pharmaceutical Sciences of the University of Kinshasa and it has been conducted according to the principles of the Helsinki Declaration (Ethical Principles of Medical Research Involving Human Subjects) as amended in 2013.

Variables of study

Questionnaire for data collection included three parts. The first part concerned socio-demographic variables: age, sex, educational level and marital status. The second part described “Karoo phenomenon”: symptoms, origin, circumstances of poisoning, traditional diagnostic and treatment, opinions of Karoo patients on this phenomenon. The third part addressed the relationship between “Karoo phenomenon” and Helicobacter pylori. Scientific parameters were: saliva pH, toxicological screening (Thin layer chromatography, and UV spectrophotometer), Blood sedimentation rate, Alanine Aminotransferase test (ALAT), Aspartate Aminotransferase test (ASAT), Urea, Creatinine, Helicobacter pylori (Chromatographic serological method), Hemoglobin, and Glucose.

Case reports

Two cases were reported: a patient’s case, and a post-mortem case. The two cases have been selected for their especial feature. Patient’s case concerned a woman of 36 year’s old, single, employed in a private communication enterprise. The post-mortem case concerned a 40 years old man, married, self-employed. They were both positive to Helicobacter pylori with extra-digestive evident signs, displayed in photos in attachment.

Results

Population of study

Table 1 shows that the population of study included 402 patients received at the Laboratory of Toxicology of the University of Kinshasa from January 2005 to June 2016, 277 males and 125 females. Patients from 20 to 50 years old were more represented in the population of study but there were also 21 patients beyond 50 years old and 4 children less than 5 years old. Unmarried patients were 181 (45%) while the currently married patients were 193 (48%). The number of patients received was in ascendant progression: 40 (9.9%) from 2005 to 2009, 56 (13.6%) from 2010 to 2013 and 306 (76.1%) from 2013 to 2016.

Variables Patients Percentage
Sex
Male 277 68.9
Female 125 31.1
Total 402  
Age (years)
0–5 4 0.9
6–20 21 5.2
21-50 349 86.9
<50 28 6.9
  402  
Educational level
No education 55 13.6
Primary 97 24.1
High 145 36
Higher 105 26.1
Current marital status
Unmarried 181 45
Married 193 48
Formerly married 28 6.9
Residence    
East of the country 185 46
Kinshasa 143 36
Other provinces of west of the country 74 18
Patients progression from 2005 to 2016
2005–2009 40 9.9
2010–2012 56 13.9
2013–2016 306 76.1

Table 1: Socio-demographic variables (n=402).

Characteristics of Karoo poisoning

Symptoms: Symptoms were diversified. They were digestive but most extra-digestive as well, divided in general and nervous symptoms (Table 2).

Digestive Symptoms General Symptoms Nervous Symptoms
Heat in the stomach and thorax Weight loss Vertigo
Intense abdominal pain High internal heat Early aging
Throat dryness High transpiration Frequent forgetting
Tongue and mouth burn General and sexual tiredness Mental confusion
Hyper-salivation Suffocation Consciousness loss
Nausea without vomiting Anemia Memory disorders
Regurgitation Skin allergy Hallucinations
Constipation Skin blackening Intermittent hands shaking
Loss of appetite High blood pressure Paralysis
Bitter taste of food and beverages Sensation of something moving under the skin Electroencephalogramm disturbance
Alkaline Saliva High blood sugar Sensation of something moving into the head
Increase of Saliva viscosity Increase of blood viscosity Blurred vision
Stomach distending Pricking sensation Frequent drowsiness
Sanguinolent spit Heart palpitations  
Anorexia Hormonal disorders on women  
Diarrhea Hard breathing  
Stomach buzz Breathlessness  
Sensation of stomach fullness Increase of blood alkalinity  

Table 2: Symptoms collected in DR Congo.

Opinions of patients on Karoo phenomenon

Table 3 presents opinions of patients on Karoo phenomenon. Most patients thought that Karoo symptoms could last months (275, 68.4%) or years (58, 14.4%). The eastern of the country was identified unanimously as the principal site of Karoo poisoning (402, 100%). Four principal symptoms were identified: internal heat (282, 70.1%), bitterness of food and beverages (257, 69.9%), intense tiredness (275, 68.4%) and inexplicable loss of weight (269, 66.9%). In case of Karoo poisoning, preference was to visit traditional practitioners instead of going to the hospital. Three traditional diagnostic tests were pointed out, all conducted on patients’ saliva. Traditional treatment was centered on the honey, sometimes mixed to lemon and garlic juice (402, 100%). The recourse to the Laboratory of Toxicology was directed by two main reasons: traditional treatment failure (388, 96.5%) and the need of scientific diagnosis (346, 86%).

Variables Patients Percentage
Duration of “Karoo symptoms”
Days 120 29.8
Weeks 143 35.5
Months 275 68.4
Years 58 14.4
Principal poisoning site
East of the country 402 100
Kinshasa 46 11.4
Other provinces of west of the country 20 4.9
Principal sign of Karoo poisoning
Bitterness of food or beverages 257 69.9
Nausea without vomiting 198 49.2
Tiredness 275 68.4
Internal heat 282 70.1
Inexplicable loss of weight 269 66.9
Reasons for going to traditional practitioners instead of to the hospital
Traditional practitioners are Karoo specialists
They have a rapid and efficient test 402 100
They have efficient treatments 402 100
At the hospital there is no test for poison 196 48.7
At the hospital Karoo poisoning is denied 368 91.5
There is no modern efficient treatment 402 100
Modern medicines get Karoo poisoning worse 402 100
  402 100
Principal traditional test made on patients’ saliva
Spit in a glass of water 385 95.7
Spit on a tongue of a yellow paper 242 60.1
Spit in a tender leaf of a plant 80 19.9
Traditional treatment    
Strong medicinal laxatives plants extracts 195 48.5
Mixture of lemon, garlic and honey 402 100
Other unknown mixtures 72 17.9
Honey 402 100
Reasons for coming to Laboratory of Toxicology
Traditional treatment failure 388 96.5
Need of a scientific diagnosis 346 86
Danger of medicinal plants 88 21.8
Need of scientific control 261 64.9

Table 3: Opinions of patients on Karoo phenomenon (n=402).

Biological parameters

Table 4 shows biological parameters checked. Toxicological screening and Saliva alkalinity determination were performed in all the patients from 2005 to 2016. The others biomarkers (H. pylori, sedimentation rate, hemoglobin, ASAT, ALAT, creatinine and urea) were recorded only since 2013, in 306 patients. H. pylori and saliva alkalinity were positive to all patients examined. Sedimentation rate was high (H. pylori was obtained in 280 patients (91.5%). Symptoms were also cleared in 280 patients (91.5%). Resistance rate to treatment was then 8.5%. Iron deficiency anemia was present in 80 patients (26.1%).

Parameters Patients Percentage
Toxicological screening (n=402)
Positive 46 (paracetamol) 11.4
Negative 356 88.5
Saliva alkalinity (n=402)
Yes 376 93.5
No 26 6.4
H. pylori (n=362)
Positive 362 100
Negative 0  
Negative after treatment 280 91.5
Still positive after treatment 26 8.4
Clearance of the symptoms after treatment 280 91.5
Hemoglobin (n=306)
Normal 226 73.8
Abnormal (under the norm) 80 26.1
Aspartate amino transferase ASAT (n=306)
Normal 260 84.9
Abnormal (up to the norm) 46 15
Alanine amino transferase ALAT (n=306)
Normal 260 84.9
Abnormal (up to the norm) 46 15
Creatinin (n=306)
Normal 302 98.6
Abnormal (up to the norm) 4 1.3
Urea (n=306)
Normal 302 98.6
Abnormal (up to the norm) 4 1.3
Blood sedimentation rate (n=306)
Normal 36 8.9
Abnormal (up to the norm) 270 88.2

Table 4: Results of biological parameter.

Case reports parameters

Patient’s case parameters

BIOLOGICAL PARAMETERS SYMPTOMS
Helicobacter pylori Positive Feet swelling
Blood sedimentation rate 85 mm/h (Internal heat in stomach and thorax
Alanine aminotransferase 24 U/L (0-41 U/L) Dizziness
Aspartate aminotransferase 28 U/L (0-31 U/L) Headache
Urea 30 mg/dl (15-45 mg/dl) Intense tiredness
Creatinine 1,2 mg/dl (0,5 – 1,5 mg/dl) Cough

Table 5: Patients’ case parameters.

Post-mortem case parameters

BIOLOGICAL PARAMETERS AUTOPSY FINDINGS
Helicobacter pylori Positive Gut distending
Blood sedimentation rate - Stomach distending
Alanine aminotransferase - Brain congestion
Aspartate aminotransferase - Lungs congestion
Urea - Cyanosis of lips, fingers and toes
Creatinine - Tongue biting
- - Pallor of hands palms and of sole of the feet
- - Cardiomegaly
- - Eyes red coloration
- - Nose bleeding
- - Gastric bleeding

Table 6: Post-mortem case parameters.

Discussion

Summary of main findings

The strange phenomenon characterized by huge extra-digestive pathologies, current in Democratic Republic of Congo, considered as massive criminal poisoning, appeared actually caused by Helicobacter pylori. (ii) Its characteristics and symptoms have been collected (Table 2). (iii) Helicobacter pylori outbreak in DRC needed environment activator factors. (v) Patients’ saliva was alkalized by gas ammonia flying up from stomach to mouth. (vi) Gas ammonia and carbon dioxide are responsible of huge patients’ extra-digestive pathologies. Carbone dioxide combines causticity and redoubtable fatal asphyxia power, as demonstrated in the post-mortem case.

Helicobacter pylori infection

Helicobacter pylori, is well known worldwide. It largely colonizes humans since immemorial time, in both developing and developed countries [1-24]. It’s widely involved in gastritis, asymptomatic for most infected individuals. A small proportion of infected individuals develop more dangerous gastritis involving peptic ulceration and gastric malignancy [22,25-33]. Helicobacter pylori is responsible for tremendous morbidity and mortality throughout the world [6,7,12,14-16]. Normally originated in Africa, Helicobacter pylori has been carried with human populations around the world after their departure from Africa [26,29]. Helicobacter pylori infected persons increase risk of developing gastric cancer. Many factors and cofactors influence gastric cancer development [8,10,32-34]. Helicobacter pylori virulence is under the control of Helicobacter pylori gene factors [25,27,30,31]. There is actually an important change in the relationships between helicobacter pylori and humans, caused by modern life change in gut micro-ecology [19,29]. In Africa, Helicobacter pylori infection displays a specificity called “African enigma” related to the fact that, in spite of a high Helicobacter pylori contamination in Africa, often from early childhood, gastric cancer prevalence is inexplicably low [6,17,21].

DRC Helicobacter pylori phenomenon

Congolese population is, until now, convinced that the phenomenon current in DR Congo is a consequence of massive criminal poisonings. Yet, our study established, in 2010, an unexpected interesting link with Helicobacter pylori. According to Table 4, the 362 patients received at the Laboratory of Toxicology of the University of Kinshasa for poisoning suspicion, were all positive to Helicobacter pylori. They were all characterized by huge extra-digestive pathologies (Table 2). Main pathologies identified were: internal heat (282, 70.1%), bitterness of food and beverages (257, 69.9%), intense tiredness (275, 68.4%) and inexplicable loss of weight (269, 66.9%). Following other hypothesis was raised in our study: (i) numerous extra-digestive pathologies observed, indicated a free and massive passage of ammonia and carbon dioxide to the blood. (ii) Ammonia and carbon dioxide released in stomach by the reaction urea-urease, in gaseous state, should be eliminated in stools. (iii) In case of constipation however, ammonia and carbon dioxide, still in gaseous state, could go up along the esophagus to the mouth and lungs and from there to the blood stream. (iv) A double intoxication then occurs, justifying numerous extra-digestive pathologies described in Table 2. (v) This statement is in perfect harmony with recent literature which reports more and more extra-digestive pathologies linked to Helicobacter pylori [23,28,35-41].

Proposed improvements on Helicobacter pylori infection

Under the light of our study, some following improvements would be proposed for best Helicobacter pylori infection understanding: (i). Helicobacter pylori infection should be named Helicobacter pylori toxic-infection to take count of the intoxication component present in many cases of Helicobacter pylori infection as frequently stated in recent literature. (ii). Helicobacter pylori extra-digestive symptoms should be definitely recognized as part of Helicobacter pylori infection. (iii) Passage of Helicobacter pylori toxins in blood via lungs way should be acknowledged. (iv). Helicobacter pylori treatment should be reevaluated to take in count the intoxication component. Our study suggested that toxicological eliminating treatment should always be combined to Helicobacter pylori medical eradication treatment. (v). the development of a rapid Helicobacter pylori diagnosis method based on ammonia identification in saliva and in stools could be useful.

An atypical wandering research work

Our research work took a long time before getting suitable results because, mainly, of unfavorable political, social, cultural and scientific environment of the end of Mobutu’s regime in DR Congo and the war it generated. The international political embargo imposed to DR Congo since 1990, provoked lack of equipment, lack of financial means for research and lack of useful South-North collaboration. Secondly, Karoo poison was not only unknown but invisible physically as well.

Thirdly, rumors, traditional believe of Congolese population and cupidity of traditional practitioners played an important impairment role. For example, as reported in Table 3, modern medicines were reputed to be inefficient against Karoo poison. The use of modern medicines, especially by perfusion, was even thought to rapidly lead to death. The consequence was that in many villages, most in the eastern region of the country, people avoided going to the hospital, for any disease. As it could be guessed, HIV/AIDS, tuberculosis and malaria took big advantage of this situation.

Some symptoms reported in Table 2, like intense tiredness, anorexia and most significant loss of weight was commune to Karoo phenomenon and to HIV. The confusion with HIV was a major complication factor in our study.

Opinion of some Congolese medical staff, denying findings concerning the role of Helicobacter pylori in Congolese Karoo phenomenon was also an important source of wandering.

Case Reports

As displayed in Figures 1-6, patient’s case main pathology was feet swelling. Helicobacter pylori was positive, blood sedimentation rate high (85 mm/h), alanine aminotransferase, aspartate aminotransferase, urea and creatinine, were in normal range (Table 5). No hypertension and diabetes diseases. Swelling was accompanied by internal heat in stomach and thorax, dizziness, headache, reflex cough, and intense tiredness (Table 5). Feet swelling was attributed to Helicobacter pylori CO2 toxin, after its passage to the blood via the lungs way, as stated in this study. Activated charcoal guaranteed feet deflating within ten days (Table 5).

pharmacogenomics-pharmacoproteomics-forensic-medicine

Figure 1: Gut distending photo forensic medicine institute/Kinshasa.

pharmacogenomics-pharmacoproteomics-distending-photo

Figure 2: Stomach distending photo forensic medicine institute/Kinshasa.

pharmacogenomics-pharmacoproteomics-Congestion-photo

Figure 3: Brain Congestion photo forensic medicine institute/Kinshasa.

pharmacogenomics-pharmacoproteomics-Lung-Congestion

Figure 4: Right Lung Congestion photo forensic medicine institute/Kinshasa.

pharmacogenomics-pharmacoproteomics-toes-cyanosis

Figure 5: Fingers and toes cyanosis photo forensic medicine institute/Kinshasa.

pharmacogenomics-pharmacoproteomics-swelling-photo

Figure 6: Feet swelling photo Shafali/Kinshasa.

The post-mortem case was received, from Forensic Medicine Institute of General Hospital of Kinshasa for toxicological analysis, after a suspect death. Death occurred suddenly, at home, during the night, after the return from a friend’s party. Immediately after death, stomach inflated extremely at an incredible speed. Autopsy findings were unexpected and amazing. Autopsy statement revealed full of abnormalities, notably: Gut distending, Stomach distending, Brain congestion, Lungs congestion, Cyanosis of lips, fingers and toes, Tongue biting, Pallor of Hands palms and pallor of sole of the feet, Cardiomegaly, Eyes red coloration, Nose bleeding, Gastric bleeding (Table 6). All those abnormalities were identified as sign of double intoxication by gas ammonia and carbon dioxide. Death occurred bluntly after brutal carbon dioxide asphyxia. Helicobacter pylori was incriminated, as the deceased was a known Helicobacter pylori chronic gastritis patient. Those two cases, selected among many others, were significant testimony of the findings of this study.

Conclusion

Our research work was very time consuming because it did face many obstacles. In spite of all problems faced, we did never give up. Results got after a so long period of time beyond 20 years of wandering, seem impressive. It’s necessary not to forget that in spite of all disturbances in Sub-Saharan African countries, many scientific researchers are there, trying painfully to contribute to the improvement of scientific world knowledge.

We think necessary to develop more scientific collaboration and networks between researchers from developing and developed countries, far beyond political considerations.

We encourage young research workers, to never give up. They have to know that in any research work, without a bit wandering mind, phenomenal results could never be achieved.

References

Citation: Phanzu JND, Malolo M, Matondo PN, Nuapia Y, Salum THB, et al. (2018) Meanders of an Atypical Research Work on Helicobacter pylori in the Democratic Republic of Congo: Influence of HIV and other Factors and Study of some Interesting Cases. J Pharmacogenomics Pharmacoproteom 9: 176. DOI: 10.4172/2153-0645.1000176

Copyright: ©2018 Phanzu JND, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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