Helicobacter pylori infection carrying the CagA gene may be associated with the diagnosis and disease progression of tuberculosis

Helicobacter pylori (H. pylori) infection is associated with infectious diseases caused by pathogens such as Orientia tsutsugamushi (the causative agent of scrub typhus) and Brucella. However, the impact of H. pylori infection on tuberculosis (TB) remains unclear, and in particular, the clinical significance of infection with CagA-positive(CagA+) strains is worthy of exploration. A total of 120 TB patients clinically diagnosed at the Affiliated Hospital of Youjiang Medical University for Nationalities and the Fourth People’s Hospital of Nanning from June 2023 to December 2024 were selected as the observation group. The control group consisted of 130 healthy individuals who underwent physical examinations at the same hospitals during the same period, matched by gender, age, and place of residence. The subjects underwent serum H. pylori antibody detection and strain typing using the Western blot method. ①The H. pylori infection rate was 67.5% in TB patients, slightly higher than 52.3% in healthy individuals, with no statistically significant difference(χ²=1.512, p = 0.219); however, the infection rate of the CagA+ strain was 51.7% in TB patients, significantly higher than 29.2% in healthy individuals(χ²=5.609, p = 0.018). ②The H. pylori infection rate was 76.2% in TB patients with more than two lesion sites, slightly higher than 57.9% in TB patients with a single lesion site, with no statistically significant difference(χ²=0.894, p = 0.345). However, the infection rate of CagA+ strains was 69.8% in TB patients with more than two lesion sites, significantly higher than 31.6% in TB patients with a single lesion site (χ² =5.575, p = 0.016). ③The H. pylori infection rate was 90.7% in retreated TB patients, higher than 54.5% in newly treated TB patients, with no statistically significant difference(χ²=3.036, p = 0.081). However, the infection rate of the CagA+ strain was 76.7% in retreated TB patients, significantly higher than 37.7% in newly treated TB patients (χ²=5.084, p = 0.024). ④The H. pylori infection rate was 79.8% in IGRA-positive (IGRA+)subjects, significantly higher than 42.6% in IGRA-negative (IGRA−) subjects(χ² =8.948, p = 0.003). Moreover, the infection rate of CagA+ strain was 62.3% in IGRA+ subjects, which was also significantly higher than 21.3% in IGRA− subjects (χ² =18.494, p = 0.001). ⑤Further multivariate regression analysis was conducted on the factors that might affect the onset of TB. The results showed that CagA+H. pylori infection (OR = 2.568; 95%CI: 1.223–5.387; χ²=6.216; p = 0.013) was independently associated with TB. Infection with CagA gene-carrying H. pylori may facilitate the diagnosis of Mycobacterium tuberculosis infection and may influence the disease course of TB.