Can H. pylori Cause Fever?
H. pylori infection does not typically cause fever as a primary clinical manifestation. Fever is not listed among the recognized clinical presentations of H. pylori infection in major international guidelines 1.
Primary Clinical Manifestations of H. pylori
The established disease spectrum of H. pylori infection includes 2, 3:
- Chronic gastritis (most common presentation) 2
- Peptic ulcer disease (gastric and duodenal ulcers) 2, 3
- Gastric MALT lymphoma 1, 2
- Gastric adenocarcinoma 2, 3
- Functional dyspepsia in some patients 4
None of these conditions characteristically present with fever as a primary symptom 4.
Recognized Extragastric Manifestations
The Maastricht IV/Florence Consensus Report specifically identifies only three confirmed extragastric manifestations 1, 5:
- Iron-deficiency anemia (Evidence level 1a, Grade A recommendation) 1, 4
- Idiopathic thrombocytopenic purpura (Evidence level 1b, Grade A recommendation) 1, 5
- Vitamin B12 deficiency (Evidence level 3b, Grade B recommendation) 1, 5
Additionally, H. pylori affects the bioavailability of thyroxine and L-dopa 1, 5.
Importantly, the guidelines explicitly state that "the evidence available shows no unequivocal causative association between H. pylori and other extragastric disorders" beyond those specifically mentioned 1, 5.
When Fever Might Be Present
If a patient with H. pylori infection presents with fever, consider these scenarios:
- Complicated peptic ulcer disease: Perforation with peritonitis or penetration into adjacent organs can cause fever, but this represents a surgical emergency rather than uncomplicated H. pylori infection 3
- Concurrent unrelated infection: The fever is likely due to another infectious process 4
- Gastric cancer complications: Advanced disease with secondary complications 1
Clinical Pitfall to Avoid
Do not attribute fever to H. pylori infection itself 4. If a patient with known or suspected H. pylori presents with fever, search for alternative explanations including:
- Concurrent bacterial, viral, or other infections
- Complications of peptic ulcer disease (perforation, penetration)
- Malignancy-related fever in advanced gastric cancer
- Completely unrelated febrile illness 4, 3
The presence of fever should prompt evaluation for these alternative diagnoses rather than being considered a typical manifestation of H. pylori infection 4.