tetano
Editor, Senior Moderator
EClinicalMedicine
. 2021 Sep;39:101054.
doi: 10.1016/j.eclinm.2021.101054. Epub 2021 Jul 31.
Effect of co-infection with intestinal parasites on COVID-19 severity: A prospective observational cohort study
Dawit Wolday[SUP] 1 [/SUP], Teklay Gebrecherkos[SUP] 1 [/SUP], Zekarias Gessesse Arefaine[SUP] 1 [/SUP], Yazezew Kebede Kiros[SUP] 1 [/SUP], Atsbeha Gebreegzabher[SUP] 2 [/SUP], Geremew Tasew[SUP] 2 [/SUP], Mahmud Abdulkader[SUP] 2 [/SUP], Hiluf Ebuy Abraha[SUP] 1 [/SUP], Abraham Aregay Desta[SUP] 3 [/SUP], Ataklti Hailu[SUP] 3 [/SUP], Getachew Tollera[SUP] 2 [/SUP], Saro Abdella[SUP] 2 [/SUP], Masresha Tesema[SUP] 2 [/SUP], Ebba Abate[SUP] 2 [/SUP], Kidist Lakew Endarge[SUP] 4 [/SUP], Tsegaye Gebreyes Hundie[SUP] 4 [/SUP], Frehiwot Kassahun Miteku[SUP] 4 [/SUP], Britta C Urban[SUP] 5 [/SUP], Henk H D F Schallig[SUP] 6 [/SUP], Vanessa C Harris[SUP] 6 7 [/SUP], Tobias F Rinke de Wit[SUP] 7 8 [/SUP]
Affiliations
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in a spectrum of clinical presentations. Evidence from Africa indicates that significantly less COVID-19 patients suffer from serious symptoms than in the industrialized world. We and others previously postulated a partial explanation for this phenomenon, being a different, more activated immune system due to parasite infections. Here, we aimed to test this hypothesis by investigating a potential correlation of co-infection with parasites with COVID-19 severity in an endemic area in Africa. Methods: Ethiopian COVID-19 patients were enrolled and screened for intestinal parasites, between July 2020 and March 2021. The primary outcome was the proportion of patients with severe COVID-19. Ordinal logistic regression models were used to estimate the association between parasite infection, and COVID-19 severity. Models were adjusted for sex, age, residence, education level, occupation, body mass index, and comorbidities. Findings: 751 SARS-CoV-2 infected patients were enrolled, of whom 284 (37.8%) had intestinal parasitic infection. Only 27/255 (10.6%) severe COVID-19 patients were co-infected with intestinal parasites, while 257/496 (51.8%) non-severe COVID-19 patients were parasite positive (p<0.0001). Patients co-infected with parasites had lower odds of developing severe COVID-19, with an adjusted odds ratio (aOR) of 0.23 (95% CI 0.17-0.30; p<0.0001) for all parasites, aOR 0.37 ([95% CI 0.26-0.51]; p<0.0001) for protozoa, and aOR 0.26 ([95% CI 0.19-0.35]; p<0.0001) for helminths. When stratified by species, co-infection with Entamoeba spp., Hymenolepis nana, Schistosoma mansoni, and Trichuris trichiura implied lower probability of developing severe COVID-19. There were 11 deaths (1.5%), and all were among patients without parasites (p = 0.009). Interpretation: Parasite co-infection is associated with a reduced risk of severe COVID-19 in African patients. Parasite-driven immunomodulatory responses may mute hyper-inflammation associated with severe COVID-19. Funding: European and Developing Countries Clinical Trials Partnership (EDCTP) - European Union, and Joep Lange Institute (JLI), The Netherlands. Trial registration: Clinicaltrials.gov: NCT04473365.
Keywords: COVID-19; Severity; africa; co-infection; parasite.
. 2021 Sep;39:101054.
doi: 10.1016/j.eclinm.2021.101054. Epub 2021 Jul 31.
Effect of co-infection with intestinal parasites on COVID-19 severity: A prospective observational cohort study
Dawit Wolday[SUP] 1 [/SUP], Teklay Gebrecherkos[SUP] 1 [/SUP], Zekarias Gessesse Arefaine[SUP] 1 [/SUP], Yazezew Kebede Kiros[SUP] 1 [/SUP], Atsbeha Gebreegzabher[SUP] 2 [/SUP], Geremew Tasew[SUP] 2 [/SUP], Mahmud Abdulkader[SUP] 2 [/SUP], Hiluf Ebuy Abraha[SUP] 1 [/SUP], Abraham Aregay Desta[SUP] 3 [/SUP], Ataklti Hailu[SUP] 3 [/SUP], Getachew Tollera[SUP] 2 [/SUP], Saro Abdella[SUP] 2 [/SUP], Masresha Tesema[SUP] 2 [/SUP], Ebba Abate[SUP] 2 [/SUP], Kidist Lakew Endarge[SUP] 4 [/SUP], Tsegaye Gebreyes Hundie[SUP] 4 [/SUP], Frehiwot Kassahun Miteku[SUP] 4 [/SUP], Britta C Urban[SUP] 5 [/SUP], Henk H D F Schallig[SUP] 6 [/SUP], Vanessa C Harris[SUP] 6 7 [/SUP], Tobias F Rinke de Wit[SUP] 7 8 [/SUP]
Affiliations
- PMID: 34368662
- PMCID: PMC8324426
- DOI: 10.1016/j.eclinm.2021.101054
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in a spectrum of clinical presentations. Evidence from Africa indicates that significantly less COVID-19 patients suffer from serious symptoms than in the industrialized world. We and others previously postulated a partial explanation for this phenomenon, being a different, more activated immune system due to parasite infections. Here, we aimed to test this hypothesis by investigating a potential correlation of co-infection with parasites with COVID-19 severity in an endemic area in Africa. Methods: Ethiopian COVID-19 patients were enrolled and screened for intestinal parasites, between July 2020 and March 2021. The primary outcome was the proportion of patients with severe COVID-19. Ordinal logistic regression models were used to estimate the association between parasite infection, and COVID-19 severity. Models were adjusted for sex, age, residence, education level, occupation, body mass index, and comorbidities. Findings: 751 SARS-CoV-2 infected patients were enrolled, of whom 284 (37.8%) had intestinal parasitic infection. Only 27/255 (10.6%) severe COVID-19 patients were co-infected with intestinal parasites, while 257/496 (51.8%) non-severe COVID-19 patients were parasite positive (p<0.0001). Patients co-infected with parasites had lower odds of developing severe COVID-19, with an adjusted odds ratio (aOR) of 0.23 (95% CI 0.17-0.30; p<0.0001) for all parasites, aOR 0.37 ([95% CI 0.26-0.51]; p<0.0001) for protozoa, and aOR 0.26 ([95% CI 0.19-0.35]; p<0.0001) for helminths. When stratified by species, co-infection with Entamoeba spp., Hymenolepis nana, Schistosoma mansoni, and Trichuris trichiura implied lower probability of developing severe COVID-19. There were 11 deaths (1.5%), and all were among patients without parasites (p = 0.009). Interpretation: Parasite co-infection is associated with a reduced risk of severe COVID-19 in African patients. Parasite-driven immunomodulatory responses may mute hyper-inflammation associated with severe COVID-19. Funding: European and Developing Countries Clinical Trials Partnership (EDCTP) - European Union, and Joep Lange Institute (JLI), The Netherlands. Trial registration: Clinicaltrials.gov: NCT04473365.
Keywords: COVID-19; Severity; africa; co-infection; parasite.