Abstract
Although the COVID-19 pandemic has left no country untouched there has been limited research to understand clinical and immunological responses in African populations. Here we characterise patients hospitalised with suspected (PCR-negative/IgG-positive) or confirmed (PCR-positive) COVID-19, and healthy community controls (PCR-negative/IgG-negative). PCR-positive COVID-19 participants were more likely to receive dexamethasone and a beta-lactam antibiotic, and survive to hospital discharge than PCR-negative/IgG-positive and PCR-negative/IgG-negative participants. PCR-negative/IgG-positive participants exhibited a nasal and systemic cytokine signature analogous to PCR-positive COVID-19 participants, predominated by chemokines and neutrophils and distinct from PCR-negative/IgG-negative participants. PCR-negative/IgG-positive participants had increased propensity for Staphylococcus aureus and Streptococcus pneumoniae colonisation. PCR-negative/IgG-positive individuals with high COVID-19 clinical suspicion had inflammatory profiles analogous to PCR-confirmed disease and potentially represent a target population for COVID-19 treatment strategies.
Highlights
The COVID-19 pandemic has left no country untouched there has been limited research to understand clinical and immunological responses in African populations
SARS-CoV-2 was confirmed by nucleic acid amplification (NAAT) in 41 participants (Fig. 1a)
We provide clinical and immunological analysis of suspected or confirmed COVID-19 patients admitted to hospital in Malawi, a low-income sub-Saharan African country
Summary
The COVID-19 pandemic has left no country untouched there has been limited research to understand clinical and immunological responses in African populations. Limited access to advanced life-preserving therapies such as mechanical ventilation, and delayed presentation to hospital, is common[3] This increases clinical and diagnostic complexity as patients may present when severely unwell, and potentially, without polymerase chain reaction (PCR)detectable SARS-CoV-2 We analysed nasal mucosa and peripheral blood samples from a cohort of patients admitted to hospital with suspected and/or confirmed COVID19. These patients were compared with adult healthy community controls. Our study provides insights on the cytokine responses in the nasal mucosa following SARS-CoV-2 infection in severe COVID-19 patients and the potential importance of additional confirmatory antibody tests for diagnosis of SARS-CoV-2 PCR-negative patients with high clinical suspicion of COVID-19
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