Abstract
Background: COVID-19 symptomatology in Africa appears significantly less serious 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. We investigated this hypothesis in an endemic area in Africa. Methods: Ethiopian COVID-19 patients were enrolled and screened for intestinal parasites. The primary outcome was the proportion of patients with severe COVID-19. Logistic regression models were used to estimate the association between parasite infection, and COVID-19 severity. Models were adjusted for sex, age, residence, 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 appeared parasite positive (pEntamoeba spp. , Hymenolopis nana, and Schistosoma mansoni 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) and Joep-Lange Institute.Declaration of Interests: We declare no competing interests.Ethics Approval Statement: The study protocol was reviewed and approved by the Health Research Ethics Review Committee of Mekelle University College of Health Sciences (No.: ERC 1769/2020), the Ethiopian Public Health Institute (No: EPHI 6.13/814), and Eka Kotebe General Hospital (No.: EK/150/5/32). Written informed consent was obtained by all participants, or their guardians, for participation in the study.
Highlights
Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) results in a spectrum of clinical presentations
Multicellular and highly complex parasites such as Ascaris, hook worm, Trichuris, Enterobius, and Schistosoma, as well as unicellular organisms including Entamoeba, Giardia, Toxoplasma, Cyclospora and Cryptosporidia are among the major organisms that contribute to the global intestinal parasitic disease burden [6,7]
Individuals presenting to the Kuyha (Mekelle University College of Health Sciences, Mekelle), and Eka Generalized Hospital (Addis Ababa) who qualified for testing were screened for SARS-CoV-2 infection with a nasopharyngeal swab, and real-time polymerase chain reaction (RT-PCR)
Summary
Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) results in a spectrum of clinical presentations. Amongst NIDs, parasitic infections affect more than 2 billion people throughout the world, with disproportionately high prevalence rates in resource-poor settings [6,7]. Chronic and/or persistent parasitic infections are common in LIMCs, and such chronic infections, possibly in part through direct modulation of the host’s immune responses, were shown to alter clinical outcomes to other infections [8,9]. Pre-existing parasitic infections may modify the host’s immune response to infection with SARS-CoV-2, with postulated beneficial and detrimental effects [10À13]. The objective of this study was to test this hypothesis by comparing the parasitic infections of COVID-19 patients stratified for clinical outcomes
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