Abstract
BackgroundDespite reports of malaria and coronavirus diseases 2019 (COVID-19) co-infection, malaria-endemic regions have so far recorded fewer cases of COVID-19 and deaths from COVID-19, indicating a probable protection from the poor outcome of COVID-19 by malaria. On the contrary, other evidence suggests that malaria might contribute to the death caused by COVID-19. Hence, this paper reviewed existing evidence hypothesizing poor outcome or protection of COVID-19 patients when co-infected with malaria.MethodsPRISMA guidelines for systematic review were employed in this study. Published articles from December 2019 to May 2021on COVID-19 and malaria co-infection and outcome were systematically searched in relevant and accessible databases following a pre-defined strategy. Studies involving human, in vivo animal studies, and in vitro studies were included.ResultsTwenty three (23) studies were included in the review out of the 3866 records identified in the selected scientific databases. Nine (9) papers reported on co-infection of COVID-19 and malaria. Five (5) papers provided information about synergism of malaria and COVID-19 poor prognosis, 2 papers reported on syndemic of COVID-19 and malaria intervention, and 7 studies indicated that malaria protects individuals from COVID-19.ConclusionsLow incidence of COVID-19 in malaria-endemic regions supports the hypothesis that COVID-19 poor prognosis is prevented by malaria. Although further studies are required to ascertain this hypothesis, cross-immunity and common immunodominant isotopes provide strong evidence to support this hypothesis. Also, increase in co-inhibitory receptors and atypical memory B cells indicate synergy between COVID-19 and malaria outcome, though, more studies are required to make a definite conclusion.
Highlights
Malaria is an infectious disease caused by unicellular protozoans from the Plasmodium genus
Papers were excluded if [1] it was a review, news, comments, or a letter to an editor (n = 57); [2] it was case report or description of COVID-19 and malaria co-infection without further study (n = 11), was on the impact of COVID-19 on malaria control interventions (n = 10) or on malaria drugs used in the treatment of COVID-19 [8] (Fig. 1)
Nine studies reported on the co-infection of malaria and COVID-19, 5 articles studied the poor outcome of COVID-19 and malaria co-infection, 7 studies described the contra-synergic interaction between malaria and COVID-19, and 2 studies were about the impact of malaria on COVID-19 mortality (Table 1)
Summary
Malaria is an infectious disease caused by unicellular protozoans from the Plasmodium genus. Corona Virus Disease of 2019 (COVID-19) is a novel coronavirus-causing acute respiratory disease. It was first reported in December 2019 in Wuhan, China. The disease which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), unprecedently caused a global pandemic to date, and is responsible for about 4.3 million deaths and counting [6]. Despite reports of malaria and coronavirus diseases 2019 (COVID-19) co-infection, malaria-endemic regions have so far recorded fewer cases of COVID-19 and deaths from COVID-19, indicating a probable protection from the poor outcome of COVID-19 by malaria. This paper reviewed existing evidence hypothesizing poor outcome or protection of COVID-19 patients when co-infected with malaria. Increase in coinhibitory receptors and atypical memory B cells indicate synergy between COVID-19 and malaria outcome, though, more studies are required to make a definite conclusion
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