TY - JOUR
T1 - Effect of co-infection with intestinal parasites on COVID-19 severity: A prospective observational cohort study
AU - Wolday, Dawit
AU - Gebrecherkos, Teklay
AU - Arefaine, Zekarias Gessesse
AU - Kiros, Yazezew Kebede
AU - Gebreegzabher, Atsbeha
AU - Tasew, Geremew
AU - Abdulkader, Mahmud
AU - Abraha, Hiluf Ebuy
AU - Desta, Abraham Aregay
AU - Hailu, Ataklti
AU - Tollera, Getachew
AU - Abdella, Saro
AU - Tesema, Masresha
AU - Abate, Ebba
AU - Endarge, Kidist Lakew
AU - Hundie, Tsegaye Gebreyes
AU - Miteku, Frehiwot Kassahun
AU - Urban, Britta
AU - Schallig, Henk H.D.F.
AU - Harris, Vanessa C.
AU - de Wit, Tobias F.Rinke
PY - 2021/9/1
Y1 - 2021/9/1
N2 - 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.
AB - 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.
KW - africa
KW - co-infection
KW - COVID-19
KW - parasite
KW - Severity
U2 - 10.1016/j.eclinm.2021.101054
DO - 10.1016/j.eclinm.2021.101054
M3 - Article
SN - 2589-5370
VL - 39
SP - 101054
JO - eClinicalMedicine
JF - eClinicalMedicine
M1 - 101054
ER -