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 C.
AU - Schallig, Henk H. D. F.
AU - Harris, Vanessa C.
AU - de Wit, Tobias F. Rinke
N1 - Funding Information: DW is European and Developing Countries Clinical Trials Partnership (EDCTP) Senior Research Fellow, and received funding for EvaLAMP project on Leishmaniasis Diagnostics; he serves as Strategic and Scientific Advisory Board of the Research Networks for Health Innovations in Sub-Saharan Africa (German Federal Ministry of Education and Research), and has received an honorarium for lectures and presentations from the Ethiopian Ministry of Science and Higher Education. VH received grants from Netherlands organization for Health Research and Development, VaillantFonds, and she serves as Gilead advisory board, and has received an honorarium from Medtalks, and Gilead. In addition, she serves as head of expertise group for Federal Medical Specialists, and is reviewer for COVID-19 grants for Netherlands organization for Health Research and Development. TRW is employee of PharmAccess Foundation, is Board Member of Mondial Diagnostics, and Advisory Board member of Healthinc, The Netherlands. All other authors have no declarations to disclose. Funding Information: This research was supported by grants from the European and Developing Countries Clinical Trials Partnership (EDCTP), supported by the European Union (RIA-2020EF-2095) and Joep Lange Institute for Global Health and Development, The Netherlands. The consortium welcomes request for data and material access through the Research Steering Committee. Data collected for the study, including individual anonymized participant data, a data dictionary defining each field in the set, study protocol, and consent forms will be made available. Data will be shared after approval of the application, and with a signed data access agreement. We would like to express our gratitude to the medical, nursing, management, and support staff at Ayder General Hospital, and Eka Kotebe General Hospital for their commitment in caring the patients, and towards combatting COVID-19 in Ethiopia. Funding Information: This research was supported by grants from the European and Developing Countries Clinical Trials Partnership (EDCTP), supported by the European Union ( RIA-2020EF-2095 ) and Joep Lange Institute for Global Health and Development, The Netherlands. Publisher Copyright: © 2021 The Author(s) Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
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., Hymenolopis 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
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., Hymenolopis 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
KW - COVID-19
KW - Severity
KW - africa
KW - co-infection
KW - parasite
UR - http://www.scopus.com/inward/record.url?scp=85111499343&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.eclinm.2021.101054
DO - https://doi.org/10.1016/j.eclinm.2021.101054
M3 - Article
C2 - 34368662
SN - 2589-5370
VL - 39
JO - EClinicalMedicine
JF - EClinicalMedicine
M1 - 101054
ER -