Effect of co-infection with parasites on severity of COVID-19

  1. Teklay Gebrecherkos
  2. Zekarias Gessesse
  3. Yazezew Kebede
  4. Atsbeha Gebreegzabher
  5. Geremew Tasew
  6. Mahmud Abdulkader
  7. Hiluf Ebuy
  8. Abraham Desta
  9. Atakilti Hailu
  10. Vanessa Harris
  11. Tobias Rinke de Wit
  12. Dawit Wolday

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Abstract

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in a spectrum of clinical presentations. The effect of co-infection with parasites on the clinical features of COVID-19 is unknown.

Methods

We prospectively enrolled consecutive COVID-19 patients and screened them for intestinal parasitic infections. Patients were followed during hospitalization for clinical outcomes. Patients with parasitic co-infection were compared to those without parasitic co-infection. The primary outcome was the proportion of COVID-19 patients who developed severe disease. Factors associated with the development of severe disease were determined by logistic regression.

Results

A total of 515 patients with PCR-confirmed SARS-CoV-2 infection were screened for intestinal parasites, of whom 267 (51.8%) were co-infected with one or more parasites. Parasitic co-infection correlated inversely with COVID-19 severity. Severe COVID-19 was significantly higher in patients without parasites [47/248 (19.0%, CI: 14.52-24.35)] than in those with parasites [21/267 (7.9%, CI: 5.17-11.79)]; p<0.0001. There was a significantly higher proportion of patients who developed severe COVID-19 in the non-protozoa group [56/369 (15.2%, CI: 11.85-19.23)] as compared to the protozoa group [12/146 (8.2%, CI: 4.70-14.00)]; p=0.036. Significant higher proportion of the patients presented at baseline with severe COVID-19 in the helminth negative group [57/341 (16.7%, CI: 13.10 – 21.08)] than in the group with pre-existing helminth infection [11/174 (6.3%, CI: 3.51 – 11.11)]; p=0.001. In addition, after adjustment for age and presence of comorbidities, COVID-19 patients with any parasite co-infection [aOR 0.41 (95% CI: 0.22–0.77); p=0.006], or with protozoa co-infection [aOR 0.45 (95% CI: 0.21–0.98); p=0.044] as well as those with helminth co-infection [aOR 0.37 (95% CI: 0.17–0.80); p=0.011] had lower probability of developing severe COVID-19 compared with those without parasite, protozoa or helminth co-infection.

Conclusion

Our results suggest that co-infection with parasitic co-infection appears to be associated with reduced COVID-19 severity. The results suggest that parasite-driven immunomodulatory responses may mute hyperinflammation associated with severe COVID-19.

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  1. ScreenIT

    SciScore for 10.1101/2021.02.02.21250995: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Ethical considerations: Patients enrolled provided written consent to participate in to the Profile-CoV study.
    IRB: The study protocol was reviewed and approved by the Health Research Ethics Review Committee
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data was analyzed using STATA (Statistical package v. 14.0, StataCorp, Texas, USA).
    STATA
    suggested: (Stata, RRID:SCR_012763)
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, our study has some limitations. First, stool samples were not able to be collected for every consecutive patient which may have resulted in a potential selection bias. Second, stool examination was determined by microscopy only. The presence of very low intensity parasite infection determined by PCR, though shown to be superior to microscopy with increased sensitivity and specificity [43], might indeed preclude the effects on immune modulation to have any significant effect. Third, the effect of individual parasite species on COVID-19 severity could not be ascertained in the current study because of the small sample size in groups with different parasite species. Finally, the inclusion of smaller proportion of severe cases as compared to non-severe cases in our cohort may potentially bias the results. In conclusion, our study demonstrates for the first time that pre-existing parasitic infection, both with protozoa and helminths, may provide some sort of protection from the pathology linked with severe COVID-19. This is corroborated by the observed low fatality rate of COVID-19 in LMICs settings where parasitic infections are endemic [15, 18, 20, 44]. We also recommend to expand the study to other LMICs and also include the effect of the interplay between parasite-microbiome on COVID-19 severity. Unraveling the mechanisms underlying severe COVID-19 offers avenues for novel preventive and therapeutic interventions.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04473365RecruitingRapid Diagnostic Profiling of SARS-CoV-2 (COVID-19)

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2021.02.02.21250995v1 on medRxiv