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Effect of co-infection with intestinal parasites on COVID-19 severity: A prospective observational cohort study

Wolday, Dawit, Gebrecherkos, Teklay, Arefaine, Zekarias Gessesse, Kiros, Yazezew Kebede, Gebreegzabher, Atsbeha, Tasew, Geremew, Abdulkader, Mahmud, Abraha, Hiluf Ebuy, Desta, Abraham Aregay, Hailu, Ataklti, Tollera, Getachew, Abdella, Saro, Tesema, Masresha, Abate, Ebba, Endarge, Kidist Lakew, Hundie, Tsegaye Gebreyes, Miteku, Frehiwot Kassahun, Urban, Britta ORCID:, Schallig, Henk H.D.F., Harris, Vanessa C. and de Wit, Tobias F. Rinke (2021) 'Effect of co-infection with intestinal parasites on COVID-19 severity: A prospective observational cohort study'. EClinicalMedicine, Vol 39, p. 101054.

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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.

Item Type: Article
Subjects: WA Public Health > WA 105 Epidemiology
WC Communicable Diseases > Virus Diseases > Viral Respiratory Tract Infections. Respirovirus Infections > WC 505 Viral respiratory tract infections
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 695 Parasitic diseases (General)
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 698 Parasitic intestinal diseases (General)
Faculty: Department: Biological Sciences > Department of Tropical Disease Biology
Digital Object Identifer (DOI):
Depositing User: Stacy Murtagh
Date Deposited: 27 Sep 2021 08:18
Last Modified: 27 Sep 2021 08:18


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