Teklay Gebrecherkos Teklu
Mekelle University, Ethiopia
Title: Effect of co-Infection with intestinal parasites on Covid-19 severity: A prospective observational cohort study
Biography
Biography: Teklay Gebrecherkos Teklu
Abstract
Statement of the problem: COVID-19 symptomatology in Africa appears significantly less serious 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. We investigated this hypothesis in an endemic area in Africa. Methodology: 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. SARS-CoV-2 infection was confirmed by RT-PCR on samples obtained from nasopharyngeal swabs, while direct microscopic examination, modified Ritchie concentration, and Kato-Katz methods were used to identify parasites and ova from a fresh stool sample. 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. Data were analyzed using STATA version 14. P-value <0.05 was considered statistically significant. Findings: A total of 751 SARS-CoV-2 infected patients were enrolled, of whom 284 (37·8%) had an 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 appeared 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 0·14 (95% CI 0·09–0·24; p<0·0001) for all parasites, AOR 0·20 ([95% CI 0·11–0·38]; p<0·0001) for protozoa, and AOR 0·13 ([95% CI 0·07–0·26]; p<0·0001) for helminths. When stratified by species, co-infection with Entamoeba spp., Hymenolopis nana, and Schistosoma mansoni implied a lower probability of developing severe COVID-19. There were 11 deaths (1·5%), and all were among patients without parasites (p=0·009). Conclusions: 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.