Malaria and Parasitic Neglected Tropical Diseases: Potential Syndemics with COVID-19?

Molecular diagnosis of infectious parasites in the post-COVID-19 era

The endemicity of several parasitic diseases across the globe and recent evidence of distress among COVID-19 patients with preexisting parasitic infections requires strengthening One Health framework and advanced strategies for parasitic detection. Owing to the greater sensitivity and accuracy, molecular technologies such as conventional polymerase chain reaction (PCR), reverse transcription (RT)-PCR, nested PCR, loop-mediated isothermal amplification (LAMP), and xMAP technology have been extensively studied for parasitic diagnosis. Varieties of genes have been targeted for primer development where 18S rRNA, internal transcribed spacer regions, and mitochondrial DNAs coding for cytochrome, and other enzymes have been widely used. More recent, low-cost sequencing and advances in big data management have resulted in a slow but steady rise of next-generation sequencing-based approaches for parasite diagnosis. However, except for few parasites of global concerns such as Plasmodium and Entamoeba, most of the molecular tools and technologies are yet to witness bench to bedside and field translations. This review looks into some of the advancements in the molecular diagnosis of parasites that have potential relevance to clinical purposes and may pave the way toward disease management in an efficient and timely manner.

Assessment of schistosomiasis endemicity and preventive treatment on coronavirus disease 2019 outcomes in Africa

Since the coronavirus disease 2019 (COVID-19) pandemic, attention has been drawn to the possible interactions between the deadly disease and a few other infections. Although schistosomiasis and other neglected tropical diseases have been proposed to influence susceptibility to COVID-19, no study has looked into this. This study therefore investigated the impact of schistosomiasis on the transmission of COVID-19 and also evaluated the role of praziquantel treatment coverage on COVID-19 outcomes in African countries. The schistosomiasis endemicity and the preventive chemotherapy coverage index statuses were obtained from the World Health Organization databank. COVID-19 data were obtained from the Worldometer COVID-19 report. The data were adjusted and the percentage of COVID-19 cases confirmed, and active cases, recovery and deaths were computed. The COVID-19 outcomes were evaluated relative to schistosomiasis endemicity and treatment coverage. COVID-19 outcomes, especially active cases and recovery rates, were significantly improved in schistosomiasis nonendemic African countries (p < 0.05). While COVID-19 confirmed cases were significantly higher in countries with >75% schistosomiasis preventive chemotherapy coverage index (p < 0.05), improved COVID-19 outcomes were observed relative to active cases and recovery in countries with >75% preventive chemotherapy coverage index (p > 0.05). Schistosomiasis endemicity may be associated with negative COVID-19 outcomes, and higher praziquantel treatment coverage could reduce COVID-19 active cases and improve the recovery rate.

Tracking and predicting the African COVID-19 pandemic

The ongoing coronavirus disease 2019 (COVID-19) pandemic is heterogeneous throughout Africa and threatening millions of lives. Surveillance and short-term modeling forecasts are critical to provide timely information for decisions on control strategies. We use a model that explains the evolution of the COVID-19 pandemic over time in the entire African continent, parameterized by socioeconomic and geoeconomic variations and the lagged effects of social policy and meteorological history. We observed the effect of the human development index, containment policies, testing capacity, specific humidity, temperature and landlocked status of countries on the local within-country and external between-country transmission. One week forecasts of case numbers from the model were driven by the quality of the reported data. Seeking equitable behavioral and social interventions, balanced with coordinated country-specific strategies in infection suppression, should be a continental priority to control the COVID-19 pandemic in Africa.

A Patient with Severe Malaria and COVID-19: How Do You Tell the Difference between These Infections?

Coronavirus infection, known as COVID-19, is characterized by clinical, epidemiological and biological features similar to those of malaria. In each case, fever, myalgia, fatigue, headaches and gastrointestinal symptoms may be present. Both diseases can also induce a cytokine storm and pro-coagulant states. An appropriate epidemiological approach and differential diagnosis are very important so that the right clinical intervention can be selected.

Malaria remains a serious global public health issue, especially in endemic countries. Elimination campaigns are helping to control the disease, but in many countries these programs are now at risk of failure due to logistic and economic problems caused by COVID-19.

The authors describe the case of a patient with co-infection with malaria and COVID-19, reminding us that during this coronavirus pandemic it is critical to consider other diagnoses, particularly in people traveling between countries.

Co-infection of malaria and dengue in pregnant women with SARS-CoV-2

Physicians and obstetricians should be vigilant so that they can swiftly identify co‐infections of malaria and dengue in pregnant women with COVID‐19.

Old friends meet a new foe: A potential role for immune-priming parasites in mitigating COVID-19 morbidity and mortality

The novel virus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and the associated Coronavirus Disease 2019 (COVID-19) represent a pathogen to which human beings have limited to no evolved immune response. The most severe symptoms are associated with overactive inflammatory immune responses, leading to a cytokine storm, tissue damage, and death, if not balanced and controlled. Hypotheses within Evolutionary Medicine, including the Hygiene/Old Friends Hypothesis, provide an important lens through which to understand and possibly control this overactive immune response. In this article, we explore the role that infection with soil-transmitted helminths (STHs; i.e. intestinal parasitic worms) may play in dampening SARS-CoV-2 symptoms and mitigating the worst COVID-19 outcomes. Specifically, STHs stimulate the immunosuppressive and regulatory T-helper 2 (TH2) branch of the immune system, which decreases ACE2-receptor expression (i.e. receptors SARS-CoV-2 uses to infect host cells), balances the inflammatory TH1/TH17 branches of the immune system triggered by SARS-CoV-2 infection, and reduces inflammation through the release of anti-inflammatory/regulatory cytokines. Because STHs are common and affect the most vulnerable and marginalized members of society, it is especially important to consider how these parasites may impact COVID-19 outcomes. Areas experiencing endemic STH infections are often characterized by a lack of preventative infrastructure and medical care, which may further exacerbate risk of SARS-CoV-2 infection and COVID-19 development. For this reason, we also explore biocultural factors that contribute to disease outcomes for both SARS-CoV-2 and STH infections. Biocultural and Evolutionary Medicine perspectives on COVID-19 are crucial for understanding the global impact of the disease. Lay summary: An evolutionary perspective is required to understand the global impact and various presentations of COVID-19. We consider how coinfection with soil-transmitted helminths (common parasitic worms that coevolved with humans) may suppress inflammatory immune activity, thereby potentially reducing COVID-19 disease severity. Structural and lifestyle factors shaping coinfection patterns are also discussed.

Malaria and COVID-19: Common and Different Findings

Malaria and COVID-19 may have similar aspects and seem to have a strong potential for mutual influence. They have already caused millions of deaths, and the regions where malaria is endemic are at risk of further suffering from the consequences of COVID-19 due to mutual side effects, such as less access to treatment for patients with malaria due to the fear of access to healthcare centers leading to diagnostic delays and worse outcomes. Moreover, the similar and generic symptoms make it harder to achieve an immediate diagnosis. Healthcare systems and professionals will face a great challenge in the case of a COVID-19 and malaria syndemic. Here, we present an overview of common and different findings for both diseases with possible mutual influences of one on the other, especially in countries with limited resources.

COVID-19 and Plasmodium vivax malaria co-infection

The ongoing outbreak of COVID-19 poses an unprecedented global health challenge. With its variety of clinical manifestations including, but not limited to, fever, cough, diarrhea, vomiting, headache, myalgia and fatigue, it may be challenging to distinguish COVID-19 from a spectrum of diseases with similar presentations, such as malaria, especially in endemic areas. Risk of concomitant infections also remains a concern owing to overburdening of healthcare services and possible scarcity of resources. We present the first reported case of confirmed COVID and malaria co-infection. In this case, we emphasize the need for vigilance from frontline clinicians for timely diagnosis and appropriate clinical management of potential co-infections in the COVID era.