Chagas disease and SARS-CoV-2 coinfection does not lead to worse in-hospital outcomes: results from the Brazilian COVID-19 Registry

Abstract

Objective: Chagas disease (CD) continues to be a major public health burden in Latina America, where co-infection with SARS-CoV-2 can occur. However, information on the interplay between COVID-19 and Chagas disease is lacking. Our aim was to assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients. Methods: Patients with COVID-19 diagnosis were selected from the Brazilian COVID-19 Registry, a prospective multicenter cohort, from March to September, 2020. CD diagnosis was based on hospital record at the time of admission. Study data were collected by trained hospital staff using Research Electronic Data Capture (REDCap) tools. Genetic matching for sex, age, hypertension, DM and hospital was performed in a 4:1 ratio. Results: Of the 7,018 patients who had confirmed infection with SARS-CoV-2 in the registry, 31 patients with CD and 124 matched controls were included. Overall, the median age was 72 (64.-80) years-old and 44.5% were male. At baseline, heart failure (25.8% vs. 9.7%) and atrial fibrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p<0.05 for both). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). Seventy-two (46.5%) patients required admission to the intensive care unit. In-hospital management, outcomes and complications were similar between the groups. Conclusions: In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fibrillation and chronic heart failure compared with non-CD controls, with no differences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation.

Chagas disease / COVID-19 comorbidity. An advantage to chagasic patients?

“…In this respect, 90% (45/50) of the here studied proven chagasic patients did not show infection at all, and/or if so, they were undetected, asymptomatic or subclinical cases. This fact seems to be supported by previous reports showing no significant differences and/or trends of worsening clinical profiles in chagasic patients due to SARS-CoV-2-infection (22).…”

“…Such a hypothesis has been explained as a possible consequence of an immunocompromised condition suggested as a synergistic action of COVID-19 on chagasic patients (11,21). However, although this explanation sounds reasonable from the theoretical point of view, it was only a hypothesis and no previous study has tested it using patient data (22). In addition, the here obtained results did not show evidence to support the hypothesis, neither in the number nor in the severity of COVID-19 in Chagas disease-infected individuals.…”

The Complexity of Co-Infections in the Era of COVID-19

“…Given the global reality of the pandemic, and regardless of seasonality, co-infections are seen among patients with unique non-viral infections. Reports have been made of SARS-CoV-2 infection complicating parasitic diseases [83][84][85]. Intestinal parasite co-infection however was seemingly associated with less severe COVID-19 [86].…”