Chagas disease and SARS-CoV-2 coinfection does not lead to worse in-hospital outcomes

Abstract

Chagas disease (CD) continues to be a major public health burden in Latina America. Information on the interplay between COVID-19 and CD 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. Consecutive patients with confirmed COVID-19 were included from March to September 2020. Genetic matching for sex, age, hypertension, diabetes mellitus and hospital was performed in a 4:1 ratio. Of the 7018 patients who had confirmed COVID-19, 31 patients with CD and 124 matched controls were included (median age 72 (64–80) years-old, 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). 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). In-hospital management, outcomes and complications were similar between the groups. 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.

COVID-19 and Chagas Disease in Buenos Aires, Argentina

“…Reassuringly, we did not observe any statistically significant difference in clinical outcomes for coinfected patients compared to controls. These data are consistent with a Brazilian series recently published (18). Molina et al have shown minor differences in C-reactive protein (CRP) in the group coinfected with CD.…”

“…The coinfected cohort had 46% of EKG abnormalities typical of CD cardiomyopathy. These data are similar to the Brazilian series with 60% EKG alterations (18). In both studies, Brazilian and ours, patients classified as CD with or without cardiomyopathy are limited mostly for missing data such as EKG and echocardiogram.…”

“…There are some limitations in our study, such as the fact that there are some missing data (i.e., CD serologies and EKG for all the patients) because during the outbreak the health system almost collapsed and resources (including human resources) had to be used with priority criteria, and not all complementary studies could be easily done on isolated patients. Another limitation is that the number of patients in the coinfected cohort, which was 29, is not substantial, but as far as we know, there is only one study with this coinfection clinical approach with a similar number of included patients carried out in Brazil (18), so we hoped to elucidate some unknown gaps with our information, thus making a contribution to the other series.…”

Sex Differences in Cardiac Pathology of SARS-CoV2 Infected and Trypanosoma cruzi Co-infected Mice

“…In addition, the post-COVID effect on CCM in CD patients could create a health crisis in Latin America during the post-COVID era since hundreds of thousands of asymptomatic (indeterminate) CD patients likely already have or will contract COVID-19. A recent clinical registry data study from Brazil suggests that Chagas disease and SARS-CoV-2 coinfection do not lead to worse in-hospital outcomes ( 17 ). In another case study, the authors reported that COVID-19 infected CD patients ( n = 2) presented with a rapid disease progression, and despite all efforts of the medical team, both patients died ( 18 ).…”

Impact of COVID-19 In-hospital Mortality in Chagas Disease Patients

“…It was observed that 31.43% of deaths had COVID-19 as the main cause. Molina et al in a study that compared hospitalization outcomes in patients with CD and without CD, both with COVID-19 in 11 Brazilian hospitals, observed a similar mortality rate (32.3%) ( 14 ). Another study that evaluated the profile of deaths in Brazilian hospitals showed that COVID-19 was the main cause of death in 2020, surpassing deaths from cardiovascular diseases ( 15 ).…”