Co-infection of COVID-19 and Malaria Exacerbates Fibrinolytic Responses: A Case-Control Study in Port Harcourt, Nigeria

Abstract

In late 2019, China experienced an outbreak of a new beta-coronavirus. COVID-19 had caused more than 3.7 million confirmed cases and killed at least 260,000 worldwide as recorded in April 2020. COVID-19 is mainly transmitted to susceptible humans through infected nasal droplets which are released via coughing, talking, or sneezing while malaria is a major public health issue in Africa especially in the sub-Saharan region. Malaria is mainly transmitted through the bites of infected female Anopheles mosquitoes. The hypercoagulable state thus reported in severe malaria infection has also been reported in COVID-19 infection but there is a paucity of information focusing on the trend and actual levels of these fibrinolytic biomarkers which can be established as a distinguishable level between the two coagulable conditions. Therefore, this study of some fibrinolytic markers (D-dimer and fibrinogen) in COVID-19 and malaria subjects in Port Harcourt will enlighten healthcare providers on associations between COVID-19 and malaria-infected patients. The cross-sectional, case-control study design was employed for this study. A total of fifty-five (55) malaria-positive subjects, fifty-five (55) COVID-19-positive subjects, fifty-five (55) co-infected subjects and fifty-five (55) control subjects who were within the ages of twenty (20) to sixty-five (65) years old participated in the study. Five milliliters (5ml) of venous blood was collected aseptically and dispensed into an Ethylene Diamine Tetraacetic acid (EDTA) anticoagulant bottle for malaria parasite detection from the thick blood film. A Sandwich-type Enzyme-Linked Immunosorbent Assay (ELISA) was used to assay for the D-dimer and fibrinogen levels while a nasopharyngeal swab was collected for confirmation of COVID-19-positive subjects using the RT-PCR technique. The mean values of D-dimer of the subjects were as follows; malaria parasite subjects (429.60 ±59.87 ng/ml), COVID-19 subjects (431.34 ±55.51 ng/ml), COVID-19 + malaria subjects (553.42 ± 59.74 ng/ml) and control subjects (319.86±51.93 ng/ml). These results revealed that the mean D-dimer values were statistically higher among the co-infected subjects (F-value= 2.816, p-value= 0.040), No significant changes were observed for fibrinogen among the studied subject groups (p=< 0.05).  Sex exerted more significance on the studied parameters than age. Amongst the fibrinolytic parameters studied, D-dimer appears to possess potential diagnostic value for mild/asymptomatic COVID-19 infection and the case is not different in  malaria infection in the tropical region of Nigeria. The D-Dimer levels were more significantly elevated in subjects with COVID-19 and malaria than in the other three groups. These results present evidence of the dual impact of COVID-19 and malaria infections in the tropics.