Chagas disease and SARS-CoV-2 coinfection does not lead to worse in-hospital outcomes: results from the Brazilian COVID-19 Registry
Authors: Molina Israel , Marcolino Milena S. , Pires Magda C. , Ramos Lucas Emanuel F. , Silva Rafael T. , Guimarães Milton H. , José R. de Oliveira Isaias , Carvalho Rafael L.R. , S. Nunes Aline Gabrielle , de Barros Ana Lara R. M. , Scotton Ana Luiza B. A. , C. Madureira Angélica Aparecida , L. Farace Bárbara , de Carvalho Cíntia A. , Rodrigues Fernanda D. A , Anschau Fernando , Botoni Fernando A. , Nascimento Guilherme F. , Duani Helena , Guimarães Henrique C. , de Alvarenga Joice C. , Moreira Leila B. , Zandoná Liege B. , de Almeida Luana F. , Oliveira Luana M. , Kopittke Luciane , C. Castro Luís , Santos Luisa Elem A. , A. S. Cabral Máderson , P. Ferreira Maria Angélica , C. S. Sampaio Natália , de Oliveira Neimy R. , Francisco Saionara C. , Lopes Sofia J. T. S. , Fereguetti Tatiani O. , dos Santos Veridiana B. , de Carvalho Victor Eliel B. , Ramires Yuri C. , Ribeiro Antonio Luiz P. , Moscoso Freddy Antonio B. , Moura Rogério , Polanczyk Carisi A. , Nunes Maria do Carmo P. 
Published: March 2021

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.

Key messages

What is already known about this subject?

Preexisting cardiovascular disease enhances vulnerability to COVID-19.

Co-infection with SARS-CoV-2 and T.cruzi can occur in patients living in areas in which both infections are epidemic.

What does this study add?

Despite a higher frequency of chronic heart failure and atrial fibrillation, our findings do not suggest that co-infection with T.cruzi and SARS-CoV-2 worsens in-hospital outcomes.

Chagas disease patients were observed to have lower C-reactive protein (CRP) levels.

How might this impact on clinical practice?

Given the current circulation of SARS-CoV-2 at high levels and millions of T cruzi-infected individuals living in Brazil, the risk for co-infections substantially increases.

Further studies are needed to investigate why CRP levels were lower in CD patients. We hypothesized that CD patients might have a lower risk of unregulated inflammatory response to COVID-19, as they already have an active chronic inflammatory and immune response response triggered by T.cruzi infection.