Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Coinfection with Malaria in Selected States in Nigeria

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Plasmodium species are the causative agents of coronavirus disease 2019 (COVID-19) and malaria respectively with similar clinical presentations. The objective of this study is to determine the burden of co-infection of SARS-CoV-2 and malaria in the general population. Five (5 mLs) of blood samples were collected for SARS-CoV-2 and malaria parasite test. The malaria test was performed using a commercially available one-step malaria antigen Plasmodium falciparum histidine-rich protein 2 (Pf HRP-II) rapid test kit. The results of the study showed that the participants that were coinfected with SARS-CoV-2 IgG and malaria were 13 (2.5%) in Lagos, 1114 (39.1%) in Delta and 49 (2.3%) in Sokoto States. The prevalence of coinfection of SARS-CoV-2 and malaria in urban areas in Lagos, Delta and Sokoto States were 7 (2.2%), 1373 (48.1%), and 5 (0.2%) respectively. In rural areas, the prevalence of coinfection of SARS-CoV-2 and malaria in Lagos, Delta and Sokoto States were 6 (0.3%), 365 (12.8%), and 44 (2.1%) respectively in this study. This suggests that participants in the urban areas were more prone to co-infections than the rural areas in Lagos and Delta states, while it was otherwise in Sokoto State. In conclusion, the co-infection of SARS-CoV-2 and malaria was very high in Delta State compared to the other States. It is important for clinics to screen for both diseases when patients present with symptoms of malaria. This is because the infections have similar symptoms and the public is quick to assume malaria infection without diagnosing for COVID-19 and vice versa.

Performance Evaluation of Real Time Polymerase Reaction Assay (SCODA) for Detection of SARS-CoV-2

In order to robustly detect and quantify gene expression from small amounts of RNA, amplification of the gene transcript is necessary. Real Time PCR is useful for detection and quantification of genetic constitution of pathogens. This technique amplifies a tiny DNA target million or billion times in such a way that it can be easily studied by scientists. Availability of highly sensitive and specific assay for the detection of SARS-Cov-2 and easy accessibility of such was necessary for early diagnosis and effective management of COVID-19 infection. The aim of this study was to evaluate the performance characteristic of SCODA. Validation of SCODA was performed using synthesized standards and clinical samples previously tested using a commercially approved COVID-19 RT-qPCR detection kit (LifeRiver). The assay showed a linearity of 98.2% on the ORF1ab target and 99.8% on the N-gene target. The sensitivity and specificity were both 100%. Analysis for the LoD95 produced 74.04 (CI: 25 - 1000) cp/μl on ORF1ab gene and 1.119 (CI: 1 - 1) cp/μl on N-gene target with a precision of CV ≤ 3%. SCODA showed high comparable performance in comparison with LifeRiver and other commercial COVID-19 RT-qPCR test kits.

Microbial Contents and Antibiotics Susceptibilities from Hand Washing Stations during COVID-19 Pandemic in Lagos, Nigeria

The COVID-19 pandemic put every government in the globe on red alert;safety protocol and long-standing infection prevention and control (IPC) measures such as hand and oral hygiene, social/ physical distancing, use of face mask were rigorously enforced. This study evaluated microbial (bacterial, fungal) contents of rinsate, bowl water, water from tap, and the neighborhood drainage in selected hand washing stations in Agege, Alimosho, Mainland, Island and Shomolu local government areas (LGAs) in Lagos, Nigeria. The identities of bacterial isolates were confirmed with 16S rRNA sequencing while the fungi were identified by colonial appearances. The antibiotics susceptibility testing (AST) of the bacteria against structurally unrelated antibiotics was performed and interpreted according to standard guidelines. Sixty-seven (67) bacterial and fifty-one (51) fungal isolates were recovered from mainly water bucket with tap and rinsates across all the LGAs. There were marked microbial loads (some too numerous to count at 10-3 dilution) across Alimosho, Lagos Island and Mainland. Forty (40) representative bacterial isolates were selected for 16S rRNA sequencing. The occurrence of microbial isolates in the samples was at varying degrees;Klebsiella spp. (37.5%), Bacillus spp. (32.5%), Enterobacter spp. (17.5%), were the predominant bacteria while Aspergillus spp. (46.2%), yeasts (34.6%), Sporothrix schenckii (11.5%) and Penicillium spp. (7.7%) constituted the fungal isolates. The biological weapon, B. anthracis was recovered from a water bucket with tap in Alimosho. The antibiotics susceptibility testing of the bacteria showed high degrees of resistance profile;45 (69.2%) to ampicillin, 41.5% amoxicillin/clavulanate while 47.6% were resistant to two (2) or more antibiotics. This study demonstrated high microbial load during the pandemic at the study LGAs, presence of environmental commensals reputed for debilitating opportunistic infections in man and risk of passing heavy load of these potential pathogens to the public.

COVID-19 Spread Patterns Is Unrelated to Malaria Co-Infections in Lagos, Nigeria

Malaria and COVID-19, though caused by different organisms, share a significant number of symptoms like fever, headaches, difficulty in breathing and fatigue. Therefore, determining if a patient is positive for COVID-19 or Malaria based on symptoms alone, might be misleading, especially during pandemic response. It has been reported that an individual begins to manifest Malaria symptoms between 10 - 15 days after infection with malaria parasite, although some individuals may be asymptomatic. Some COVID-19 infected patients, like Malaria, are also asymptomatic but could contribute to transmission of SARS-CoV-2 virus. These similarities in symptoms have led to misconception about COVID-19 being real and misdiagnoses of both infections, especially in Nigeria. However, there are possibilities that Malaria and COVID-19 could co-exist in some individuals thereby leading to mismanagement and treatment of only one infection while neglecting the possibility of the patient being infected with both diseases. We aim to determine possible correlation between Malaria and COVID-19 in a Malaria endemic country like Nigeria. This study was carried out using the qPCR molecular testing approach, a gold standard for COVID-19 testing and rapid diagnostic test kits to detect Malaria parasites in 617 individuals residing in urban settings. We demonstrated that COVID-19 and Malaria infection amongst adults in urban settings are unrelated thereby focusing on symptoms alone may result in misdiagnosis. Our findings show that Malaria is not among the underlying medical conditions strongly associated with increased risk for severe COVID-19 illness amongst adults in urban settings.

Outcome of Symptom-Based RT-PCR Testing for SARS-CoV-2: Experience from a Large Public Testing Centre in Nigeria

Background: Access to testing for SARS-CoV-2 in Nigeria is still highly restricted. Only patients who are symptomatic for SARS-CoV-2 are selected for testing. This pattern of testing will miss a large proportion of individuals with the infection who are asymptomatic and presymptomatic. This study reports the experience of a symptom-based study from a large testing centre in Nigeria. Methods: A cross-sectional study, reviewing data collected from respondents presenting at the Nigerian Institute of Medical Research (NIMR) modified drive-through center for COVID-19 test between the period March 31st and August 31st, 2020 were included in the analysis. Results: A total of 9891 participants were recruited into the study and 2465 participants (24.9%) had a positive PCR result for SARS-CoV-2. The majority of the respondents were above 18 years old, n = 9163 (93.4%). The average age of the respondents was 36.7 years (sd 13.8 years). The age of the participants has a significant effect on SARS-CoV-2 status (AOR = 1.009, CI, 1.005 to 1.012, p = 0.0001). There was a male preponderance, n = 5652 (57.6%). The odds of having a positive status for SARS-CoV-2 were 0.9 times lower for female participants. The majority of the respondents had a history of travel, n = 6788 (68.6%). Cough was the commonest symptom, n = 1062 (10.7%) followed by fever, n = 979 (9.9%). The mortality rate was 0.1%. Among the participants with comorbidity, 31 (51.7%) had positive results for SARS-CoV-2 while 29 (48.3%) had negative results. Conclusion: Symptom-based approach to testing for SARS-CoV-2 in Nigeria revealed a high positivity rate, while mortality from those tested in the study is low. Age and gender appear to play a significant role in the dynamics of the disease.