Distinct clinical and immunological profiles of patients with evidence of SARS-CoV-2 infection in sub-Saharan Africa
Ben Morton, Kayla G. Barnes, Catherine Anscombe, Khuzwayo C. Jere, Prisca Benedicto-Matambo, Jonathan Mandolo, Raphael Kamng’ona, Comfort Brown, James Nyirenda, Tamara Phiri, Ndaziona Peter Kwanjo Banda, Charlotte van der Veer, Kwazizira S. Mndolo, Kelvin Mponda, Jamie Rylance, Chimota Phiri, Jane Mallewa, Mulinda Nyirenda, Grace Katha, Paul Kambiya, James Jafali, Henry C. Mwandumba, Stephen B. Gordon, Jacob Phulusa, Mercy Mkandawire, Sylvester Kaimba, Herbert Thole, Sharon Nthala, Edna Nsomba, Lucy Keyala, Peter Mandala, Beatrice Chinoko, Markus Gmeiner, Vella Kaudzu, Samantha Lissauer, Bridget Freyne, Peter MacPherson, Todd D. Swarthout, Pui‐Ying Iroh Tam, Simon Sichone, Ajisa Ahmadu, Oscar Kanjewa, Vita Nyasulu, End Chinyama, Allan Zuza, Brigitte Denis, Evance Storey, Nedson Bondera, Danford Matchado, Adams Chande, Arthur Chingota, Chimenya Ntwea, Langford Mkandawire, Chimwemwe Mhango, Agness Lakudzala, Mphatso Chaponda, Percy Mwenechanya, Leonard Mvaya, Dumizulu Tembo, Data and statistics, Marc Henrion, James Chirombo, Clemens Masesa, Joel Gondwe, Jennifer Cornick, Kondwani Jambo
Abstract
Although the COVID-19 pandemic has left no country untouched there has been limited research to understand clinical and immunological responses in African populations. Here we characterise patients hospitalised with suspected (PCR-negative/IgG-positive) or confirmed (PCR-positive) COVID-19, and healthy community controls (PCR-negative/IgG-negative). PCR-positive COVID-19 participants were more likely to receive dexamethasone and a beta-lactam antibiotic, and survive to hospital discharge than PCR-negative/IgG-positive and PCR-negative/IgG-negative participants. PCR-negative/IgG-positive participants exhibited a nasal and systemic cytokine signature analogous to PCR-positive COVID-19 participants, predominated by chemokines and neutrophils and distinct from PCR-negative/IgG-negative participants. PCR-negative/IgG-positive participants had increased propensity for Staphylococcus aureus and Streptococcus pneumoniae colonisation. PCR-negative/IgG-positive individuals with high COVID-19 clinical suspicion had inflammatory profiles analogous to PCR-confirmed disease and potentially represent a target population for COVID-19 treatment strategies.