The Role of Gut Microbiota Dysbiosis as a Potential Factor in Early Diagnosis, Prognosis and Therapeutic Strategy of COVID-19 Patients

Kevin Tandarto(1), Kadek Ari Suyandi(2), Lily Chandrawati(3),

(1) Department of Internal Medicine, S.K. Lerik General Hospital, Kupang
(2) Department of Internal Medicine, Kasih Ibu General Hospital, Badung
(3) Department of Internal Medicine, S.K. Lerik General Hospital, Kupang
Corresponding Author


The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the most widespread global pandemic since the 1918 influenza pandemic. The consequences of the coronavirus disease 2019 (COVID-19) are devastating and become the current world major public health issue. Not only SARS-CoV-2 attack the respiratory system, but also can affect multiple organs. Clinical manifestation varies from asymptomatic to severe multiorgan dysfunctions. COVID-19 is typically associated with a set of comorbidities such as hypertension, diabetes, obesity, and/or advanced age, which significantly exacerbates the consequences of infection. During the early stages of the disease, SARS-CoV-2 can also cause gastrointestinal symptoms such as vomiting, diarrhea, or abdominal pain. Intestinal dysfunction alters intestinal microbes and increases inflammatory cytokines. As a result, diagnosing gastrointestinal symptoms that procede respiratory problems during COVID-19 infection may be required for better early diagnosis and treatment. Discovering the composition of the microbiota and its metabolic products in the context of COVID-19 can aid in the identification of novel disease biomarkers and therapeutic targets. In the context of COVID-19, elucidating changes to the microbiome as reliable biomarkers represents an overlooked piece of the disease puzzle that requires further investigation.


microbiota; COVID-19; correlation; diagnosis; prognosis; therapeutic


Malik YS, Kumar N, Sircar S, Kaushik R, Bhat S, Dhama K,

et al. Coronavirus disease pandemic (Covid-19): challenges

and a global perspective. Pathogens 2020 Jul 1;9:1–31.

Natalia S, Thorion FI, Adlino L, John CE, Kurniawan A,

Pratama N, et al. The clinical features of covid-19 patients

with positive viral RNA stool test results and possibility

of fecal-oral transmission: a systematic review. Indones J

Gastroenterol Hepatol Dig Endosc 2021;22:42–51.

Ren Z, Wang H, Cui G, Lu H, Wang L, Luo H, et al. Alterations

in the human oral and gut microbiomes and lipidomics in

COVID-19. Gut 2021;70:1253–65.

Srinath BS, Shastry RP, Kumar SB. Role of gut-lung

microbiome crosstalk in COVID-19. Res Biomed Eng


Adiwinata R, Revana Irawan V, Arifputra J, Waleleng BJ,

Gosal F, Rotty L, et al. Potential of fecal-oral transmission

and gastrointestinal manifestation of COVID-19. Indones J

Gastroenterol Hepatol Dig Endosc 2020;21:53–8.

Sulaiman AS, Kurniawan J, Jasirwan COM, Nababan SH,

Calista KF, Lesmana CRA, et al. COVID-19 related to liver

impairment and its impact on chronic liver disease. Indones

J Gastroenterol Hepatol Dig Endosc 2020;21:220–5.

Wowor AC, Pratomo B, Mustika S. The relationship of

diarrhea in COVID-19 patients with transaminitis, severity,

and mortality. Indones J Gastroenterol Hepatol Dig Endosc


Enaud R, Prevel R, Ciarlo E, Beaufils F, Wieërs G, Guery B,

et al. The gut-lung axis in health and respiratory diseases: a

place for inter-organ and inter-kingdom crosstalks. Front Cell

Infect Microbiol 2020;10:9.

Sun Z, Song Z-G, Liu C, Tan S, Lin S, Zhu J, et al. Gut

microbiome alterations and gut barrier dysfunction are

associated with host immune homeostasis in COVID-19

patients. BMC Med 2022;20:24.

Lau RI, Zhang F, Liu Q, Su Q, Chan FKL, Ng SC. Gut

microbiota in COVID-19: key microbial changes, potential

mechanisms and clinical applications. Nat Rev Gastroenterol

Hepatol 2022;x:1-15.

Brooks EF, Bhatt AS. The gut microbiome: a missing link

in understanding the gastrointestinal manifestations of

COVID-19? Cold Spring Harb Mol Case Stud 2021;7:a006031.

Ke S, Weiss ST, Liu YY. Dissecting the role of the human

microbiome in COVID-19 via metagenome-assembled

genomes. Nat Commun 2022;13:1-15.

Villapol S. Gastrointestinal symptoms associated with

COVID-19: impact on the gut microbiome. Transl Res


Zuo T, Wu X, Wen W, Lan P. Gut microbiome alterations

in COVID-19. Genomics Proteomics Bioinformatics


Lin L, Jiang X, Zhang Z, Huang S, Zhang Z, Fang Z, et al.

Gastrointestinal symptoms of 95 cases with SARS-CoV-2

infection. Gut 2020;69:997–1001.

Sehli S, Allali I, Chahboune R, Bakri Y, al Idrissi N, Hamdi

S, et al. Metagenomics approaches to investigate the gut

microbiome of COVID-19 patients. Bioinform Biol Insights


Hilpert K. Is the gut microbiome a target for adjuvant treatment

of COVID-19? Biologics 2021;1:285–99.

Sukrisman L, Sinto R, Priantono D. Hematologic profiles

and correlation between absolute lymphocyte count and

neutrophil/ lymphocyte ratio with markers of inflammation

of covid-19 in an indonesian national referral hospital. Int J

Gen Med 2021;14:6919–24.

Cruz AS, Mendes-Frias A, Oliveira AI, Dias L, Matos

AR, Carvalho A, et al. Interleukin-6 is a biomarker for the

development of fatal severe acute respiratory syndrome

Coronavirus 2 pneumonia. Front Immunol 2021;12:613422.

Ali N. Elevated level of C-reactive protein may be an early

marker to predict risk for severity of COVID-19. J Med Virol


Illg Z, Muller G, Mueller M, Nippert J, Allen B. Analysis of

absolute lymphocyte count in patients with COVID-19. Am

J Emerg Med 2021;46:16–9.

Kumar P, Chander B. COVID 19 mortality: probable

role of microbiome to explain disparity. Med Hypotheses


Hussain I, Cher GLY, Abid MA, Abid MB. Role of gut

microbiome in COVID-19: an insight into pathogenesis and

therapeutic potential. Front Immunol 2021;12:4164.

Russel RJ. COVID-19 pathophysiology: interactions of gut

microbiome, melatonin, vitamin D, stress, kynurenine and the

alpha 7 nicotinic receptor: treatment implications. Melatonin

Res 2020;3:322–45.

Burchill E, Lymberopoulos E, Menozzi E, Budhdeo S, McIlroy

JR, Macnaughtan J, et al. The unique impact of COVID-19

on human gut microbiome research. Front Med (Lausanne)


Peng Y, Zhang D, Chen T, Xia Y, Wu P, Seto WK, et al. Gut

microbiome and resistome changes during the first wave of

the COVID-19 pandemic in comparison with pre-pandemic

travel-related changes. J Travel Med 2021;28:taab067.

Van der Lelie D, Taghavi S. COVID-19 and the gut microbiome:

more than a gut feeling. mSystems 2020;5:e00453-20.

Hung YP, Lee CC, Lee JC, Tsai PJ, Ko WC. Gut dysbiosis

during COVID-19 and potential effect of probiotics.

Microorganisms 2021;9:1605.

Belančić A. Gut microbiome dysbiosis and endotoxemia

- additional pathophysiological explanation for increased

COVID-19 severity in obesity. Obes Med 2020;20:e13128.

Albashir AAD. The potential impacts of obesity on COVID-19.

Clin Med (London) 2020;20:E109–13.

Hartmann-Boyce J, Morris E, Goyder C, Kinton J, Perring J,

Nunan D, et al. Diabetes and COVID-19: risks, management,

and learnings from other national disasters. Diabetes Care


Popkin BM, Du S, Green WD, Beck MA, Algaith T, Herbst

CH, et al. Individuals with obesity and COVID-19: a global

perspective on the epidemiology and biological relationships.

Obesity Reviews 2020;21:e13128.

Rossini V, Tolosa-Enguis V, Frances-Cuesta C, Sanz Y. Gut

microbiome and anti-viral immunity in COVID-19. Crit Rev

Food Sci Nutr 2022;x:1–16.

Wang H, Wang H, Sun Y, Ren Z, Zhu W, Li A, et al. Potential

associations between microbiome and COVID-19. Front Med

(Lausanne) 2021;8:785496.

Thalanayar Muthukrishnan P, Faillace R. Compassionate

use of others’ immunity - understanding gut microbiome in

COVID-19. Crit Care 2020;24:1–2.

Walton GE, Gibson GR, Hunter KA. Mechanisms linking

the human gut microbiome to prophylactic and treatment

strategies for COVID-19. Br J Nutr 2021;126:219–27.

Schmulson M, Dávalos MF, Berumen J. Beware:

gastrointestinal symptoms can be a manifestation of

COVID-19. Rev Gastroenterol Mex 2020;85:282–7.

Allali I, Bakri Y, Amzazi S, Ghazal H. Gut-lung axis in

COVID-19. Interdiscip Perspect Infect Dis 2021;2021:6655380.

Farsi Y, Tahvildari A, Arbabi M, Vazife F, Sechi LA, Shahidi

Bonjar AH, et al. Diagnostic, prognostic, and therapeutic roles

of gut microbiota in COVID-19: a comprehensive systematic

review. Front Cell Infect Microbiol 2022;12:804644.

Ferreira C, Viana SD, Reis F. Is gut microbiota dysbiosis

a predictor of increased susceptibility to poor outcome of

COVID-19 patients? An update. Microorganisms 2021;9:1–

Gasmi A, Tippairote T, Mujawdiya PK, Peana M, Menzel

A, Dadar M, et al. The microbiota-mediated dietary and

nutritional interventions for COVID-19. Clin Immunol


Liu F, Ye S, Zhu X, He X, Wang S, Li Y, et al. Gastrointestinal

disturbance and effect of fecal microbiota transplantation in

discharged COVID-19 patients. J Med Case Rep 2021;15:60.

Biliński J, Winter K, Jasiński M, Szczęś A, Bilinska N,

Mullish BH, et al. Rapid resolution of COVID-19 after faecal

microbiota transplantation. Gut 2022;71:230–2.

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DOI: 10.24871/2432023242


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