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Gut Microbiome Disruption Following SARS-CoV-2: A Review

Righi et al., Microorganisms, doi:10.3390/microorganisms12010131
Jan 2024  
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Probiotics for COVID-19
18th treatment shown to reduce risk in March 2021
*, now known with p = 0.0000013 from 26 studies.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
3,800+ studies for 60+ treatments.
Review of gut microbiome changes associated with COVID-19 during acute infection and post-acute COVID syndrome (PCS). Authors report increased opportunistic pathogens and reduced beneficial symbionts in acute COVID-19 lead to dysbiosis and inflammation. Changes can persist for weeks after initial infection resolves. In PCS lasting 12+ months, reduced microbiome diversity and altered composition are seen, often with increased pathogens and reduced butyrate producers. Specific microbiome signatures associate with respiratory dysfunction. Probiotics, prebiotics, and microbiome-targeted dietary interventions may be beneficial before, during, and after infection.
The immune effects of probiotics are strain-specific.
Reviews covering probiotics for COVID-19 include Baud, Di Pierro, Kurian, Olaimat, Petrariu, Righi, Singh, Stavropoulou, Taufer, Taufer (B).
Righi et al., 9 Jan 2024, peer-reviewed, 11 authors. Contact: (corresponding author),,,,
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Gut Microbiome Disruption Following SARS-CoV-2: A Review
Elda Righi, Ilaria Dalla Vecchia, Nina Auerbach, Matteo Morra, Anna Górska, Concetta Sciammarella, Lorenza Lambertenghi, Elisa Gentilotti, Massimo Mirandola, Evelina Tacconelli, Assunta Sartor
Microorganisms, doi:10.3390/microorganisms12010131
COVID-19 has been associated with having a negative impact on patients' gut microbiome during both active disease and in the post-acute phase. In acute COVID-19, rapid alteration of the gut microbiome composition was observed, showing on one side a reduction in beneficial symbionts (e.g., Roseburia, Lachnospiraceae) and on the other side an increase in opportunistic pathogens such as Enterococcus and Proteobacteria. Alpha diversity tends to decrease, especially initially with symptom onset and hospital admission. Although clinical recovery appears to align with improved gut homeostasis, this process could take several weeks, even in mild infections. Moreover, patients with COVID-19 post-acute syndrome showed changes in gut microbiome composition, with specific signatures associated with decreased respiratory function up to 12 months following acute disease. Potential treatments, especially probiotic-based therapy, are under investigation. Open questions remain on the possibility to use gut microbiome data to predict disease progression and on potential confounders that may impair result interpretation (e.g., concomitant therapies in the acute phase; reinfection, vaccines, and occurrence of novel conditions or diseases in the post-acute syndrome). Understanding the relationships between gut microbiome dynamics and disease progression may contribute to better understanding post-COVID syndrome pathogenesis or inform personalized treatment that can affect specific targets or microbiome markers.
Conflicts of Interest: The authors declare no conflicts of interest.
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