WJMM World Journal of Medical Microbiology Science Publications 10.31586/wjmm.2022.372 WJMM-372 Opinion Role of Probiotics in COVID-19 Management? Hassan Samar Osama Ahmed 1 Mohamed Manal Sabry 2 Nessim Mina Mikhail 2 Ashram Mohamed Nabil Badawy Al 2 Allam Mohamed Farouk 1 3 * Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt Department of Preventive Medicine and Public Health, University of Cordoba School of Medicine, Cordoba 14004, Spain Corresponding author at: Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt 04 08 2022 1 1 04 08 2022 04 08 2022 04 08 2022 04 08 2022 © Copyright 2022 by authors and Trend Research Publishing Inc. 2022 This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/ Probiotics as an intestinal microbe regulator, not only improve the ability of the gastrointestinal microbiota to modulate immune activity, but also strengthen the body's immune system, inhibit allergic reactions and has a significant role especially in the anti-viral immunomodulation. Therefore, in patients with COVID-19, the intestinal micro-eco-regulator, represented by probiotics, may be a therapeutic choice. However, there is still a lack of evidence-based studies to support probiotic treatment of patients with COVID-19. New cohort studies and randomized controlled clinical trials to assess the effectiveness of probiotics in the management of COVID-19 are strongly and urgently needed. Probiotics COVID-19 Gut microbiota clinical trials cohort study GIT. Research Opinion

At the end of 2019, a novel coronavirus was identified as the causative of a cluster of pneumonia cases in Wuhan (China), resulting in an epidemic throughout China, followed by a global pandemic. In February 2020, the World Health Organization (WHO) announced the disease COVID-19, which stands for coronavirus disease 2019 ().

The common symptoms of COVID-19 infection include fever, dry cough, shortness of breath, and breathing difficulties less common symptoms include anosmia, sore throat, runny nose, vomiting and diarrhoea ().

Early reports from Wuhan showed that 2-10% of patients with COVID-19 infection had gastrointestinal symptoms such as diarrhoea, vomiting and abdominal pain. About 10% of the patients presented with diarrhoea and nausea 1-2 days before the development of fever and respiratory symptoms (). Moreover, another study involving 1141 COVID-19 patients found that 183 of the 1141 patients (nearly 16%) presented with gastrointestinal symptoms only ().

COVID-19 disease are characterised by gut microbiome dysbiosis, immune dysregulation, hyper-inflammation, and cytokine storm ().

Gut microbiota configuration was associated with COVID-19 disease severity, and altered gut microbiota persisted even after clearance of the virus, suggesting that the virus might inflict prolonged harm to human microbiome homoeostasis ().

Probiotics are live microorganisms that when administered in adequate amounts confer a health benefit on the host ().

Probiotics as an intestinal microbe regulator, not only improve the ability of the gastrointestinal microbiota to modulate immune activity, but also strengthen the body's immune system, inhibit allergic reactions and has a significant role especially in the anti-viral immunomodulation ().

Therefore, in patients with COVID-19, the intestinal micro-eco-regulator, represented by probiotics, may be a therapeutic choice. However, there is still a lack of evidence-based studies to support probiotic treatment of patients with COVID-19.

New cohort studies and randomized controlled clinical trials to assess the effectiveness of probiotics in the management of COVID-19 are strongly and urgently needed.

 References Angurana SK, Bansal A. Probiotics and Coronavirus disease 2019: think about the link. Br J Nutr. 2021 Nov 28;126(10):1564-1570. doi: 10.1017/S000711452000361X. Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19) 2021 Case Definition. Avaialbe at: https://ndc.services.cdc.gov/case-definitions/coronavirus-disease-2019-2021/ (last access May 5, 2022). Effenberger M, Grabherr F, Mayr L, Schwaerzler J, Nairz M, Seifert M, Hilbe R, Seiwald S, Scholl-Buergi S, Fritsche G, Bell-mann-Weiler R, Weiss G, Müller T, Adolph TE, Tilg H. Faecal calprotectin indicates intestinal inflammation in COVID-19. Gut 2020;69(8):1543-1544. doi: 10.1136/gutjnl-2020-321388. Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B, Morelli L, Canani RB, Flint HJ, Salminen S, Calder PC, Sanders ME. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol 2014;11(8):506-14. doi: 10.1038/nrgastro.2014.66. Su S, Shen J, Zhu L, Qiu Y, He JS, Tan JY, Iacucci M, Ng SC, Ghosh S, Mao R, Liang J. Involvement of digestive system in COVID-19: manifestations, pathology, management and challenges. Therap Adv Gastroenterol. 2020;13:1756284820934626. doi: 10.1177/1756284820934626. World Health Organization. Clinical management of COVID-19: interim guidance, 27 May 2020. Available at: https://apps.who.int/iris/bitstream/handle/10665/332196/WHO-2019-nCoV-clinical-2020.5-eng.pdf?sequence=1&isAllowed=y (last access May 5, 2022). World Health Organization. Rolling updates on coronavirus disease (COVID-19). Updated 31 July 2020. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen (last access May 5, 2022). Yeo C, Kaushal S, Yeo D. Enteric involvement of coronaviruses: is faecal-oral transmission of SARS-CoV-2 possible? Lancet Gastroenterol Hepatol 2020;5(4):335-337. doi: 10.1016/S2468-1253(20)30048-0. Zhang H, Yeh C, Jin Z, Ding L, Liu BY, Zhang L, Dannelly HK. Prospective study of probiotic supplementation results in immune stimulation and improvement of upper respiratory infection rate. Synth Syst Biotechnol 2018;3(2):113-120. doi: 10.1016/j.synbio.2018.03.001.