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(ISSN
–
2689-1026)
VOLUME
04
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Pages:
32-39
SJIF
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FACTOR
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(2022:
6.
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IF
–
7.569
Publisher:
The USA Journals
ABSTRACT
The purpose of this study is to analyze changes in the intestinal microflora of patients with COVID-19 in foreign
countries and the role of microorganisms in the development of dysbacteriosis. Patients with Covid-19 usually
complain of fever, cough, expectoration, shortness of breath, headache, and fatigue, but at the same time, some
patients with Covid-19 experience gastrointestinal symptoms such as diarrhea, anorexia, nausea, and vomiting,
complaints from the gastrointestinal trac. The literature review analyzed the etiological causes of intestinal
dysbacteriosis in COVID-19. It has been established that in the intestinal microflora of patients with COVID-19, there is
an increase in the number of opportunistic and pathogenic bacteria and a decrease in the number of beneficial
microorganisms.
KEYWORDS
COVID-19, SARS-CoV-2, intestinal microflora, diarrhea, bacteria
Research Article
CHARACTERISTICS OF INTESTINAL MICROBIOTSENOSIS IN COVID-19
PATIENTS
Submission Date:
April 05, 2022,
Accepted Date:
April 15, 2022,
Published Date:
April 28, 2022 |
Crossref doi:
https://doi.org/10.37547/TAJMSPR/Volume04Issue04-09
Aminjon Ne'matov
Doctor of Medical Science, professor, Academician of the Academy of Medical and Technical Sciences of
the Russian Federation, Center for the Development of Professional Qualifications of Medical Workers,
Tashkent Medical Academy, Uzbekistan
Islambek Kudiyarov
Assistant, Tashkent Medical Academy, Uzbekistan
Nodira Yodgorova
Doctor of Philosophy in Medical Science, associate professor, Tashkent Medical Academy, Uzbekistan
Zuxra Orinbayeva
Assistant, Tashkent Medical Academy Tashkent, Uzbekistan
Journal
Website:
https://theamericanjou
rnals.com/index.php/ta
jmspr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
33
Volume 04 Issue 04-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
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2689-1026)
VOLUME
04
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04
Pages:
32-39
SJIF
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FACTOR
(2020:
5.
286
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(2021:
5.
64
)
(2022:
6.
319
)
OCLC
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1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
INTRODUCTION
Today SARS-CoV-2 caused COVID-19 disease was
officially declared a pandemic on March 11, 2020 by the
World Health Organization as a worldwide outbreak of
coronavirus infection. To date, 390 961 200 people
worldwide have been infected with COVID-19, and 5
725 993 have died as a result of the pandemic (WHO
05.02.2022y) [45]. which requires the development of
laboratory tests, treatment methods and prevention
measures for COVID-19. [2,32,35]. Coronavirus infection
(COVID-19) is a new strain of the SARS CoV-2
coronavirus family that spreads by airborne and
household contact way, prone to damage lung tissue.
It can range from asymptomatic virus carriers to severe
clinical manifestations of the disease, as an infectious
disease, intoxication, inflammation of the upper and
lower respiratory tract [35] i.e. bilateral pneumonia
(viral diffuse alveolar injury with microangiopathy), the
development of acute respiratory distress syndrome
were noted [27]. However, with COVID-19, damage has
been observed to organs and systems other than the
div's respiratory organs and systems, including the
digestive system. The gastrointestinal tract (GIT) can
serve as an "entry gate for infection" along with
respiratory tract [7,15,17,19]. Changes in the
composition of the intestinal microflora in patients
with COVID-19 infection have been identified in several
studies [4,28,30].
MATERIALS AND METHODS
In order to write this article other articles, literature,
and research findings on the intestinal microflora in
COVID-19 have been analyzed.
RESULTS
As of January 31, 2020, the team of Chinese researchers
led by Dr. Zhong studied 1,099 Chinese patients, and
diarrhea was diagnosed in 3.8% of them [9]. Similarly,
Huang et al found that diarrhea was the main symptom
in one of every 41 patients, and that the incidence of
diarrhea was 2.4%. ани
қ
лашди [12]. In the later stages
of the COVID-19 pandemic, a significant increase in the
number of patients with diarrhea was observed,
indicating an increase in the incidence of diarrhea.
49.5% of the patients admitted to Wuhan Hospital in
Hubei Province of China with Covid-19 infection were
patients with diarrhea [3].
Evaluating the results of follow-up of patients in China,
it can be noted that the lesions of the gastrointestinal
tract in Covid-19 vary. Symptoms of diarrhea in Covid-
19 have also been reported in the pediatric population,
with diarrhea and vomiting occurring in 8.8% and 6.4%
of sick children, respectively, and in such patients (both
adults and children) respiratory symptoms of
coronavirus infection may appear later than
gastroenterological symptoms or may not be visible at
all [11,16,26]. A study of 140 patients with Covid-19 in
Wuhan showed that 39.6% of these patients had
gastrointestinal symptoms, 24 had 17.3% nausea, 18 had
12.9% diarrhea and 7 had 5% vomiting. 74 patients with
Covid-19 with gastrointestinal symptoms in Zhejiang
Province, 53 had 71.6% diarrhea alone, 11 had 14.9%
vomiting, and 10 had 13.5% nausea. A meta-analysis
involving 4,243 patients from China, Singapore, South
Korea, the United Kingdom, and the United States
showed that 17.6% of patients had gastrointestinal
symptoms, 26.8% had anorexia, 12.5% had diarrhea,
10.2% had nausea and vomiting, 9.2% had abdominal
pain and discomfort, and other symptoms were
observed in 23.7% of patients. The frequency of
diarrhea ranged from 2.0% to 10.1%, and nausea and
34
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vomiting
ranged
from
1.0%
to
10.1%
[25].
Gastrointestinal symptoms such as diarrhea, nausea,
vomiting, and abdominal pain occur in approximately
20–40% of patients with Covid-19 infection [1,33,46].
We analyzed 19 published scientific studies on Covid-19
disease that was associated with diarrhea, nausea,
abdominal pain, vomiting, anorexia, and bleeding. Of
the 19 scientific papers, 13 were from China, 4 from the
United States, 1 from Singapore, and 1 from Europe. In
our analysis, the symptom of diarrhea was the most
common, ranging from 2% to 33.7% of all patients. The
mean duration of diarrhea in patients with Covid-19
was 1 to 9 days [14]. Other common gastrointestinal
symptoms include anorexia (341/2914, 11.7%), nausea
(253/2914, 8.7%), and vomiting (131/2914, 4.5%), pain
(90/2914, 3.1%) and bleeding (5/ 2914, 0.2%).Symptoms
of diarrhea were reported more frequently than at the
time of hospitalization [15]. Recently, we reported a
strong link between diarrhea and disease severity [10].
These data suggest that diarrhea symptoms may
indicate the severity of Covid-19 [24].
Earlier (January 2021), U.S. researchers introduced the
results of a study on the medical portal Biocodex,
which showed that in COVID-19 disease, a disruption of
the intestinal microflora, is associated with the disease.
The study found that symptoms associated with the
disease, such as vomiting, nausea, and diarrhea, were
often observed when the disease was severe. In a
study of 318 patients diagnosed with COVID-19, 34.8%
had gastrointestinal symptoms, including 33.7% with
diarrhea. It is worth noting that gastrointestinal
symptoms, such as diarrhea can sometimes occur
before fever and respiratory symptoms.
According to British expert Professor Tim Spector
(2021), in patients with severe COVID-19 disease, the
intestinal microflora is severely damaged and the state
of the intestinal microbiome is of great importance in
protecting against coronavirus and many other
diseases.
According to Anna Balandina (01.22.2021), an infectious
disease doctor in the Russian Federation, the
disruption of the intestinal microflora may be due to
the entry of SARS-CoV-2 virus into the intestinal
epithelial cell and the presence of special receptors on
its surface. The virus affects both respiratory tract cells
and gastrointestinal tract cells through these
receptors. Therefore, the cells die and the processes of
cell digestion, absorption of nutrients are disrupted.
The digestive system can serve as a gateway for other
infections, which slows down the recovery process
after COVID-19 disease. The term “intestinal virus”
began to appear in the scientific literature. If the
presence of pathogenic viruses in the human gut has
been proven more than a century ago, their effects on
human homeostasis have only recently been studied.
The result of scientific studies is that pathogenic
viruses belonging to the families Adenoviridae,
Picornaviridae, Reoviridae, Mimiviruse, affecting
physiological processes in the intestine can lead to
changes in the composition of the intestinal microflora
in terms of quantity and quality [22].
The gastrointestinal tract has been shown to be an
extrapulmonary site for replication of SARS-CoV-2 virus
because angiotensin-converting enzyme receptors
(ASE2) are expressed not only on type II pneumocyte
membranes but also on the apical surface of intestinal
epithelial cells. This suggests that SARS-CoV-2 is
transmitted through the fecal-oral mechanism [5,21].
The SARS-CoV-2 virus enters the gastrointestinal tract
through the mechanism of fecal-oral transmission, and
as a result of the virus binding to intestinal cells
through ASE2 receptors, it manifests clinical signs of
the gastrointestinal tract. Zuo and others (2021) found
that almost half of the patients with Covid-19 infection
35
Volume 04 Issue 04-2022
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had SARS-CoV-2 virus in their fecal samples, and in
patients which SARS-CoV-2 virus positive conditioned,
the amount of pathogens such as Collinsella
aerofaciens, Collinsella tanakaei, Streptococcus
infantis, and Morganella morganii might be high
[6,8,33,47,48]. Previously, it was reported that SARS-
CoV-2 virus was found in fecal samples (four out of
eight patients) regardless of the presence of diarrhea
symptoms [15]. In addition, another study showed that
SARS-CoV-2 RNA was found in the fecal samples of 22
(52.4%) patients out of 42 Covid-19 patients with
gastrointestinal symptoms. SARS-CoV-2 RNA was
found in the fecal samples of 9 (39.1%) patients out of
23
Covid-19
patients
without
gastrointestinal
symptoms [31]. Fecal samples of patients with severe
Covid-19 infection had higher levels of conditionally
pathogenic bacteria, such as Morganella morganii,
Collinsella aerofaciens, Streptococcus infantis and
Collinsella
tanakaei.
Bacteroides
stercoris,
Parabacteroides merdae, Lachnospiraceae, and
Alistipes onderdonkii bacteria were more prevalent in
the fecal samples of patients without signs of Covid-19
infection [33].
In September 2020, Koloskova E.A. published data on
the examination of fecal samples of 15 patients with
SARS-CoV-2 by sequencing of 16sRNA. It is detected
that in such patients there is a decrease in the amount
of commensal bacteria (Eubacterium ventriosum,
Faecalibacterium
prausnitzii,
Roseburia,
Lachnospiraceae) and conditionally increase in
pathogenic bacteria (Clostridia hathewayi, Actomyces
viscosus and Bacteroides nordii, Candida albicis,
Candida albicans, Candida albicans). Thus, bacteria of
Clostridium hatthewayi (Firmicutes type), Bacteroides
nordii (Bacteroidetes type) and Actinomyces viscosus
species were found to be significantly higher in the
examined patients than in healthy volunteers,
indicating that the severity of Covid-19 disease is
directly related to conditionally pathogenic bacteria
(Clostridium ramosum, Clostridium hathewayi) [37].
In January 2021, a study conducted by a group of
Chinese scientists involving 100 patients with COVID-19
was published. Accordingly, changes in the
composition of the intestinal microbiocenosis in
patients were confirmed to occur earlier. Examination
of the feces of patients by 16sRNA sequencing method
showed a decrease in the number of bacterial species
of Faecalibacterium prausnitzii and Eubacterium
rectale (type Firmicutes), Bifidobacterium adolescentis
(Actinobacteria type) compared to healthy people.
Intestinal dysbacteriosis associated with decreased
levels of Lactobacillus and Bifidobacterium has been
observed in patients with Covid-19 [29].
Increased levels of Collinsella, Streptococcus,
Morganella, Coprobacillus, Clostridium ramosum, and
Clostridum mathewayi were increased in patients with
severe Covid-19 disease, and parabacteroides,
Bacteroides, Alistipes, Lachnospiraceae, F.Prausnitzii
were increased in mildly ill patients [21,33]. Moreira-
Rosario and others [18] studied the effect of Covid-19
disease on changes in the composition of the intestinal
microbiocenosis. The results of the study revealed
changes in the ratio of Firmicute and Bacteroid. The
authors also found a decrease in the number of
butyrate-forming bacteria belonging to the family
Lachnospiraceae (Reseburia and Lachnospira), a
decrease in the amount of bacteria in the genus
Actinobacteria (Protein) and increase in the amount of
Protein (Bificobacteria and Collin) in the comparison of
mild to severe and moderate Covid-19 [4,22].
It was observed that the most common commensals in
healthy middle-aged people were Eubacterium,
Faecalibacterium
prausnitzii,
Roseburia
and
Lachnospiraceae, while in middle-aged COVID-19
patients these commensals were reduced and
36
Volume 04 Issue 04-2022
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Publisher:
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conditionally-pathogenic
Clostridium
hathewayi,
Actinomyces viscosus and Bacteroides nordii were
increased [17,33]. Some intestinal commensals with
known immunomodulatory potential, such as
Faecalibacterium prausnitzii, Eubacterium rectale, and
bifidobacteria, were less common in COVID-19 patients
[30].
In another study, Zuo et al analyzed fecal samples from
15 patients who recovered from Covid-19 disease using
the sequencing method [33]. The study found that the
virus persisted in the feces for a long time even after
SARS-CoV-2 was eliminated [2,6], a significant increase
in conditionally pathogenic bacteria and a decrease in
beneficial microorganisms compared with a healthy
control group. This has been suggested to be a risk
factor for gastroenterologists, endoscopy staff, and
for other patients during endoscopy and colonoscopy
[5,6,13,30,34]. Indeed, dysfunction of the persistent
intestinal microflora can lead to chronic inflammation
of the gastrointestinal tract and an increase in
intestinal permeability, all of which leads to disruption
of the gastrointestinal tract [24].
In conclusions
the SARS-CoV-2 virus enters the
gastrointestinal
tract
through
the
fecal-oral
mechanism and causes varying degrees of intestinal
dysbacteriosis in almost all Covid-19 patients. An
increase in the number of conditionally-pathogenic
bacteria and a decrease in the amount of beneficial
commensals were observed in Covid-19 disease,
indicating that the clinical severity of Covid-19 disease
is directly related to conditionally-pathogenic bacteria.
It has been found that viral RNA can be stored for a
long time in the gut of patients recovered from Covid-
19 disease. In Uzbekistan, the study of the intestinal
microflora of Covid-19 patients and the identification of
similarities and differences from foreign data, to find
ways to correct it remain relevant.
REFERENCES
1.
Byungchang Jin , Rajan Singx , Se Eun Ha , Xanna
Zogg , Pol J Park va Seungil Ro. Pathophysiological
mechanisms underlying gastrointestinal symptoms
in patients with COVID-19. Jahon J Gastroenterol.
2021 yil 21 may; 27(19):
2.
Chen Y, Gu S, Chen Y, Lu H, Shi D, Guo J, et al. Six-
month follow-up of gut microbiota richness in
patients with COVID-19. Gut 2021. 10.1136/gutjnl-
2021-324090
3.
Coronavirus confirmed as pandemic by World
Health
Organization.
BBC
New.
URL:
https://www.bbc.com/news/world-51839944
4.
D.Fang, J.Ma, J.Guan, M.Wang, Y.Song, D.Tian,
Manifestations of digestive system in hospitalized
patients with novel coronavirus pneumonia in
Wuhan, China: a single-center, descriptive study,
Chin J Dig, 40 2020y
5.
Dhar D., Mohanty A. Gut Microbiota and Covid 19-
Possible Link and Implications. Virus Res.
2020;285:198018.
6.
Ding S, Liang TJ. Is SARS-CoV-2 Also an Enteric
Pathogen With Potential Fecal–Oral Transmission?
A COVID-19 Virological and Clinical Review
Gastroenterologiya. 2020 Jul; 159(1): 53–61
7.
Gaebler C, Wang Z, Lorenzi JCC, Muecksch F, Finkin
S, Tokuyama M, et al.
Evolution of antidiv immunity to SARS-CoV-2.
Nature 2021;591:639–44.
8.
Goh KL, Chuah KH. COVID-19 and the digestive
system: More than just a "flu". JGH Open.
2020;4:318-319.
9.
Gu J., Han, B. , Wang J. COVID-19: gastrointestinal
manifestations
and
potential
fecal–oral
transmission. Gastroenterology. 2020 Mar 3.
Pii:S0016 5085(20)30281-X.
10.
Gu L, Deng H, Ren Z, Zhao Y, Yu S, Guo Y, et al.
Dynamic Changes in the Microbiome and Mucosal
37
Volume 04 Issue 04-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
04
Pages:
32-39
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
(2022:
6.
319
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
Immune
Microenvironment of the Lower
Respiratory Tract by Influenza Virus Infection.
Front Microbiol (2019) 10:2491.
11.
Guan W.J., Ni Z.Y., Hu Y., Liang W.H., Ou C.Q., He
J.X. Clinical characteristics of coronavirus disease
2019 in China. N. Engl. J. Med. 2020;382:1708–1720.
12.
Ha S, Jin B, Klemmensen B, Park P, Mahbub S,
Gladvill V, Lovely FM, Gottfrid-Blackmore A,
Habtezion A, Verma S, Ro S. Elevated serotonin in
COVID-19-associated diarrhea. Intestine. 2021:
13.
Han C, Duan C, Zhang S, Spiegel B, Shi H, Wang W,
et al. . Digestive Symptoms in COVID-19 Patients
With Mild Disease Severity: Clinical Presentation,
Stool Viral RNA Testing, and Outcomes. Am J
Gastroenterol (2020) 115:916–23.
14.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al.
Clinical features of patients infected with 2019
novel coronavirus in Wuhan, China. Lancet
2020;395:497–506.
15.
Hugon, P. Et al. A comprehensive repertoire of
prokaryotic species identified in human beings/ P.
Hugon, J.C. Dufour, P.E. Fourmier et al. // The
Lancet Infectious Diseases. – 2015. – Vol. 15, №. 10.
– P. 1211–1219.
16.
Jin X, Lian JS, Xu JH, et al. Epidemiological, clinical
and virological characteristics of 74 cases of
coronavirus-infected disease 2019 (COVID-19) with
gastrointestinal symptoms. 2020; 69 :1002–1009.
17.
Lin L, Jiang X, Zhang Z, Huang S, Fang Z, Gu Z, Gao
L, Shi H, Mai L, Liu Y, Lin X, Lai R, Yan Z, Li X, Shan
H. Gastrointestinal symptoms of 95 cases with
SARS-CoV-2 infection. Gut 2020; 69: 997-1001
18.
Liu K., Fang Y.Y., Deng Y., Liu W., Wang M.F., Ma
J.P. et al. Clinical characteristics of novel
coronavirus cases in tertiary hospitals in Hubei
Province. Chin Med J 2020;00:00–00.
19.
Mamatmusaeva F.Sh., Мамаnоv P.А., Kudiyarov
I.A., Orinbaeva Z.N., N.G’.Yo’ldosheva “Covid-19
rekonvaletstsentlaridagi
disbakterioz
holati”
(Farmatsiya, immunitet va vaktsina № 2 jurnal
2021y Toshkent) 53-bet Med 2020:1–4.
20.
Moreira-Rosário, A.; Marques, C.; Pinheiro, H.;
Araújo, J.R.; Ribeiro, P.; Rocha, R.; Mota, I.;
Pestana, D.; Ribeiro, R.; Pereira, A.; et al. Gut
Microbiota Diversity and C-Reactive Protein Are
Predictors of Dis-ease Severity in COVID-19
Patients. Front. Microbiol. 2021, 12, 705020.
21.
Onder G, Rezza G, Brusaferro S. Case-fatality rate
and characteristics of patients
dying in relation to COVID-19 in Italy. JAMA
2020;323:1775–6.
22.
P.А.Мамаnоv, Sh.A.Tursunova., M.A.Mo’minova.,
I.A.Kudiyarov.,
N.A.Pirmatova.,
A.Valiyjanov.,
F.Sh.Mamatmusaeva
“Ichak
mikroflorasining
Covid-19
bemorlaridagi
holati”
(Farmatsiya,
immunitet va vaktsina № 2 jurnal 2021y Toshkent).
67-68 bet
23.
Park S-K, Lee C-W, Park D-I, Woo H-Y, Cheong HS,
Shin H-C, et al. Detection of SARS-CoV-2 in Fecal
Samples From Patients With Asymptomatic and
Mild COVID-19 in Korea. Clin Gastroenterol Hepatol
(2021) 19:1387–94.e2.
24.
Penninger JM, Grant MB, Sung JJY. The Role of
Angiotensin Converting Enzyme 2 in Modulating
Gut Microbiota, Intestinal Inflammation, and
Coronavirus Infection. Gastroenterology 2021; 160:
39-46
25.
Scarpellini, E. The human gut microbiota and
virome: potential therapeutic implications / E.
Scarpellini, G. Ianiro, F. Attili et al. // Digestive and
Liver Disease. – 2015. – Vol. 47, №. 12. – P. 1007–
1012.
26.
Segal J.P., Mak J.W.Y., Mullish B.H., Alexander J.L.,
Ng S.C., Marchesi J.R. et al. The gut microbiome: an
under-recognised contributor to the COVID-19
pandemic? Therap Adv Gastroenterol. 2020;6:1178–
84.
38
Volume 04 Issue 04-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
04
Pages:
32-39
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
(2022:
6.
319
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
27.
Tang L, Gu S, Gong Y, Li B, Lu H, Li Q, et al. Clinical
significance of the correlation between changes in
the major intestinal bacteria species and COVID-19
severity. Engineering 2020;6:1178–84
28.
Thomas S, Izard J, Walsh E, Batich K,
Chongsathidkiet P, Clarke G, et al. The Host
Microbiome Regulates and Maintains Human
Health: A Primer and Perspective for Non-
Microbiologists. Cancer Res (2017) 77:1783–812.
29.
Tian Huang, Long-Quan Li1, Yong-Qing Wang,
Zheng-Ping Wang, Yuan Liang «Progress on
Gastrointestinal
Symptoms,
Treatment
and
Protection in COVID-19 Patients»
30.
Wang D., Hu B., Hu C. , Zhu F., Liu X., Zhang J. Et al.
Clinical characteristics of 138 hospitalized patients
with 2019 novel coronavirus-infected pneumonia in
Wuhan, China. JAMA. 2020;323(11):1061-1069.
31.
Wölfel R, Corman VM, Guggemos W, Seilmaier M,
Zange S, Müller MA, et al. Virological assessment of
hospitalized patients with COVID-2019. Nature
2020; 581:465–9
32.
World Health Organization. Coronavirus disease
2019
(COVID-19)
Situation
Report
–
48.
Lastaccessed, March 9, 2020.
33.
Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H.
Evidence for gastrointestinal infection of SARS-
CoV-2. Gastroenterology. 2020; 158 (6):1831-3. e3
34.
Xu K., Cai H., Shen Y., Ni Q., Chen Y., Hu S., Li J.,
Wang H., Yu L., Huang H., et al. Management of
corona virus disease-19 (COVID-19): The Zhejiang
experience. Zhejiang Da Xue Xue Bao Yi Xue Ban.
2020;49:147–157.
35.
Xu Y, Li X, Zhu B, Liang H, Fang C, Gong Y, et al.
Characteristics of pediatric SARS-CoV-2 infection
and potential evidence for persistent fecal viral
shedding. Nat Med 2020:1–4.
36.
Yeoh Y. K., Zuo T., Lui G., Zhang F., Liu Q., Li A. Et
al.Gut microbiota composition reflects disease
severity and dysfunctional immune responses in
patients with COVID-19. Gut. 2021 Jan 11;70:698–
706
37.
Young BE, Ong SWX, Kalimuddin S, Low JG, Tan SY,
Loh J, Ng OT, Marimuthu K, Ang LW, Mak TM, Lau
SK, Anderson DE, Chan KS, Tan TY, Ng TY, Cui L,
Said Z, Kurupatham L, Chen MI, Chan M, Vasoo S,
Wang LF, Tan BH, Lin RTP, Lee VJM, Leo YS, Lye DC.
Epidemiologic Features and Clinical Course of
Patients Infected With SARS-CoV-2 in Singapore.
JAMA. 2020 Apr 21;323(15):1488-1494
38.
Zhai S.L., Wei W.K., Lv D.H., Xu Z.H. Where did
SARS-cov-2 come from? Vet Rec. 2020;186
39.
Zuo T, Liu Q, Zhang F, Lui GC, Tso EY, Yeoh YK, Chen
Z, Boon SS, Chan FK, Chan PK, Ng SC.Depicting
SARS-CoV-2 faecal viral activity in association with
gut microbiota composition in patients with
COVID-19. Gut 2021; 70: 276-284
40.
Zuo T, Liu Q, Zhang F, Yeoh YK, Wan Y, Zhan H, et
al. Temporal landscape of human gut RNA and DNA
virome in SARS-CoV-2 infection and severity.
Microbiome 2021;9:91.
41.
Zuo T, Zhang F, Lui GCY, Yeoh YK, Li AYL, Zhan H, et
al. Alterations in Gut Microbiota of Patients With
COVID-19 During Time of Hospitalization. until
discharge. Gastroenterology 2020;159:1302-10. e5.
42.
Акилов Х.А., Камилов А.И., Мусабаев Э.И., ва
бош., “COVID-19ни енгил шаклда кечираётган
беморларни уй шароитида олиб бориш бўйича
ва
қ
тинчалик клиник
қ
ўлланма. 2020 й, б-1-10
43.
Жумамуродов С.Т., Нурузова З.А. Инфекции,
со¬путствующие течению covid-19 // Вестник
ТМА № 3, 2021 б-18.
44.
Колоскова Е. А. Микробиологические факторы
риска развития осложнений при COVID - 19
инфекции.2020
45.
https://www.gazeta.uz/ru/coronavirus-stat
46.
https://pubmed.ncbi.nlm.nih.gov/32108071/
47.
https://cdhf.ca/health-lifestyle/diarrhea-as-a-
symptom-of-the-coronavirus-covid-19/
39
Volume 04 Issue 04-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
04
Pages:
32-39
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
(2022:
6.
319
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
48.
https://www.news-medical.net/health/COVID-19-
and-diarrhea.aspx
