The lung-gut axis during viral respiratory infections: the impact of gut dysbiosis on secondary disease outcomes

Mucosal Immunol. 2021 Mar;14(2):296-304. doi: 10.1038/s41385-020-00361-8. Epub 2021 Jan 26.


Bacteria that colonize the human gastrointestinal tract are essential for good health. The gut microbiota has a critical role in pulmonary immunity and host's defense against viral respiratory infections. The gut microbiota's composition and function can be profoundly affected in many disease settings, including acute infections, and these changes can aggravate the severity of the disease. Here, we discuss mechanisms by which the gut microbiota arms the lung to control viral respiratory infections. We summarize the impact of viral respiratory infections on the gut microbiota and discuss the potential mechanisms leading to alterations of gut microbiota's composition and functions. We also discuss the effects of gut microbial imbalance on disease outcomes, including gastrointestinal disorders and secondary bacterial infections. Lastly, we discuss the potential role of the lung-gut axis in coronavirus disease 2019.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • COVID-19 / immunology
  • Diet
  • Dietary Fiber / metabolism
  • Dysbiosis / immunology
  • Dysbiosis / microbiology
  • Gastrointestinal Microbiome*
  • Humans
  • Immunity, Mucosal
  • Influenza, Human / immunology
  • Lung / immunology*
  • Probiotics
  • Respiratory Syncytial Viruses
  • Respiratory Tract Infections


  • Dietary Fiber