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10.1136/ijgc-2018-000060 113 SkovV.GlintborgD.KnudsenS.JensenT.KruseT

McLachlan, S

Long COVID patients consistently show: 13 Persistent gut dysbiosis with reduced microbial diversity lasting months after infection Depletion of butyrate-producing bacteria leading to reduced SCFA production and impaired immune regulation SARS-CoV-2mediated ACE2 downregulation disrupting renin-angiotensin system (RAS) balance and gut microbial homeostasis Increased intestinal permeability allowing endotoxin (LPS) translocation and systemic cytokine activation Gutorgan axis disruption contributing to respiratory, neurologic, cardiovascular, renal, and musculoskeletal symptoms Some studies have identified persistent viral RNA in gut tissue, suggesting the gastrointestinal tract may serve as a viral reservoir

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