Cited by 495Gut microbiota and healthInfluenza Virus Research StudiesRespiratory viral infections research

The DOI matches its Crossref record; 147 of the 147 references it cites were found in a registry or an index; none of the 216 sources its claims cite is checked for support yet.

Respiratory viral infection-induced microbiome alterations and secondary bacterial pneumonia.

Open access
Hanada, Shigeo, Pirzadeh, Mina, Carver, Kyle Y., Deng, Jane C.·2018·Frontiers in Immunology

Abstract

Influenza and other respiratory viral infections are the most common type of acute respiratory infection. Viral infections predispose patients to secondary bacterial infections, which often have a more severe clinical course. The mechanisms underlying post-viral bacterial infections are complex, and include multifactorial processes mediated by interactions between viruses, bacteria, and the host immune system. Studies over the past 15 years have demonstrated that unique microbial communities reside on the mucosal surfaces of the gastrointestinal tract and the respiratory tract, which have both direct and indirect effects on host defense against viral infections. In addition, antiviral immune responses induced by acute respiratory infections such as influenza are associated with changes in microbial composition and function ("dysbiosis") in the respiratory and gastrointestinal tract, which in turn may alter subsequent immune function against secondary bacterial infection or alter the dynamics of inter-microbial interactions, thereby enhancing the proliferation of potentially pathogenic bacterial species. In this review, we summarize the literature on the interactions between host microbial communities and host defense, and how influenza, and other acute respiratory viral infections disrupt these interactions, thereby contributing to the pathogenesis of secondary bacterial infections.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review synthesizes evidence that acute respiratory viral infections—especially influenza—induce dysbiosis in the gut and respiratory tract microbiomes, which in turn alters host immune priming and inter-microbial competition, contributing to secondary bacterial pneumonia. It argues that these microbiome shifts are driven largely by systemic antiviral immune signals rather than direct viral presence at distant sites.

Key findings

  • Respiratory viral infection alters the gut microbiome despite no detectable virus in the GI tract: murine influenza models show reduced segmented filamentous bacteria and Lactobacillus/Lactococcus with increased Enterobacteriaceae/Proteobacteria, effects mediated by type I and type II interferons and possibly by reduced caloric intake.
  • Viral infection is associated with increased colonization by potential pathogens in the upper respiratory tract: in adults with influenza A, *S. aureus*, *S. pneumoniae*, and *H. influenzae* were present in 12%, 24%, and 32% of infected patients versus 5%, 11%, and 10% of uninfected patients; in children, influenza was associated with a 15-fold increase in nasopharyngeal *S. pneumoniae* titer.
  • In a mouse model, intranasal live attenuated influenza vaccine increased nasopharyngeal bacterial density up to 100,000-fold and prolonged *S. pneumoniae* or *S. aureus* carriage 2- to 5-fold.
  • Gut microbiome depletion (antibiotics or germ-free status) impairs antiviral and antibacterial immunity—reduced antibody and CD4+/CD8+ T cell responses, defective macrophage IFN responses, decreased phagocytosis and TNF-α—while commensal re-colonization (e.g., *Lactobacillus reuteri*, *Enterococcus faecalis*, *Lactobacillus crispatus*, *Clostridium orbiscindens*) protected against bacterial pneumonia via GM-CSF.
  • Inter-microbial competition matters: nasal implantation of a *Corynebacterium* strain eradicated *S. aureus* in 71% of persistent carriers, and *C. accolens* inhibits *S. pneumoniae* growth in vitro via a lipase releasing free fatty acids.

Methods

  • Narrative literature review (not a primary study) covering human and animal studies on gut and respiratory tract microbiomes during respiratory viral infection, with a stated focus on the bacterial microbiome because of a paucity of mycobiome and virome studies.
  • Synthesizes cross-sectional and longitudinal human studies (16S rRNA sequencing, qPCR, metagenomics, culture-independent pyrosequencing) alongside murine, ferret, and in vitro models, organized by anatomic niche (gut, URT, LRT) and by mechanism (host immune effects, inter-microbial effects, direct viral effects on bacteria).
  • No systematic search strategy, inclusion criteria, or quantitative synthesis is reported.

Limitations

  • Stated by the paper: protocols for sampling, processing, and bioinformatics of the respiratory microbiome are not standardized; most studies are in animal models, and human studies are small and largely limited to the URT; fungi and viruses (including phages) are largely omitted because 16S rRNA analysis cannot capture them; species-composition studies are insufficient without functional transcriptomic/proteomic characterization; long-term effects of microbiome-modulating therapies (especially antibiotics) are unknown.
  • Stated by the paper: cross-sectional human studies are poorly controlled and small relative to confounding variables (age, gender, oral hygiene, smoking, medication, healthcare employment, exposure to children), and are confounded by viral type, sampling timing, infection severity, and antimicrobial use.
  • Evident from the text: the central mechanistic claim—that viral-induced microbiome changes cause secondary bacterial pneumonia in humans—is explicitly described as not yet examined ("the effects of these alterations on risk of secondary bacterial pneumonia have not been studied"), and much of the supporting evidence is from murine models under SPF conditions that may not reflect more diverse human or wild-mouse microbiota.

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Integrity signals

Registry

Crossref · 10.3389/fimmu.2018.02640

Cites

147 of 147 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 216 cited sources checked · 0 supported · 0 flagged

Show all 87 claims

  • It may state two separate claims as one. 68
  • Probably not a substantial claim. 38
90 of 90
  • The paper relies on this without support.

    Bacterial pneumonia frequently arises as a result of aspirated bacterial pathogens.

    “Given that bacterial pneumonia frequently arises as a result of aspirated bacterial pathogens, a potential mechanism by which viral infections might increase the risk of secondary bacterial infections is through increased colonization of the upper respiratory tract by bacterial pathogens.”
  • The paper relies on this without support.

    Interspecies competition maintains homeostasis of the microbial community, preventing one microbe from dominating the community.

    “However, interspecies competition also maintains homeostasis of the microbial community, either through their abilities to capture scare resources (e.g., iron), or targeted killing of other bacteria (e.g., bacteriocins), preventing one microbe from dominating the community.”
  • The paper relies on this without support.

    Mechanisms have evolved in bacteria that confer competitive advantages, permitting them to survive in an otherwise inhospitable host environment.

    “It has long been appreciated that mechanisms have evolved in bacteria that confer competitive advantages, permitting them to survive in an otherwise inhospitable host environment.”
  • The paper relies on this without support.

    Innate immune cells including macrophages and neutrophils are recruited to the lung by cytokines and chemokines for phagocytosis and bactericidal activity.

    “Innate immune cells including macrophages and neutrophils are recruited to the lung by cytokines and chemokines for phagocytosis and bactericidal activity.”
4 of 4

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Citations

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Metadata

Authors
Hanada, S., Pirzadeh, M., Carver, K. Y., & Deng, J. C.
Affiliations
University of Michigan (US)
Corresponding author
Deng, Jane C.
Venue
Frontiers in Immunology
Published
2018-11-16
Volume
9
Pages
2640-2640
ISSN
1664-3224 (ISSN-L)
OpenAlex
W2900850632
Cited by
495
References
147
Citations by year
2026: 29 · 2025: 53 · 2024: 58 · 2023: 77 · 2022: 89 · 2021: 110 · 2020: 72 · 2019: 7
FWCI
4.66
Type
journal article
Language
en
Open access
Locations
  • Frontiers in Immunology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • U.S. Department of Veterans Affairs
  • National Institutes of Health
  • National Heart, Lung, and Blood Institute (R01HL108949)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
  • Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
  • Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
Keywords
respiratory viral infections, influenza, secondary bacterial pneumonia, airway microbiome, dysbiosis, gut microbiota, mucosal microbiota, host defense, viral-bacterial interactions, antiviral immunity
MeSH terms
Gastrointestinal Microbiome, Host Microbial Interactions, Humans, Immunity, Innate, Respiratory Tract Infections, Virus Diseases, Pneumonia, Bacterial, Coinfection, Microbiota, Dysbiosis

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