American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2021, 9(1), 24-31
DOI: 10.12691/ajmcr-9-1-8
Open AccessReview Article

Gastrointestinal Symptoms and Immune Response in COVID 19 - Review of a Cat and Mouse Game Theory

Abhilash Haridas1, and Payal Mukker2

1Department of Gastroenterology, Sree Gokulam Medical College & Sree Gokulam GG Hospital, Trivandrum, India

2Department of Medicine, Sree Gokulam Medical College & Gokulam Covid Care Center (GCC), Trivandrum, India

Pub. Date: October 27, 2020

Cite this paper:
Abhilash Haridas and Payal Mukker. Gastrointestinal Symptoms and Immune Response in COVID 19 - Review of a Cat and Mouse Game Theory. American Journal of Medical Case Reports. 2021; 9(1):24-31. doi: 10.12691/ajmcr-9-1-8


Gastrointestinal (GI) symptoms are not uncommon in COVID-19 infection. The varied symptomatology and severity of GI symptoms are related to the difference in host viral interaction. We have reviewed the GI manifestations of these patients and noted that three subgroups exist.A group with self-limited GI disease, a group with predominant GI manifestations and group with severe GI disease. A review of the immune response in the different groups with GI manifestations has been done and illustrated by a cat and mouse game theory. In self-limited GI disease, there is early active innate immunity with type I interferon response and followed by an efficient adaptive immune response causing viral clearance. In patients with predominant GI symptoms, viral factors override innate immune mechanisms and cause delayed and weak innate antiviral response. The subsequential adaptive response is a "mishit" response with mucosal injury and GI symptoms. In the later part of this infection, a resurgent adaptive immunity induction can occur, causing persistent fecal shedding followed by viral clearance. In severe disease, there is heightened dysregulation of the adaptive immune response leading to cytokine storm and severe complications like pyroptosis, endothelitis, and hemophagocytic lymphohistiocytosis.

COVID-19 SARS CoV-2 gastrointestinal symptoms innate immunity adaptive immunity cytokine storm

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