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Kot WY, Li JW, Chan AKY, Zheng LW. A reflection on COVID-19 and oral mucosal lesion: a systematic review. FRONTIERS IN ORAL HEALTH 2023; 4:1322458. [PMID: 38169876 PMCID: PMC10759230 DOI: 10.3389/froh.2023.1322458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction The aim of this systematic review is to provide a clinical update of the current knowledge on COVID-19 and oral mucosal lesions, to analyze the types and prevalence of oral mucosal lesions in patients with COVID-19, and to clarify the potential association between COVID-19 and oral mucosal lesions. Methods The literature search was conducted using PubMed, Web of Science, Scopus and the Cochrane Library, as well as literatures via manual searches of the reference lists of included studies. Studies published in English that mentioned oral mucosal lesions in patients with COVID-19 were included, resulting in a total of 31 studies. Results Most of the included studies were considered to have a moderate to high risk of bias according to the Joanna Briggs Institute bias assessment tools. Based on COVID-19 severity, the characteristics and patterns of oral mucosal lesions in COVID-19 patients were described, analyzed and synthesized. Overall, ulcers without specific diagnosis had the highest prevalence in COVID-19 patients, followed by traumatic ulcers, candidiasis, petechiae and aphthous-like lesions. Homogeneity of data cannot be achieved in statical analysis, indicating randomness of outcome (ulcers without specific diagnosis, 95% CI: 28%-96%, I2 = 98.7%). Discussion Given the limited evidence from currently available studies, the association between COVID-19 and oral mucosal lesions remains difficult to clarify. Healthcare professionals should be aware of the possible association between COVID-19 and oral mucosal lesions, and we hereby discuss our findings.
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Affiliation(s)
- Wai Ying Kot
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jing Wen Li
- Division of Oral & Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Alice Kit Ying Chan
- Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Li Wu Zheng
- Division of Oral & Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Sarasati A, Agustina D, Surboyo MDC. The Oral Lesion in the COVID-19 Patient: Is It True Oral Manifestation or Not? Infect Drug Resist 2023; 16:4357-4385. [PMID: 37424667 PMCID: PMC10329433 DOI: 10.2147/idr.s411615] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/21/2023] [Indexed: 07/11/2023] Open
Abstract
Objective Many previously reported publications mentioned that oral lesion in COVID-19 patients was varied. The term oral manifestations refer to pathognomonic features that are found consistently with a specific cause and effect. In this context, the oral manifestation of COVID-19 was inconclusive. This systematic review aimed to analyse previously reported publications related to oral lesions in COVID-19 patients to define as oral manifestations or not. The PRISMA guidelines were implemented in this review. Methods All umbrella reviews, systematic reviews, systematic reviews and meta-analyses, comprehensive reviews, and original and non-original studies were included. Twenty-one of systematic review, 32 original studies and 68 non-original studies reported the oral lesion in COVID-19 patients. Results Most of the publications mentioned that ulcers, macular, pseudomembranes and crusts were frequent oral lesions. The reported oral lesions in COVID-19 patients did not show any pathognomonic features and might be unrelated directly to COVID-19 infections, however, more likely due to gender, age, underlying diseases, and medication. Conclusion The oral lesions found in previous studies do not have pathognomonic features and are inconsistent. Therefore, the reported oral lesion, in present time, cannot be defined as an oral manifestation.
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Affiliation(s)
- Andari Sarasati
- Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Dewi Agustina
- Department of Oral Medicine, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
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Rueda CAC, Vinitzky Brener I. Oral lesions in patients with severe COVID-19 in the National Institute of Respiratory Diseases in Mexico: Case series. J Dent Res Dent Clin Dent Prospects 2023; 17:54-60. [PMID: 37650015 PMCID: PMC10462920 DOI: 10.34172/joddd.2023.37072] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/11/2023] [Indexed: 09/01/2023] Open
Abstract
Oral manifestations in patients with COVID-19 have already been reported in the literature. Determining whether the oral manifestations in these cases are directly related to SARS-CoV-2 infection or not has been challenging for both clinicians and researchers, although at present it has not been possible to prove. There are several possible causes for the development of the oral lesions in patients with COVID-19, among them are, opportunistic infections, drug reactions, iatrogenic and those directly related to viral infection. The present work describes the main characteristics of 10 severe COVID-19 hospitalized patients with oral manifestations. By analyzing the characteristics of the reported patients, and what is published in the literature, we conclude that for this series of cases the manifestations are not directly related to SARS-CoV-2, however, it is a possibility that should be considered for all patients.
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Affiliation(s)
- Carlos Alberto Carrasco Rueda
- Oral and Maxillofacial Surgeon, Stomatology Department, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosio Villegas” Mexico City, México
| | - Ilan Vinitzky Brener
- Oral and Maxillofacial Surgeon, Stomatology Department, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosio Villegas” Mexico City, México
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Rudolph A, Savage DR. Vulval Aphthous Ulcers in Adolescents Following COVID-19 Vaccination - Analysis of an international case series. J Pediatr Adolesc Gynecol 2023:S1083-3188(23)00311-X. [PMID: 36934803 PMCID: PMC10020135 DOI: 10.1016/j.jpag.2023.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023]
Abstract
STUDY OBJECTIVE To review and characterise reports of vulval aphthous ulcers (VAU) following COVID-19 vaccination in VigiBase, the World Health Organization global database of reported potential side effects of medicinal products, to demonstrate the importance and power of case reports for rare suspected adverse reactions and to investigate whether they suggest a potential for COVID-19 vaccination to be a trigger. METHODS Cases reporting the Medical Dictionary for Regulatory Activities' (MedDRA) Preferred Term (PT) "Vulvovaginal ulceration" and related PTs in adolescent patients aged 12 to 17 years in association with any COVID-19 vaccine were extracted from VigiBase. The cases were clinically reviewed, and causality was assessed by applying the Bradford Hill criteria to the obtained case series. RESULTS As of June 30th, 2022, there were 444 reports for the selected MedDRA PTs following COVID-19 vaccination in VigiBase. Ninety-four de-duplicated reports concerned adolescent female patients. Thirty-seven cases were clinically consistent with the diagnosis of VAU. Upon causality assessment, the analysed case series fulfilled six of the nine Austen Bradford Hill criteria supporting a potential causal relationship. CONCLUSION VAU can be perceived as a traumatic experience, especially in adolescent patients. There is, furthermore, a risk that the ulcers will be misdiagnosed resulting in avoidable investigation and treatment burdens for patients. We communicate our findings to support the small number of published case reports and raise awareness of VAU occurring in a temporal association with COVID-19 vaccination. Furthermore, our analysis supports observations about the value of case reports for the recognition and assessment of rare adverse events.
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Affiliation(s)
- Annette Rudolph
- WHO Collaborating Centre for International Drug Monitoring, Uppsala Monitoring Centre, Sweden.
| | - Dr Ruth Savage
- WHO Collaborating Centre for International Drug Monitoring, Uppsala Monitoring Centre, Sweden; New Zealand Pharmacovigilance Centre, Division of Health Sciences, University of Otago, New Zealand; Department of General Practice, University of Otago, Christchurch, New Zealand
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Ganesan A, Kumar S, Kaur A, Chaudhry K, Kumar P, Dutt N, Nag VL, Garg MK. Oral Manifestations of COVID-19 Infection: An Analytical Cross-Sectional Study. J Maxillofac Oral Surg 2022; 21:1326-1335. [PMID: 35153394 PMCID: PMC8817159 DOI: 10.1007/s12663-021-01679-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/26/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives The current COVID-19 pandemic has created a huge impact across the globe. Recent literature has reported the occurrence of varied oral lesions in COVID-19 patients in the form of sporadic case reports. This analytical cross-sectional study was carried out to gauge and understand the pattern of oral lesions in qualitative RT-PCR-confirmed COVID-19 patients. Methods A cross-sectional study involves a total of 500 qualitative RT-PCR confirmed, hospitalized COVID-19 patients who were meticulously scanned for any hard and soft tissue lesions developing concomitantly with the disease occurrence. Results This study included a total of 367 (73.4%) males and 133 (26.6%) female patients with a mean age of 53.46 ± 17.50 years. Almost 51.2% of patients presented with gustatory disturbance, 28% with xerostomia and 15.4% of patients were found to have oral findings like erythema, ulcers, depapillation of tongue. There was a statistically significant correlation between oral manifestations and disease severity (p ≤ 0.001). Conclusion COVID-19 is found to effect oral health with greater probability in patients with severe diseases (SARI) which may be due to disease itself, immune response and lack of motivation for personal hygiene measures. Supplementary Information The online version contains supplementary material available at 10.1007/s12663-021-01679-x.
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Affiliation(s)
- Aparna Ganesan
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan India
| | - Shailendra Kumar
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan India
| | - Amanjot Kaur
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan India
| | - Kirti Chaudhry
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan India
| | - Pravin Kumar
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan India
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan India
| | - Vijaya Lakshmi Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan India
| | - M. K. Garg
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan India
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Mahmoud MS, Taha MS, Mansour OI, Barakat E, Allah SA, Omran A, Askoura A. Oral mucosal lesions during SARS-CoV-2 infection: a case series and literature review. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [PMCID: PMC8816309 DOI: 10.1186/s43163-022-00203-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Abstract
Background
The most common manifestations of infection with COVID-19 are fever, sore throat, dry cough, headache, and body aches. The available evidence for successful and safe pharmacological therapy against COVID-19 has not yet been identified, and the possible evidence relates to many adverse reactions. Taste disorders, petechiae, desquamative gingivitis, unspecific oral ulcerations, xerostomia, and candidiasis are the oral manifestations related to SARS-CoV-2 infection.
Main body of the abstract
We reviewed the literature regarding the reported oral mucosal lesions in cases with confirmed COVID-19 infection together with presenting five cases with oral mucosal lesions associated with COVID-19 infection. Direct causal association between COVID-19 infection and oral mucosal lesions is still vague, hence further research is required.
Conclusion
Oral examination is mandatory in cases with suspected or confirmed COVID-19 infection.
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Kumar H, Nishat R, Desai A. A review on oral manifestations of COVID-19 disease. J Family Med Prim Care 2022; 11:5879-5886. [PMID: 36618227 PMCID: PMC9810878 DOI: 10.4103/jfmpc.jfmpc_205_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/02/2022] [Accepted: 04/06/2022] [Indexed: 11/11/2022] Open
Abstract
COVID-19, a multi-system-affecting disease presents with an extensive clinical spectrum, ranging from no symptoms at all to fatal lung involvement. Several orofacial manifestations have also been reported, among which dysgeusia is one of the earliest reported symptoms. Several other manifestations of extensive variety have also been reported by various authors worldwide since the outbreak of the disease. This comprehensive review dispenses a synopsis of the orofacial manifestations of COVID-19 along with a working classification, the knowledge of which is of utmost importance to medical and dental professionals for early detection and prevention of transmission of the disease.
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Affiliation(s)
- Harish Kumar
- Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneshwar, Odisha, India
| | - Roquaiya Nishat
- Department of Dentistry, Nalanda Medical College Hospital, Patna, Bihar, India,Address for correspondence: Dr. Roquaiya Nishat, Department of Dentistry, Nalanda Medical College Hospital, Patna, Bihar, India. E-mail:
| | - Anupama Desai
- Department of Periodontology and Oral Implantology, A.M.E’S Dental College, Raichur, Karnataka, India
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Vulvar Aphthous Ulcers in an Adolescent After Coronavirus Disease 2019 (COVID-19) Vaccination. Obstet Gynecol 2022; 140:514-517. [PMID: 35930388 PMCID: PMC9377366 DOI: 10.1097/aog.0000000000004885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/19/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Nonsexually acquired genital ulcers have been described among girls who are prepubertal after various viral illnesses due to mucosal inflammation from an immunologic response. Until recently, nonsexually acquired genital ulcers have only been associated with viral infections. CASE We present a case of an adolescent girl developing nonsexually acquired genital ulcers after both her first and second coronavirus disease 2019 (COVID-19) vaccine doses. Her course followed an expected timeline for severity and resolution of ulcers. CONCLUSIONS Aphthous ulcers may arise from inflammatory effects of COVID-19 vaccination. Clinical monitoring after COVID-19 vaccination from all formulations should include assessment for nonsexually acquired genital ulcers if vaginal pain is reported.
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Fakhruddin KS, Samaranayake LP, Buranawat B, Ngo H. Oro-facial mucocutaneous manifestations of Coronavirus Disease-2019 (COVID-19): A systematic review. PLoS One 2022; 17:e0265531. [PMID: 35648785 PMCID: PMC9159624 DOI: 10.1371/journal.pone.0265531] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/04/2022] [Indexed: 12/26/2022] Open
Abstract
We reviewed the prevalence, the likely aetiopathogenesis, and the management of oro-facial mucocutaneous manifestations of Coronavirus Disease-2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2). English language manuscripts searched using standard databases yielded 26 articles that met the inclusion criteria. In total, 169 cases (75 females; 94 males) from 15 countries with a spectrum of COVID-19 severities were reviewed. Gustatory perturbations were prevalent in over 70%. Mucocutaneous manifestations were reported predominantly on the tongue, palate, buccal mucosa, gingivae, and lips and included ulcers, blisters, erosions, papillary hyperplasia, macules, glossitis, and mucositis. Ulcerative lesions, present in over 50 percent, were the most common oral manifestation. Lesions resembling candidal infections, with burning mouth, were prevalent in 19%. Petechiae and angina bullosa were generally seen, subsequent to COVID-19 therapies, in 11%. Ulcerated, necrotic gingivae were documented in severely ill with poor oral hygiene. These manifestations, present across the COVID-19 disease spectrum, were commonly associated with the immunosuppressed state and/ or the concurrent antimicrobial/steroidal therapies. In summary, a wide variety of orofacial mucocutaneous lesions manifest in COVID-19. They are likely to be secondary to the disease-associated immune impairment and/or pharmaco-therapy rather than a direct result of SARS-CoV-2 infection per se.
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Affiliation(s)
| | | | - Borvornwut Buranawat
- Department of Periodontics and Implant Dentistry, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
| | - Hien Ngo
- Dental School, University of Western Australia, Nedlands, WA, Australia
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Schwab G, Palmieri M, Zerbinati RM, Sarmento DJS, Reis T, Ortega KL, Kano IT, Caixeta RAV, Hasséus B, Sapkota D, Junges R, Giannecchini S, Costa ALF, Jales SMCP, Lindoso JAL, Gallo CB, Braz-Silva PH. Lack of direct association between oral mucosal lesions and SARS-CoV- 2 in a cohort of patients hospitalised with COVID-19. J Oral Microbiol 2022; 14:2047491. [PMID: 35295979 PMCID: PMC8920376 DOI: 10.1080/20002297.2022.2047491] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background COVID-19 is a disease affecting various human organs and systems, in which the virus seeks to interact with angiotensin-converting enzyme 2 receptors. These receptors are present in the oral cavity, but the direct relationship between such an interaction and possible oral manifestations of COVID-19 is still unclear. Aim The present study evaluated oral manifestations in a cohort of COVID-19 patients during the period of hospitalisation. Methods In total, 154 patients presenting moderate-to-severe forms of COVID-19 had their oral mucosa examined twice a week until the final outcome, either discharge or death. The oral alterations observed in the patients were grouped into Group 1 (pre-existing conditions and opportunistic oral lesions) and Group 2 (oral mucosal changes related to hospitalization). Results Oral lesions found in the patients of Group 1 are not suggestive of SARS-CoV-2 infection as they are mainly caused by opportunistic infections. On the other hand, oral alterations found in the patients of Group 2 were statistically (P < 0.001) related to intubation and longer period of hospitalisation. Conclusion It is unlikely that ulcerative lesions in the oral cavity are a direct manifestation of SARS-CoV-2 or a marker of COVID-19 progression.
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Affiliation(s)
- Gabriela Schwab
- Laboratory of Virology (Lim-52-hc-fmusp), Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Michelle Palmieri
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Rodrigo M. Zerbinati
- Laboratory of Virology (Lim-52-hc-fmusp), Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Dmitry J. S. Sarmento
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
- School of Dentistry, State University of Paraíba, Araruna, Brazil
| | - Thais Reis
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Karem L. Ortega
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Italo T. Kano
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Rafael A. V. Caixeta
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Bengt Hasséus
- Department of Oral Medicine and Pathology, Institute of Odontology, University of Gothenburg, Gothenburg, Sweden
| | - Dipak Sapkota
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Roger Junges
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Simone Giannecchini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - André L. F. Costa
- Postgraduate Program in Dentistry, Cruzeiro Do Sul University, São Paulo, Brazil
| | - Sumatra M. C. P. Jales
- Division of Dentistry, Hospital Das Clínicas da Faculdade de Medicina da Universidade de São Paulo – Hcfmusp, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - José A. L. Lindoso
- Institute of Infectious Diseases Emilio Ribas, São Paulo, Brazil
- Laboratory of Protozoology (Lim-49-hc-fmusp), Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, São Paulo, Brazil
- Department of Infectious Diseases, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Camila Barros Gallo
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Paulo H. Braz-Silva
- Laboratory of Virology (Lim-52-hc-fmusp), Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, São Paulo, Brazil
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Mini MM, Tinky BC, Fathima SCR, Aswathi K, Ramachandran S, Girija KL, Ramesh S. Evaluation of orofacial symptoms and oral health-related quality of life among COVID-19 patients attending a tertiary hospital in Thiruvananthapuram: A cross-sectional study. JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY 2022. [DOI: 10.4103/jiaomr.jiaomr_110_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Erbaş GS, Botsali A, Erden N, Arı C, Taşkın B, Alper S, Vural S. COVID-19-related oral mucosa lesions among confirmed SARS-CoV-2 patients: a systematic review. Int J Dermatol 2022; 61:20-32. [PMID: 34549816 PMCID: PMC8652904 DOI: 10.1111/ijd.15889] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/31/2021] [Accepted: 08/16/2021] [Indexed: 02/05/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for coronavirus disease 2019 (COVID-19), which manifests as a flu-like respiratory infection affecting multiple organ systems, including the gastrointestinal system, central nervous system, cardiovascular system, skin, and mucosa. In this review, we investigated the literature on specific manifestations of COVID-19 in the oral mucosa. An online literature search in PubMed, Scopus, Google Scholar, and Medline was conducted to retrieve relevant studies on confirmed COVID-19 patients with oral mucosa findings published between December 31, 2019, and April 07, 2021. After an independent review by two authors, 39 articles considering 59 laboratory-confirmed cases of SARS-CoV-2 infection were included in the final analysis. The most common finding, reported in 29 patients (43.9%), was Kawasaki-like syndrome. In addition, oral ulcers including aphthous, hemorrhagic, and necrotic ulcers were reported in 24 patients (36.3%). Other lesions reported included pustules, macules, bullae, maculopapular enanthema, and erythema multiforme-like lesions. Concomitant skin lesions were present in 60.6% of patients. Fever was reported in 86.2% of patients. Forty-eight patients (76.1%) were hospitalized. Loss of taste and smell was present in 30.8% of the patients. A comprehensive understanding of the dermatologic manifestations of COVID-19 can improve and facilitate patient management and referrals.
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Affiliation(s)
- Gizem S. Erbaş
- School of MedicineTechnical University of MunichMunchenGermany
| | - Aysenur Botsali
- Department of DermatologyUniversity of Health Sciences, Gülhane Training and Research HospitalAnkaraTurkey
| | - Nihan Erden
- Koç University School of MedicineİstanbulTurkey
| | - Canan Arı
- Department of Dermatology and VenereologyAnkara Dışkapı Yıldırım Bayezit Eğitim ve Araştırma HospitalAnkaraTurkey
| | - Banu Taşkın
- Department of Dermatology and VenereologyKoç University School of MedicineİstanbulTurkey
| | - Sibel Alper
- Department of Dermatology and VenereologyKoç University School of MedicineİstanbulTurkey
| | - Secil Vural
- Department of Dermatology and VenereologyKoç University School of MedicineİstanbulTurkey
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Reis VP, Bezerra AR, Maia ABP, Marques LC, Conde DC. An integrative review of oral manifestations in patients with COVID-19: signs directly related to SARS-CoV-2 infection or secondary findings? Int J Dermatol 2021; 61:278-290. [PMID: 34541674 PMCID: PMC8653326 DOI: 10.1111/ijd.15881] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/01/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
We conducted an integrative review on oral manifestations in patients with COVID‐19 based on the current available literature evidence. A bibliographic search was carried out on March 11, 2021, among published studies in the years 2019–2021 in the PubMed database and based on the search strategy (“COVID‐19” AND “oral lesions” OR “oral mucositis” OR “oral manifestation”). After applying the inclusion and exclusion criteria, 29 articles were considered suitable for this review. A total of 110 cases of patients with COVID‐19 who had oral manifestations were reported. The presence of ulcerated lesions was the most common finding, having a herpetiform and aphthous clinical pattern observed in most cases. Macules, petechiae, hemorrhagic blisters, pustular enanthem, mucositis, and halitosis were also among the most frequently described oral manifestations. The tongue was the most commonly affected site, followed by the palate and lip. Most of the reported cases were diagnosed only by the clinical aspect of the lesion associated with a positive SARS‐CoV‐2 test or the presence of other COVID‐19 symptoms. Current scientific evidence still could not affirm that most of the oral lesions observed in patients with COVID‐19 are related to the virus's direct or indirect action on the oral mucosa. To confirm this association, prospective and longitudinal studies are further needed, together with a larger number of patients, complemented by histopathological examination of these lesions. Additionally, molecular techniques, such as immunohistochemistry and in situ hybridization, may be necessary to perform the differential diagnosis with other oral lesions.
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Affiliation(s)
- Vanessa Paiva Reis
- Oral Maxillofacial Surgery and Traumatology Service, Military Police Polyclinic of Cascadura (Policlínica da Polícia Militar de Cascadura), Rio de Janeiro State Military Police, Rio de Janeiro, Brazil
| | - Adriana Raymundo Bezerra
- Oral Maxillofacial Surgery and Traumatology Service, Military Police Central Dental Clinic (Odontoclínica Central da Polícia Militar), Rio de Janeiro State Military Police, Rio de Janeiro, Brazil
| | - Adriane Batista Pires Maia
- Oral Maxillofacial Surgery and Traumatology Service, Military Police Central Hospital (Hospital Central da Polícia Militar), Rio de Janeiro State Military Police, Rio de Janeiro, Brazil
| | - Letícia Côgo Marques
- Dentistry Sector, Healthcare and Social Assistance Section of The Universidade Federal do Espírito Santo (UFES), Vitória, Brazil.,Postgraduate Program in Pathology, School of Medicine, Universidade Federal Fluminense (UFF), Niterói, Brazil
| | - Danielle Castex Conde
- Postgraduate Program in Pathology, School of Medicine, Universidade Federal Fluminense (UFF), Niterói, Brazil.,Oral Maxillofacial Surgery and Traumatology Service and Anatomical Pathology Service, Military Police Central Hospital (Hospital Central da Polícia Militar), Rio de Janeiro State Military Police, Rio de Janeiro, Brazil
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Aragoneses J, Suárez A, Algar J, Rodríguez C, López-Valverde N, Aragoneses JM. Oral Manifestations of COVID-19: Updated Systematic Review With Meta-Analysis. Front Med (Lausanne) 2021; 8:726753. [PMID: 34513886 PMCID: PMC8424005 DOI: 10.3389/fmed.2021.726753] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/04/2021] [Indexed: 12/11/2022] Open
Abstract
There is increasing evidence for oral lesions and manifestations of COVID-19. The aim of this meta-analysis was to investigate the types of oral manifestations of COVID-19 and their prevalence. PubMed/Medline, Scopus, Web of Science, and Google Scholar databases were used to search for publications on oral manifestations in patients with PCR-confirmed COVID-19. A total of 310 records were selected, and 74 were included. Oral lesions in COVID-19 were classified according to their etiologies, including iatrogenic lesions caused by intubation and opportunistic infections. Of the included studies, 35 reported oral lesions probably caused by severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) infection. Meta-analysis of prevalence data on oral manifestations and aphthous lesions indicated high heterogeneity, while meta-analysis of xerostomia prevalence data revealed a pooled prevalence, with considerable heterogeneity. In conclusion, the meta-analysis yielded high heterogeneity between studies: oral lesions yielded a prevalence of 0.33 (95% CI 0.11-0.60), xerostomia lesions a prevalence of 0.44 (95% CI 0.36-0.52) and aphthous lesions 0.10 (95% CI 0.01-0.24). In addition, a gap in the evidence regarding the prevalence of oral lesions in COVID-19 was identified and the need for further observational studies focusing on this issue and on the causal relationships between oral lesions and COVID-19 was highlighted.
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Affiliation(s)
- Javier Aragoneses
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - Ana Suárez
- Department of Preclinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Juan Algar
- Department of Clinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Cinthia Rodríguez
- Department of Dentistry, Federico Henriquez y Carvajal University, Santo Domingo, Dominican Republic
| | - Nansi López-Valverde
- Department of Surgery, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
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15
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Wu YH, Wu YC, Lang MJ, Lee YP, Jin YT, Chiang CP. Review of oral ulcerative lesions in COVID-19 patients: A comprehensive study of 51 cases. J Dent Sci 2021; 16:1066-1073. [PMID: 34306539 PMCID: PMC8279930 DOI: 10.1016/j.jds.2021.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Indexed: 01/21/2023] Open
Abstract
Numerous oral manifestations of COVID-19 have been reported in the literatures. Common oral lesions in COVID-19 patients included ulcerations, xerostomia, dysgeusia, gingival inflammation, and erythema. Among them, oral ulceration is the most frequent finding and is present as various but distinct patterns. Thus, we conducted a comprehensive review of 51 COVID-19 patients with oral ulcerative lesions to further analyze the various oral ulcerative lesions in COVID-19 patients. There were a median age of 41.4 years and a slight female predilection in these patients. Most oral lesions manifested as an aphtha-like ulceration but lack of an evidence of recurrent aphthous stomatitis. Some of them were present as herpetiform ulcerations without HSV infection. Widespread ulcerations accompanied with necrosis were observed in the more severe and immunosuppressed older patients. Although some reported patients were asymptomatic, most of them had systemic symptoms concurring or slightly preceding the oral ulcerative lesions and the latency from the onset of systemic symptoms to oral ulcerative lesions were under 10 days, suggesting that oral ulceration was one of the early symptoms of COVID-19. Therefore, the oral ulcerative lesions may be considered as oral markers for early diagnosis of the underlying COVID-19 infection in the asymptomatic patients.
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Affiliation(s)
- Yu-Hsueh Wu
- Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Oral Medicine, School of Dentistry, National Cheng Kung University, Tainan, Taiwan
| | - Yang-Che Wu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Dentistry, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Ming-Jane Lang
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yi-Pang Lee
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ying-Tai Jin
- Department of Pathology, Taiwan Adventist Hospital, Taipei, Taiwan
- Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan
- Corresponding author. Department of Pathology, Taiwan Adventist Hospital, No. 424, Section 2, Bade Road, Taipei 10556, Taiwan.
| | - Chun-Pin Chiang
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan
- Corresponding author. Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Section 3, Chung-Yang Road, Hualien 970, Taiwan.
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16
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Porzionato A, Stocco E, Emmi A, Contran M, Macchi V, Riccetti S, Sinigaglia A, Barzon L, De Caro R. Hypopharyngeal Ulcers in COVID-19: Histopathological and Virological Analyses - A Case Report. Front Immunol 2021; 12:676828. [PMID: 34290701 PMCID: PMC8287416 DOI: 10.3389/fimmu.2021.676828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/21/2021] [Indexed: 01/02/2023] Open
Abstract
In coronavirus disease 2019 (COVID-19), ulcerative lesions have been episodically reported in various segments of the gastrointestinal (GI) tract, including the oral cavity, oropharynx, esophagus, stomach and bowel. In this report, we describe an autopsy case of a COVID-19 patient who showed two undiagnosed ulcers at the level of the anterior and posterior walls of the hypopharynx. Molecular testing of viruses involved in pharyngeal ulcers demonstrated the presence of severe acute respiratory syndrome - coronavirus type 2 (SARS-CoV-2) RNA, together with herpes simplex virus 1 DNA. Histopathologic analysis demonstrated full-thickness lympho-monocytic infiltration (mainly composed of CD68-positive cells), with hemorrhagic foci and necrosis of both the mucosal layer and deep skeletal muscle fibers. Fibrin and platelet microthrombi were also found. Cytological signs of HSV-1 induced damage were not found. Cells expressing SARS-CoV-2 spike subunit 1 were immunohistochemically identified in the inflammatory infiltrations. Immunohistochemistry for HSV1 showed general negativity for inflammatory infiltration, although in the presence of some positive cells. Thus, histopathological, immunohistochemical and molecular findings supported a direct role by SARS-CoV-2 in producing local ulcerative damage, although a possible contributory role by HSV-1 reactivation cannot be excluded. From a clinical perspective, this autopsy report of two undiagnosed lesions put the question if ulcers along the GI tract could be more common (but frequently neglected) in COVID-19 patients.
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Affiliation(s)
- Andrea Porzionato
- Department of Neuroscience, Section of Human Anatomy, University of Padova, Padova, Italy
| | - Elena Stocco
- Department of Neuroscience, Section of Human Anatomy, University of Padova, Padova, Italy
| | - Aron Emmi
- Department of Neuroscience, Section of Human Anatomy, University of Padova, Padova, Italy
| | - Martina Contran
- Department of Neuroscience, Section of Human Anatomy, University of Padova, Padova, Italy
| | - Veronica Macchi
- Department of Neuroscience, Section of Human Anatomy, University of Padova, Padova, Italy
| | - Silvia Riccetti
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | | | - Luisa Barzon
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Raffaele De Caro
- Department of Neuroscience, Section of Human Anatomy, University of Padova, Padova, Italy
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17
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Christl J, Alaniz VI, Appiah L, Buyers E, Scott S, Huguelet PS. Vulvar Aphthous Ulcer in an Adolescent With COVID-19. J Pediatr Adolesc Gynecol 2021; 34:418-420. [PMID: 33601070 PMCID: PMC7883736 DOI: 10.1016/j.jpag.2021.02.098] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/07/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Vulvar aphthous ulcers have been associated with various prodromal viral illnesses. We describe the case of an adolescent girl who developed vulvar aphthous ulcers during infection with Coronavirus, SARS-CoV-2. CASE A 19-year-old girl presented to the emergency department with cough, sore throat, fevers, and rash, and tested positive for COVID-19. She re-presented 2 days later with vulvar pain and was found to have a vulvar aphthous ulcer. She was admitted for pain control and treated with oral steroids. Improvement in her vulvar pain was noted, along with resolution of fevers, cough, and rash. SUMMARY AND CONCLUSION This case illustrates the novel association of COVID-19 with vulvar aphthous ulcers in adolescents. Use of oral steroids for symptomatic management of COVID-19 led to rapid clinical improvement.
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Affiliation(s)
- J Christl
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - V I Alaniz
- Section of Pediatric and Adolescent Gynecology, Children's Hospital Colorado, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - L Appiah
- Section of Pediatric and Adolescent Gynecology, Children's Hospital Colorado, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - E Buyers
- Section of Pediatric and Adolescent Gynecology, Children's Hospital Colorado, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - S Scott
- Section of Pediatric and Adolescent Gynecology, Children's Hospital Colorado, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - P S Huguelet
- Section of Pediatric and Adolescent Gynecology, Children's Hospital Colorado, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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18
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Krapf JM, Casey RK, Goldstein AT. Reactive non-sexually related acute genital ulcers associated with COVID-19. BMJ Case Rep 2021; 14:14/5/e242653. [PMID: 33952571 PMCID: PMC8103359 DOI: 10.1136/bcr-2021-242653] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Acute genital ulcers (AGU), known as Lipschütz ulcers, are painful vulvar ulcers typically affecting non-sexually active girls and women. AGU have been associated with viral infections, namely, Epstein-Barr virus (EBV). Here, we describe a case of AGU in the setting of SARS-CoV-2 in a non-sexually active adolescent girl hospitalised for pain control and urinary retention, who failed a course of oral corticosteroids and then improved with colchicine. Testing for herpes simplex virus, EBV and Behcet's syndrome were all negative. Testing for SARS-CoV-2 was positive. COVID-19 increases cytokines such as tumour necrosis factor alpha, which has been shown to affect endothelial cell adhesion and neutrophil chemotaxis, leading to aphthosis.
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Affiliation(s)
- Jill M Krapf
- Gynecology, Center for Vulvovaginal Disorders, Washington, DC, USA .,Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Rachel K Casey
- Pediatric Specialists of Virginia, Inova Fairfax Medical Campus, Department of Obstetrics and Gynecology, Fairfax, Virginia, USA
| | - Andrew T Goldstein
- Gynecology, Center for Vulvovaginal Disorders, Washington, DC, USA.,Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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19
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La Rosa GRM, Libra M, De Pasquale R, Ferlito S, Pedullà E. Association of Viral Infections With Oral Cavity Lesions: Role of SARS-CoV-2 Infection. Front Med (Lausanne) 2021; 7:571214. [PMID: 33521007 PMCID: PMC7840611 DOI: 10.3389/fmed.2020.571214] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/09/2020] [Indexed: 01/08/2023] Open
Abstract
Different viral agents, such as herpesviruses, human papillomavirus, and Coxsackie virus, are responsible for primary oral lesions, while other viruses, such as human immunodeficiency virus, affect the oral cavity due to immune system weakness. Interestingly, it has been reported that coronavirus disease 2019 (COVID-19) patients can show cutaneous manifestations, including the oral cavity. However, the association between oral injuries and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is still unclear. This narrative review aimed to summarize the available literature and provide an overview of oral lesions associated with COVID-19. An online literature search was conducted to select relevant studies published up to November 2020. The results of 17 studies showed variability in oral lesions associated with COVID-19, including ulcerations, aphthous-like lesions, and macules. The tongue, lips, and palate were the most frequent anatomical locations. According to current knowledge, the etiopathogenesis of multiple COVID-19-associated lesions seems to be multifactorial. The appearance of such lesions could be related to the direct or indirect action of SARS-CoV-2 over the oral mucosa cells, coinfections, immunity impairment, and adverse drug reactions. Nevertheless, COVID-19-associated oral lesions may be underreported, mainly due to lockdown periods and the lack of mandatory dispositive protection. Consequently, further research is necessary to determine the diagnostic and pathological significance of oral manifestations of COVID-19. All medical doctors, dentists, and dermatologists are encouraged to perform an accurate and thorough oral examination of all suspected and confirmed COVID-19 cases to recognize the disease's possible early manifestations.
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Affiliation(s)
- Giusy Rita Maria La Rosa
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, Oncologic, Clinic and General Pathology Section, University of Catania, Catania, Italy
| | - Rocco De Pasquale
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Sebastiano Ferlito
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Eugenio Pedullà
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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20
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Riad A, Kassem I, Stanek J, Badrah M, Klugarova J, Klugar M. Aphthous stomatitis in COVID-19 patients: Case-series and literature review. Dermatol Ther 2021; 34:e14735. [PMID: 33389769 PMCID: PMC7883083 DOI: 10.1111/dth.14735] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/30/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Abanoub Riad
- Czech National Centre for Evidence‐Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre)Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk UniversityBrnoCzech Republic
- Department of Public Health, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Islam Kassem
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryAlexandria UniversityAlexandriaEgypt
| | - Jan Stanek
- Department of Prosthetic Dentistry, Faculty of Medicine and DentistryPalacky UniversityOlomoucCzech Republic
| | - Mai Badrah
- Department of Internal Medicine, Faculty of MedicineAlexandria UniversityAlexandriaEgypt
| | - Jitka Klugarova
- Czech National Centre for Evidence‐Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre)Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk UniversityBrnoCzech Republic
- Department of Public Health, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Miloslav Klugar
- Czech National Centre for Evidence‐Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre)Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk UniversityBrnoCzech Republic
- Department of Public Health, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
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21
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Ramya JE, Goldlin TJA, Kalyanaraman S, Ravichandran M. A pharmacovigilance study of covishield in a tertiary care teaching hospital in Tamil Nadu. J Pharmacol Pharmacother 2021. [DOI: 10.4103/jpp.jpp_63_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Karthika P, Rathy R, Jayanthi P, Harish R, Ameena M, Krishnasree R. Oral Manifestations of COVID-19 Patients: A Systematic Review. JOURNAL OF OROFACIAL SCIENCES 2021. [DOI: 10.4103/jofs.jofs_91_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Ricardo Criado P, Pincelli TPH, Criado RFJ, Abdalla BMZ, Belda Junior W. Potential interactions of SARS-CoV-2 with human cell receptors in the skin: Understanding the enigma for a lower frequency of skin lesions compared to other tissues. Exp Dermatol 2020; 29:936-944. [PMID: 32867008 DOI: 10.1111/exd.14186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/21/2020] [Accepted: 08/21/2020] [Indexed: 12/28/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents a new public health problem, with a total of 10.577.263 documented COVID-19 cases worldwide and 513.441 deaths up to the present date. Few cases of disease-related cutaneous manifestations have been reported in the literature, and such manifestations are scarce. Integumentary manifestations from COVID-19 include exanthemas and papular dermatoses, urticarial eruptions, atopic dermatitis, vesiculobullous lesions and skin signs of hypercoagulable states, such as acral ischaemia, livedo and retiform purpura. Most common extracutaneous manifestations from the disease include headache, cough, anosmia, ageusia, fever, dyspnoea, nausea, diarrhoea and cardiovascular events. The objectives of this review were to discuss the role of human cell receptors described as interaction targets of SARS-CoV-2, as well to understand the current state of knowledge on skin expression of these receptors, in order to substantiate future research. The authors present a thorough literature review on SARS-CoV-2 and its possible interaction with cell receptors and human tissues including the skin. They discuss a molecular hypothesis to explain the lower prevalence of dermatological manifestations from direct SARS-CoV-2 infection. Distinct human cell receptors binding the virus appear to be less expressed in the skin compared to other organs. Additionally, the presence of resolvins and the disintegrin metalloprotease ADAM17 provide a putative protection to the skin, explaining the majority of COVID-19 manifestations to be extracutaneous. This review represents an excellent opportunity for future studies using skin biopsies from COVID-19 patients to investigate molecular expression in the pathophysiology of cutaneous manifestations of the disease.
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Affiliation(s)
- Paulo Ricardo Criado
- Dermatology Department, Centro Universitário Saúde ABC, Santo André, Brazil.,LIM-50, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Walter Belda Junior
- LIM-50, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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24
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Novelli L, Motta F, De Santis M, Ansari AA, Gershwin ME, Selmi C. The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 - A systematic review of the literature. J Autoimmun 2020; 117:102592. [PMID: 33401171 PMCID: PMC7833462 DOI: 10.1016/j.jaut.2020.102592] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/15/2022]
Abstract
The diverse clinical manifestations of COVID-19 is emerging as a hallmark of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. While the initial target of SARS-CoV-2 is the respiratory tract, it is becoming increasingly clear that there is a complex interaction between the virus and the immune system ranging from mild to controlling responses to exuberant and dysfunctional multi-tissue directed autoimmune responses. The immune system plays a dual role in COVID-19, being implicated in both the anti-viral response and in the acute progression of the disease, with a dysregulated response represented by the marked cytokine release syndrome, macrophage activation, and systemic hyperinflammation. It has been speculated that these immunological changes may induce the loss of tolerance and/or trigger chronic inflammation. In particular, molecular mimicry, bystander activation and epitope spreading are well-established proposed mechanisms to explain this correlation with the likely contribution of HLA alleles. We performed a systematic literature review to evaluate the COVID-19-related autoimmune/rheumatic disorders reported between January and September 2020. In particular, we investigated the cases of incident hematological autoimmune manifestations, connective tissue diseases, antiphospholipid syndrome/antibodies, vasculitis, Kawasaki-like syndromes, acute arthritis, autoimmune-like skin lesions, and neurologic autoimmune conditions such as Guillain–Barré syndrome. We screened 6263 articles and report herein the findings of 382 select reports which allow us to conclude that there are 2 faces of the immune response against SARS-CoV-2, that include a benign virus controlling immune response and a many faceted range of dysregulated multi-tissue and organ directed autoimmune responses that provides a major challenge in the management of this viral disease. The number of cases for each disease varied significantly while there were no reported cases of adult onset Still disease, systemic sclerosis, or inflammatory myositis. The immune system plays a major role in the acute progression of COVID-19. SARS-CoV-2 infection shares features with autoimmune diseases. SARS-CoV-2 can induce Guillain-Barré syndrome, arthritis, chilblain-like lesions.
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Affiliation(s)
- Lucia Novelli
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy
| | - Francesca Motta
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy
| | - Aftab A Ansari
- Division of Rheumatology, Department of Medicine, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - M Eric Gershwin
- Division of Rheumatology, Department of Medicine, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy.
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25
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Iranmanesh B, Khalili M, Amiri R, Zartab H, Aflatoonian M. Oral manifestations of COVID-19 disease: A review article. Dermatol Ther 2020; 34:e14578. [PMID: 33236823 PMCID: PMC7744903 DOI: 10.1111/dth.14578] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 12/11/2022]
Abstract
Dysgeusia is the first recognized oral symptom of novel coronavirus disease (COVID‐19). In this review article, we described oral lesions of COVID‐19 patients. We searched PubMed library and Google Scholar for published literature since December 2019 until September 2020. Finally, we selected 35 articles including case reports, case series and letters to editor. Oral manifestations included ulcer, erosion, bulla, vesicle, pustule, fissured or depapillated tongue, macule, papule, plaque, pigmentation, halitosis, whitish areas, hemorrhagic crust, necrosis, petechiae, swelling, erythema, and spontaneous bleeding. The most common sites of involvement in descending order were tongue (38%), labial mucosa (26%), and palate (22%). Suggested diagnoses of the lesions were aphthous stomatitis, herpetiform lesions, candidiasis, vasculitis, Kawasaki‐like, EM‐like, mucositis, drug eruption, necrotizing periodontal disease, angina bullosa‐like, angular cheilitis, atypical Sweet syndrome, and Melkerson‐Rosenthal syndrome. Oral lesions were symptomatic in 68% of the cases. Oral lesions were nearly equal in both genders (49% female and 51% male). Patients with older age and higher severity of COVID‐19 disease had more widespread and sever oral lesions. Lack of oral hygiene, opportunistic infections, stress, immunosuppression, vasculitis, and hyper‐inflammatory response secondary to COVID‐19 are the most important predisposing factors for onset of oral lesions in COVID‐19 patients.
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Affiliation(s)
- Behzad Iranmanesh
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Khalili
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Rezvan Amiri
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamed Zartab
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahin Aflatoonian
- Leishmaniasis Research Center, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
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26
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Halboub E, Al-Maweri SA, Alanazi RH, Qaid NM, Abdulrab S. Orofacial manifestations of COVID-19: a brief review of the published literature. Braz Oral Res 2020; 34:e124. [PMID: 33146320 DOI: 10.1590/1807-3107bor-2020.vol34.0124] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/07/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has spread exponentially across the world. The typical manifestations of COVID-19 include fever, dry cough, headache and fatigue. However, atypical presentations of COVID-19 are being increasingly reported. Recently, a number of studies have recognized various mucocutaneous manifestations associated with COVID-19. This study sought to summarize the available literature and provide an overview of the potential orofacial manifestations of COVID-19. An online literature search in the PubMed and Scopus databases was conducted to retrieve the relevant studies published up to July 2020. Original studies published in English that reported orofacial manifestations in patients with laboratory-confirmed COVID-19 were included; this yielded 16 articles involving 25 COVID-19-positive patients. The results showed a marked heterogeneity in COVID-19-associated orofacial manifestations. The most common orofacial manifestations were ulcerative lesions, vesiculobullous/macular lesions, and acute sialadentitis of the parotid gland (parotitis). In four cases, oral manifestations were the first signs of COVID-19. In summary, COVID-19 may cause orofacial manifestations that might be the initial features in several cases. However, the occurrence of orofacial manifestations in COVID-19 seems to be underreported, mainly due to the lack of oral examination of patients with suspected and/or confirmed COVID-19. Oral examination of all suspected and confirmed COVID-19 cases is crucial for better understanding and documenting COVID-19-associated orofacial manifestations.
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Affiliation(s)
- Esam Halboub
- Jazan University, College of Dentistry, Department of Maxillofacial Surgery and Diagnostic Sciences, Jazan, Saudi Arabia
| | - Sadeq Ali Al-Maweri
- AlFarabi College of Dentistry and Nursing, Department of Oral Medicine and Diagnostic Sciences, Riyadh, Saudi Arabia
| | - Rawan Hejji Alanazi
- AlFarabi College of Dentistry and Nursing, Department of Oral Medicine and Diagnostic Sciences, Riyadh, Saudi Arabia
| | - Nashwan Mohammed Qaid
- AlFarabi College of Dentistry and Nursing, Department of Restorative Dental Sciences, Riyadh, Saudi Arabia
| | - Saleem Abdulrab
- Primary Health Care Corporation, Madinat Khalifa Health Center, Doha, Qatar
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27
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Pangti R, Gupta S, Nischal N, Trikha A. Recognizable vascular skin manifestations of SARS-CoV-2 (COVID-19) infection are uncommon in patients with darker skin phototypes. Clin Exp Dermatol 2020; 46:180-182. [PMID: 32803786 PMCID: PMC7461456 DOI: 10.1111/ced.14421] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 01/26/2023]
Affiliation(s)
- R Pangti
- Departments of, Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - S Gupta
- Departments of, Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - N Nischal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - A Trikha
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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