Oral Mucosal Manifestations Associated With PCR Positivity in Patients With COVID-19
Keywords:
COVID-19, PCR test, oral mucosa, Manifestations, microvesicles, petechiaeAbstract
Introduction: To date various oral manifestations in patients with coronavirus disease 2019 (COVID-19) have been reported.
Objectives: In the present study, we investigated the relationship between Polymerase Chain Reaction (PCR) positivity and oral signs in patients with suspected COVID-19.
Methods: A total of 383 patients who presented to the emergency department for the first time with any symptoms associated with COVID-19 were included in the study. Oral examinations were performed and the findings, PCR status, and thorax computerized tomography (CT) reports were recorded.
Results: Oral mucosa was involved in 246 (64.2%) patients. 175 (78,4%) of patients with COVID-19 confirmed the diagnosis with PCR test or CT results had oral manifestation. Dry mouth, microvesicles on the tonsils or pharynx, and petechiae in the oropharynx were significantly higher in patients with positive PCR tests (P = 0.001, P < 0.001, P < 0.001, respectively). The ratio of intact oral mucosa was statistically significantly higher in patients with negative PCR tests compared to those with positive PCR tests (P < 0.001). Microvesicles on the tonsils or pharynx were most associated with PCR positivity in patients without lung involvement (P < 0.001). Dry mouth, erythema of the tonsils and pharynx, petechiae in the oropharynx, and primary/secondary herpes infection are more related to PCR positivity in patients without lung involvement (P < 0.05). Lung involvement in patients with PCR positivity is related to only cheilitis (P = 0.034).
Conclusions: Our study revealed that especially microvesicles, petechiae, erythema on the tonsils or pharynx, and some other oral lesions such as dry mouth, oral aphthae, and primary/secondary herpes infection are associated with PCR positivity.
References
Guo YR, Cao QD, Hong ZS, Tan YY, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status. Mil Med Res. 2020;7(1):11. DOI: 10.1186/s40779-020-00240-0. PMID: 32169119. PMCID: PMC7068984.
Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. DOI: 10.1056/NEJMoa2002032. PMID: 32109013. PMCID: PMC7092819.
Cireli E, Mertoğlu A, Balcı G, Bayram A, Kuranoğlu N, Çırak AK. Is Polymerase Chain Reaction Positivity More Common in Patients with COVID-19 Pneumonia with Fever? Dubai Medical Journal. 2022:1–7. DOI: 10.1159/000524218. PMCID: PMC9148887.
Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, Li T, Chen Q. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020;12(1):8. DOI: 10.1038/s41368-020-0074-x. PMID: 32094336. PMCID: PMC7039956.
Petrescu N, Lucaciu O, Roman A. Oral mucosa lesions in COVID-19. Oral Dis. 2022;28 Suppl 1(Suppl 1):935-936. DOI: 10.1111/odi.13499. PMID: 32558983. PMCID: PMC7323044.
Erbaş GS, Botsali A, Erden N, Arı C, et al. COVID-19-related oral mucosa lesions among confirmed SARS-CoV-2 patients: a systematic review. Int J Dermatol. 2022;61(1):20-32. DOI: 10.1111/ijd.15889. PMID: 34549816. PMCID: PMC8652904.
Cuevas-Gonzalez MV, Espinosa-Cristóbal LF, Donohue-Cornejo A, et al. COVID-19 and its manifestations in the oral cavity: A systematic review. Medicine (Baltimore). 2021;100(51):e28327. DOI: 10.1097/MD.0000000000028327. PMID: 34941133. PMCID: PMC8701462.
Piccolo V, Bassi A, Grimalt R, et al. Lingua villosa nigra in a child after COVID: Review and differential diagnosis with oral pigmentations of childhood. J Eur Acad Dermatol Venereol. 2023 Mar 27. DOI: 10.1111/jdv.19070. PMID: 36974423.
Amorim Dos Santos J, Normando AGC, et al. Oral Manifestations in Patients with COVID-19: A Living Systematic Review. J Dent Res. 2021;100(2):141-154. DOI: 10.1177/0022034520957289. PMID: 32914677.
Goudouris ES. Laboratory diagnosis of COVID-19. J Pediatr (Rio J). 2021;97(1):7-12. DOI: 10.1016/j.jped.2020.08.001. PMID: 32882235. PMCID: PMC7456621.
Drago F, Paolino S, Rebora A, et al. The challenge of diagnosing atypical exanthems: a clinico-laboratory study. J Am Acad Dermatol. 2012;67(6):1282-1288. DOI: 10.1016/j.jaad.2012.04.014. PMID: 22627037.
Egido-Moreno S, Valls-Roca-Umbert J, Jané-Salas E, López-López J, Estrugo-Devesa A. COVID-19 and oral lesions, short communication and review. J Clin Exp Dent. 2021;13(3):e287-e294. DOI: 10.4317/jced.57981. PMID: 33680331. PMCID: PMC7920556.
Tuter G, Yerebakan M, Celik B, Kara G. Oral manifestations in SARS-CoV-2 infection. Med Oral Patol Oral Cir Bucal. 2022;27(4):e330-e339. DOI: 10.4317/medoral.25259. PMID: 35717616. PMCID: PMC9271340.
Doceda MV, Gavriiloglou M, Petit C, Huck O. Oral Health Implications of SARS-CoV-2/COVID-19: A Systematic Review. Oral Health Prev Dent. 2022;20(1):207-218. DOI: 10.3290/j.ohpd.b2960801. PMID: 35481345.
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. 2022;61(3):278-290. DOI: 10.1111/ijd.15881. PMID: 34541674. PMCID: PMC8653326.
Nuno-Gonzalez A, Martin-Carrillo P, Magaletsky K, et al. Prevalence of mucocutaneous manifestations in 666 patients with COVID-19 in a field hospital in Spain: oral and palmoplantar findings. Br J Dermatol. 2021;184(1):184-185. DOI: 10.1111/bjd.19564. PMID: 32969503. PMCID: PMC7537506.
Aghazadeh N, Homayouni M, Sartori-Valinotti JC. Oral vesicles and acral erythema: report of a cutaneous manifestation of COVID-19. Int J Dermatol. 2020;59(9):1153-1154. DOI: 10.1111/ijd.15047. PMID: 32710552.
Cebeci Kahraman F, Çaşkurlu H. Mucosal involvement in a COVID-19-positive patient: A case report. Dermatol Ther. 2020;33(4):e13797. DOI: 10.1111/dth.13797. PMID: 32520428. PMCID: PMC7300528.
Kitakawa D, Oliveira FE, Neves de Castro P, Carvalho LFCS. Short report - Herpes simplex lesion in the lip semimucosa in a COVID-19 patient. Eur Rev Med Pharmacol Sci. 2020;24(17):9151-9153. DOI: 10.26355/eurrev_202009_22863. PMID: 32965008.
Jimenez-Cauhe J, Ortega-Quijano D, de Perosanz-Lobo D, et al. Enanthem in Patients With COVID-19 and Skin Rash. JAMA Dermatol. 2020;156(10):1134-1136. DOI: 10.1001/jamadermatol.2020.2550. PMID: 32667631. PMCID: PMC7364334.
Martín Carreras-Presas C, Amaro Sánchez J, López-Sánchez AF, Jané-Salas E, Somacarrera Pérez ML. Oral vesiculobullous lesions associated with SARS-CoV-2 infection. Oral Dis. 2021;27 Suppl 3(Suppl 3):710-712. DOI: 10.1111/odi.13382. PMID: 32369674. PMCID: PMC7267423.
Iranmanesh B, Khalili M, Amiri R, Zartab H, Aflatoonian M. Oral manifestations of COVID-19 disease: A review article. Dermatol Ther. 2021;34(1):e14578. DOI: 10.1111/dth.14578. PMID: 33236823. PMCID: PMC7744903.
Soares CD, Mosqueda-Taylor A, de Carvalho MGF, de Almeida OP. Oral vesiculobullous lesions as an early sign of COVID-19: immunohistochemical detection of SARS-CoV-2 spike protein. Br J Dermatol. 2021;184(1):e6. DOI: 10.1111/bjd.19569. PMID: 33140407. PMCID: PMC9214009.
Brandini DA, Takamiya AS, Thakkar P, Schaller S, Rahat R, Naqvi AR. Covid-19 and oral diseases: Crosstalk, synergy or association? Rev Med Virol. 2021;31(6):e2226. DOI: 10.1002/rmv.2226. PMID: 33646645. PMCID: PMC8014590.25. Patel J, Woolley J. Necrotizing periodontal disease: Oral manifestation of COVID-19. Oral Dis. 2021;27 Suppl 3(Suppl 3):768-769. DOI: 10.1111/odi.13462. PMID: 32506662. PMCID: PMC7301037.
Riad A, Kassem I, Issa J, Badrah M, Klugar M. Angular cheilitis of COVID-19 patients: A case-series and literature review. Oral Dis. 2022;28 Suppl 1(Suppl 1):999-1000. DOI: 10.1111/odi.13675. PMID: 33043573. PMCID: PMC7675282.
Kämmerer T, Walch J, Flaig M, French LE. COVID-19-associated herpetic gingivostomatitis. Clin Exp Dermatol. 2021;46(1):174-176. DOI: 10.1111/ced.14402. PMID: 33405295. PMCID: PMC9213960.
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