Lack of direct association between oral mucosal lesions and SARS-CoV- 2 in a cohort of patients hospitalised with COVID-19

Gabriela Schwab; Michelle Palmieri; Rodrigo M Zerbinati; Dmitry J S Sarmento; Thais Reis; Karem L Ortega; Italo T Kano; Rafael A V Caixeta; Bengt Hasséus; Dipak Sapkota; Roger Junges; Simone Giannecchini; André L F Costa; Sumatra M C P Jales; José A L Lindoso; Camila Barros Gallo; Paulo H Braz-Silva

doi:10.1080/20002297.2022.2047491

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 Mar 10;14(1):2047491. doi: 10.1080/20002297.2022.2047491. eCollection 2022.

Authors

Gabriela Schwab¹, Michelle Palmieri², Rodrigo M Zerbinati¹, Dmitry J S Sarmento^{2

3}, Thais Reis², Karem L Ortega², Italo T Kano², Rafael A V Caixeta², Bengt Hasséus⁴, Dipak Sapkota⁵, Roger Junges⁵, Simone Giannecchini⁶, André L F Costa⁷, Sumatra M C P Jales⁸, José A L Lindoso^{9

10

11}, Camila Barros Gallo², Paulo H Braz-Silva^{1

2}

Affiliations

¹ Laboratory of Virology (Lim-52-hc-fmusp), Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, São Paulo, Brazil.
² Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil.
³ School of Dentistry, State University of Paraíba, Araruna, Brazil.
⁴ Department of Oral Medicine and Pathology, Institute of Odontology, University of Gothenburg, Gothenburg, Sweden.
⁵ Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway.
⁶ Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
⁷ Postgraduate Program in Dentistry, Cruzeiro Do Sul University, São Paulo, Brazil.
⁸ 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.
⁹ Institute of Infectious Diseases Emilio Ribas, São Paulo, Brazil.
¹⁰ Laboratory of Protozoology (Lim-49-hc-fmusp), Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, São Paulo, Brazil.
¹¹ Department of Infectious Diseases, School of Medicine, University of São Paulo, São Paulo, Brazil.

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.

Keywords: COVID-19; HSV-1; Oral ulcer; SARS-CoV-2; opportunistic infections.

Grants and funding

This study was supported by the São Paulo Research Foundation (FAPESP) according to grant numbers [2021/07490-0 and 2021/03004-3]; by the Coordination for improvement of Higher Education Personnel (CAPES) according to finance code 001, and by the Pró-Reitoria de Pesquisa da Universidade de São Paulo according to grant number [2021.1.10424.1.9].