Oral Medicine Department, Hospital Sírio-Libanês, São Paulo, Brazil; Dental Oncology Service, Instituto do Câncer do Estado de São Paulo (ICESP-FMUSP), São Paulo, Brazil.
Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, Brazil.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2021 Feb;131(2):e45-e51. doi: 10.1016/j.oooo.2020.07.014. Epub 2020 Aug 18.
Several viruses transmitted through saliva, such as herpes simplex virus, cytomegalovirus, and Zika virus, are capable of infecting and replicating in the oral mucosa, leading to painful oral ulcers. Few studies have described the oral manifestations of coronavirus disease 2019 (COVID-19). There is growing evidence that angiotensin-converting enzyme 2 (ACE2), the main host cell receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is highly expressed on the epithelial cells of the tongue and of the salivary glands, which may explain the development of dysgeusia in patients with COVID-19. Hence, it is important to understand if SARS-CoV-2 can infect and replicate in oral keratinocytes and fibroblasts, causing oral ulcerations and superficial necrosis. Here, we report a series of 8 cases of COVID-19 infection, with oral necrotic ulcers and aphthous-like ulcerations which developed early in the course of disease after the development of dysgeusia and affected the tongue, lips, palate, and oropharynx. A short review of the literature regarding the important role of ACE2 in SARS-CoV-2 cellular entry is also provided, bringing new insights into oral keratinocytes and minor salivary glands as potential targets.
几种通过唾液传播的病毒,如单纯疱疹病毒、巨细胞病毒和寨卡病毒,能够感染和复制口腔黏膜,导致疼痛的口腔溃疡。很少有研究描述了 2019 年冠状病毒病(COVID-19)的口腔表现。越来越多的证据表明,血管紧张素转换酶 2(ACE2)是严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)的主要宿主细胞受体,在舌和唾液腺的上皮细胞中高度表达,这可能解释了 COVID-19 患者味觉障碍的发展。因此,了解 SARS-CoV-2 是否能够感染和复制口腔角质形成细胞和成纤维细胞,导致口腔溃疡和表面坏死非常重要。在这里,我们报告了一系列 8 例 COVID-19 感染病例,这些患者在味觉障碍发生后不久,在疾病早期就出现了口腔坏死性溃疡和口疮样溃疡,累及舌、唇、腭和口咽。还对 ACE2 在 SARS-CoV-2 细胞进入中的重要作用进行了文献综述,为口腔角质形成细胞和小唾液腺作为潜在靶点提供了新的见解。
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