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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Oral lesions in COVID-19 patients&#46; A&#44; Migratory glossitis and petechiae on the cheek&#46; B&#44; Unilateral caviar tongue&#46; C&#44; Pseudomembranous candidiasis&#46; D&#44; Leukoplakia on the floor of the mouth and the ventral aspect of the tongue &#40;non-smoker&#41;&#46; E&#44; Pseudomembranous candidiasis&#46; F&#44; Erythematous candidiasis&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Over the course of the pandemic&#44; a range of COVID-19 presentations affecting various systems&#44; including the skin and mucous membranes&#44; have been described&#46; Lesions of the oral mucosa have been described in few studies&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and it remains unclear whether they are a consequence of COVID-19 treatments&#44; immune alterations caused by the virus&#44; or other factors such as the high levels of stress associated with infection&#46; The presence in the oral mucosa of angiotensin-converting enzyme 2 &#40;ACE2&#41; and transmembrane protease serine 2 &#40;TMPRSS2&#41; receptors&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> and of the viral spike protein&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> suggests a direct effect of the virus in some of the observed oral manifestations&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The oral manifestations described in COVID-19 patients are varied&#44; although many have been previously described as secondary clinical signs in other diseases&#46; A recent study of 666 patients carried out in Spain reported oral lesions in more than 25&#37; of patients&#46; These included inflammation of the lingual papillae&#44; glossitis with lateral indentations&#44; aphthous stomatitis&#44; mucositis&#44; and glossitis with patchy depapillation &#40;migratory glossitis&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Other lesions such as enanthem&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> ulcerations&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> vascular and hemorrhagic lesions&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> candidiasis&#44;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> and herpetic lesions<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> have also been reported&#46; However&#44; there is still no evidence that these lesions are caused directly by the virus&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Our objective was to characterize oral lesions and associated clinical findings in COVID-19 patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">The study population consisted of hospitalized patients &#40;n&#160;&#61;&#160;55&#41; with COVID-19 confirmed by polymerase chain reaction &#40;PCR&#41; and a rapid antigen fluorescent immunoassay &#40;FIA&#41; diagnostic test&#46; All patients had moderate or severe disease&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">After obtaining informed consent&#44; the medical history of each patient was reviewed and an examination of the oral cavity was performed&#46; Each patient was questioned to evaluate taste disturbances and xerostomia&#46; The clinical findings of the oral examination were recorded in a database designed specifically for this purpose&#46; In cases in which oral lesions required medical treatment&#44; this was recorded&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Data were analyzed using descriptive statistics&#46; The variable &#8220;age&#8221; was compared using the Student&#8217;s t-test and <span class="elsevierStyleItalic">P</span>-values &#60;0&#46;05 were considered statistically significant&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">The study population consisted of 30 men &#40;54&#46;5&#37;&#41; and 25 women &#40;45&#46;5&#37;&#41;&#44; ranging in age from 1 to 89 years &#40;mean&#160;&#177;&#160;standard deviation&#44; 51&#160;&#177;&#160;23&#46;24 y&#41; All patients were hospitalized and 19 &#40;34&#46;5&#37;&#41; were admitted to the intensive care unit &#40;ICU&#41;&#46; All patients in the ICU were treated with dexamethasone and remdesivir&#46; Most of the patients hospitalized in the ward received antiviral therapy consisting of a combination of lopinavir and ritonavir&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Patients with no underlying disease accounted for 45&#46;5&#37; of the study population&#46; In those with underlying disease&#44; hypertension was the most common disease &#40;18&#46;2&#37;&#41;&#44; and 10&#46;9&#37; had hypertension with concomitant diabetes&#46; Asthma was another frequently recorded disease &#40;16&#46;4&#37;&#41;&#46; Recorded past history included hepatitis and oncological processes&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In 22 patients &#40;40&#37;&#41; at least one alteration or lesion was observed in the oral mucosa &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; Erythematous and pseudomembranous forms of candidiasis were diagnosed in 7 patients &#40;12&#46;7&#37;&#41;&#44; and severe angular cheilitis in 1 patient &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; All were treated with topical and systemic antifungals&#46; The patient with angular cheilitis was treated with a topical mixture consisting of an antibiotic and an antifungal&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Hemorrhagic ulcerative lesions were observed in 4 patients &#40;7&#46;3&#37;&#41; and multiple ulcerations resembling canker sores in 3 patients &#40;5&#46;5&#37;&#41;&#46; Two patients presented enanthems in the labial or cheek mucosa &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figs&#46; 1</a>C and <a class="elsevierStyleCrossRef" href="#fig0010">2</a>A&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Other observed lesions included white plaques &#40;1 patient&#41; and lichenoid lesions &#40;1 patient&#41;&#46; In these cases a biopsy was indicated after recovery from the viral infection&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Finally&#44; 1 patient developed a recurrent cold sore&#44; 3 had lingual varicose veins&#44; and 3 were diagnosed with migratory glossitis&#44; onset of which may or may not have occurred before COVID-19&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Oral lesions were more common in men than in women &#40;13 and 9 cases&#44; respectively&#41;&#44; although there was no significant difference between the 2 groups &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;0&#46;58&#44; Pearson&#8217;s &#967;<span class="elsevierStyleSup">2</span> test&#41;&#46; There was no significant difference in mean age between the patients with lesions and those without &#40;53&#46;45&#160;&#177;&#160;22&#46;51 and 49&#46;36&#160;&#177;&#160;23&#46;92 y&#44; respectively&#59; <span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;0&#46;52&#41;&#46; Only 6 &#40;27&#46;3&#37;&#41; of the 22 patients with oral manifestations were admitted to the ICU&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Alteration or a total loss of taste was recorded in 33 patients &#40;60&#37;&#41;&#44; pain or burning in the mouth in 20 patients &#40;36&#46;4&#37;&#41;&#44; and xerostomia in 15 patients &#40;27&#46;3&#37;&#41;&#46; Both dysgeusia and oral pain or burning were common in patients with mucosal lesions &#40;68&#46;2&#37; and 77&#46;3&#37;&#44; respectively&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Emerging evidence has sparked much debate regarding the true relationship between oral manifestations in COVID-19 patients and the viral infection itself&#46; The first descriptions of the oral mucosa in COVID-19 patients&#44; recorded in Spain&#44; primarily described ulcerative lesions&#44; similar to those associated with herpetic infections&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">It has been suggested that oral ulcers may be an initial sign of viral infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a> In our study&#44; ulcers were the most commonly observed lesions and included both hemorrhagic and aphthous-like lesions&#46; None of our patients underwent biopsies to detect viral proteins in the affected tissue&#44; although the presence of viral spike protein in the oral cavity has been reported&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> suggesting that these ulcers may be due to tissue damage caused directly by the virus&#46; Vascular damage revealed in histological studies of oral cavity lesions suggests that oral lesions may be a consequence of thrombotic vascular damage in the mucosa and subsequent vasculitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;17</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Enanthem-type lesions have also been described in COVID-19 patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;18&#44;19</span></a> These include petechiae&#44; erythematous macules&#44; and erythematous&#8211;vesicular patterns in the oral mucosa&#44; often associated with secondary viral clinical signs&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In our study&#44; enanthem-type lesions were only observed in 1 child and 1 adult&#44; and were accompanied by intense pain&#44; which may be associated with the tissue damage caused by the virus&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Manifestations secondary to viral infection were frequently observed in the buccal mucosa of our patients&#46; Candidiasis and recurrent herpetic infection are common lesions in COVID-19 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> A causal relationship between viral infection and these lesions cannot be established&#58; their appearance seems to constitute a secondary response to drug treatment&#44; immune system alterations&#44; and high levels of stress caused by viral infection&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Caviar tongue and geographic tongue were also recorded in our COVID-19 patients&#44; although these entities are quite common in the general population&#46; A limitation of the present study is that it was impossible to accurately determine the moment of onset of these alterations and therefore to directly relate these changes to COVID-19&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Finally&#44; changes in taste perception and oral burning or pain were very frequent&#44; and were also associated with the appearance of oral lesions&#46; Taste disorders can be a significant and specific clinical sign of COVID-19&#44; and may even constitute an early marker of viral infection&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of Interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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            0 => "COVID-19"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to describe oral lesions in a group of patients with COVID-19&#46; We recruited 55 patients&#44; 25 women &#40;45&#46;5&#37;&#41; and 30 men &#40;54&#46;5&#37;&#41;&#44; aged between 1 and 89 years with confirmed COVID-19 at different stages of severity&#46; After obtaining informed consent&#44; we examined their mouths and recorded clinical findings&#46; Forty percent of the patients had at least 1 oral lesion&#46; The most common lesions were candidiasis and ulcers &#40;7 patients each&#41;&#59; 2 patients had enanthems&#46; Geographic tongue and caviar tongue were also observed&#46; Altered taste&#44; dry mouth&#44; and painful&#47;burning mouth were noted in 60&#37;&#44; 27&#46;3&#37;&#44; and 36&#46;4&#37; of patients&#44; respectively&#46; Oral mucosal alterations and lesions were prevalent in this series of COVID-19 patients&#46; Altered taste and a painful&#47;burning mouth were common symptoms&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El prop&#243;sito de este trabajo fue caracterizar las alteraciones orales en un grupo de pacientes COVID-19&#46; Para ello se evaluaron 55 pacientes hospitalizados&#44; confirmados COVID-19 en distintos estadios de severidad&#46; Previo consentimiento informado&#44; se examin&#243; la cavidad oral y se registraron los hallazgos cl&#237;nicos&#46; El grupo de estudio estuvo conformado por 25 mujeres &#40;45&#44;5&#37;&#41; y 30 hombres &#40;54&#44;5&#37;&#41;&#44; con edades comprendidas entre 1 y 89 a&#241;os&#46; Un 40&#37; de los pacientes mostraron alguna lesi&#243;n bucal&#46; Las lesiones m&#225;s comunes fueron candidiasis y ulceraciones &#40;7 pacientes cada uno&#41; y en dos pacientes se observ&#243; enantema&#46; Tambi&#233;n se encontraron alteraciones de la normalidad como glositis migratoria y varicosidades linguales&#46; Asimismo&#44; se registraron alteraciones del gusto&#44; xerostom&#237;a y dolor&#47;ardor bucal en el 60&#37;&#44; 27&#44;3&#37; y 36&#44;4&#37; respectivamente&#46; En los pacientes COVID-19 se observaron con frecuencia alteraciones y lesiones en la mucosa bucal&#46; Finalmente&#44; la disgeusia y el dolor y&#47;o el ardor oral fueron s&#237;ntomas comunes en estos pacientes&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Villarroel-Dorrego M&#44; Chac&#243;n L&#44; Rosas R&#44; Barrios V&#44; Pern&#237;a Y&#44; V&#233;lez H&#46; Hallazgos bucales en pacientes COVID-19&#46; Actas Dermosifiliogr&#46; 2022&#59;113&#58;183&#8211;186&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Oral lesions in COVID-19 patients&#46; A&#44; Pseudomembranous candidiasis&#46; B&#44; Angular cheilitis&#46; C&#44; Enanthem on the cheek&#46; D&#44; Soft palate ulcers and xerostomia&#46; E&#44; Aphthoid ulcer on the lip&#46; F&#44; Hemorrhagic ulcers on the tongue&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Oral lesions in COVID-19 patients&#46; A&#44; Migratory glossitis and petechiae on the cheek&#46; B&#44; Unilateral caviar tongue&#46; C&#44; Pseudomembranous candidiasis&#46; D&#44; Leukoplakia on the floor of the mouth and the ventral aspect of the tongue &#40;non-smoker&#41;&#46; E&#44; Pseudomembranous candidiasis&#46; F&#44; Erythematous candidiasis&#46;</p>"
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                            0 => "A&#46; Nuno-Gonzalez"
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                      "titulo" => "Oral cavity lesions as a manifestation of the novel virus &#40;COVID-19&#41;"
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                          "etal" => false
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                          "etal" => false
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                          "etal" => false
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Brief Comunication
Oral Findings in Patients With COVID-19
Hallazgos bucales en pacientes COVID-19
M. Villarroel-Dorrego
Corresponding author
mariana.villarroel@ucv.ve

Corresponding author.
, L. Chacón, R. Rosas, V. Barrios, Y. Pernía, H. Vélez
Servicio de Cirugía Bucal y Maxilofacial, Hospital General del Este Dr. Domingo Luciani, Caracas, Venezuela
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Oral lesions in COVID-19 patients&#46; A&#44; Migratory glossitis and petechiae on the cheek&#46; B&#44; Unilateral caviar tongue&#46; C&#44; Pseudomembranous candidiasis&#46; D&#44; Leukoplakia on the floor of the mouth and the ventral aspect of the tongue &#40;non-smoker&#41;&#46; E&#44; Pseudomembranous candidiasis&#46; F&#44; Erythematous candidiasis&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Over the course of the pandemic&#44; a range of COVID-19 presentations affecting various systems&#44; including the skin and mucous membranes&#44; have been described&#46; Lesions of the oral mucosa have been described in few studies&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and it remains unclear whether they are a consequence of COVID-19 treatments&#44; immune alterations caused by the virus&#44; or other factors such as the high levels of stress associated with infection&#46; The presence in the oral mucosa of angiotensin-converting enzyme 2 &#40;ACE2&#41; and transmembrane protease serine 2 &#40;TMPRSS2&#41; receptors&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> and of the viral spike protein&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> suggests a direct effect of the virus in some of the observed oral manifestations&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The oral manifestations described in COVID-19 patients are varied&#44; although many have been previously described as secondary clinical signs in other diseases&#46; A recent study of 666 patients carried out in Spain reported oral lesions in more than 25&#37; of patients&#46; These included inflammation of the lingual papillae&#44; glossitis with lateral indentations&#44; aphthous stomatitis&#44; mucositis&#44; and glossitis with patchy depapillation &#40;migratory glossitis&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Other lesions such as enanthem&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> ulcerations&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> vascular and hemorrhagic lesions&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> candidiasis&#44;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> and herpetic lesions<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> have also been reported&#46; However&#44; there is still no evidence that these lesions are caused directly by the virus&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Our objective was to characterize oral lesions and associated clinical findings in COVID-19 patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">The study population consisted of hospitalized patients &#40;n&#160;&#61;&#160;55&#41; with COVID-19 confirmed by polymerase chain reaction &#40;PCR&#41; and a rapid antigen fluorescent immunoassay &#40;FIA&#41; diagnostic test&#46; All patients had moderate or severe disease&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">After obtaining informed consent&#44; the medical history of each patient was reviewed and an examination of the oral cavity was performed&#46; Each patient was questioned to evaluate taste disturbances and xerostomia&#46; The clinical findings of the oral examination were recorded in a database designed specifically for this purpose&#46; In cases in which oral lesions required medical treatment&#44; this was recorded&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Data were analyzed using descriptive statistics&#46; The variable &#8220;age&#8221; was compared using the Student&#8217;s t-test and <span class="elsevierStyleItalic">P</span>-values &#60;0&#46;05 were considered statistically significant&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">The study population consisted of 30 men &#40;54&#46;5&#37;&#41; and 25 women &#40;45&#46;5&#37;&#41;&#44; ranging in age from 1 to 89 years &#40;mean&#160;&#177;&#160;standard deviation&#44; 51&#160;&#177;&#160;23&#46;24 y&#41; All patients were hospitalized and 19 &#40;34&#46;5&#37;&#41; were admitted to the intensive care unit &#40;ICU&#41;&#46; All patients in the ICU were treated with dexamethasone and remdesivir&#46; Most of the patients hospitalized in the ward received antiviral therapy consisting of a combination of lopinavir and ritonavir&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Patients with no underlying disease accounted for 45&#46;5&#37; of the study population&#46; In those with underlying disease&#44; hypertension was the most common disease &#40;18&#46;2&#37;&#41;&#44; and 10&#46;9&#37; had hypertension with concomitant diabetes&#46; Asthma was another frequently recorded disease &#40;16&#46;4&#37;&#41;&#46; Recorded past history included hepatitis and oncological processes&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In 22 patients &#40;40&#37;&#41; at least one alteration or lesion was observed in the oral mucosa &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; Erythematous and pseudomembranous forms of candidiasis were diagnosed in 7 patients &#40;12&#46;7&#37;&#41;&#44; and severe angular cheilitis in 1 patient &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; All were treated with topical and systemic antifungals&#46; The patient with angular cheilitis was treated with a topical mixture consisting of an antibiotic and an antifungal&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Hemorrhagic ulcerative lesions were observed in 4 patients &#40;7&#46;3&#37;&#41; and multiple ulcerations resembling canker sores in 3 patients &#40;5&#46;5&#37;&#41;&#46; Two patients presented enanthems in the labial or cheek mucosa &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figs&#46; 1</a>C and <a class="elsevierStyleCrossRef" href="#fig0010">2</a>A&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Other observed lesions included white plaques &#40;1 patient&#41; and lichenoid lesions &#40;1 patient&#41;&#46; In these cases a biopsy was indicated after recovery from the viral infection&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Finally&#44; 1 patient developed a recurrent cold sore&#44; 3 had lingual varicose veins&#44; and 3 were diagnosed with migratory glossitis&#44; onset of which may or may not have occurred before COVID-19&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Oral lesions were more common in men than in women &#40;13 and 9 cases&#44; respectively&#41;&#44; although there was no significant difference between the 2 groups &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;0&#46;58&#44; Pearson&#8217;s &#967;<span class="elsevierStyleSup">2</span> test&#41;&#46; There was no significant difference in mean age between the patients with lesions and those without &#40;53&#46;45&#160;&#177;&#160;22&#46;51 and 49&#46;36&#160;&#177;&#160;23&#46;92 y&#44; respectively&#59; <span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;0&#46;52&#41;&#46; Only 6 &#40;27&#46;3&#37;&#41; of the 22 patients with oral manifestations were admitted to the ICU&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Alteration or a total loss of taste was recorded in 33 patients &#40;60&#37;&#41;&#44; pain or burning in the mouth in 20 patients &#40;36&#46;4&#37;&#41;&#44; and xerostomia in 15 patients &#40;27&#46;3&#37;&#41;&#46; Both dysgeusia and oral pain or burning were common in patients with mucosal lesions &#40;68&#46;2&#37; and 77&#46;3&#37;&#44; respectively&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Emerging evidence has sparked much debate regarding the true relationship between oral manifestations in COVID-19 patients and the viral infection itself&#46; The first descriptions of the oral mucosa in COVID-19 patients&#44; recorded in Spain&#44; primarily described ulcerative lesions&#44; similar to those associated with herpetic infections&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">It has been suggested that oral ulcers may be an initial sign of viral infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a> In our study&#44; ulcers were the most commonly observed lesions and included both hemorrhagic and aphthous-like lesions&#46; None of our patients underwent biopsies to detect viral proteins in the affected tissue&#44; although the presence of viral spike protein in the oral cavity has been reported&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> suggesting that these ulcers may be due to tissue damage caused directly by the virus&#46; Vascular damage revealed in histological studies of oral cavity lesions suggests that oral lesions may be a consequence of thrombotic vascular damage in the mucosa and subsequent vasculitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;17</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Enanthem-type lesions have also been described in COVID-19 patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;18&#44;19</span></a> These include petechiae&#44; erythematous macules&#44; and erythematous&#8211;vesicular patterns in the oral mucosa&#44; often associated with secondary viral clinical signs&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In our study&#44; enanthem-type lesions were only observed in 1 child and 1 adult&#44; and were accompanied by intense pain&#44; which may be associated with the tissue damage caused by the virus&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Manifestations secondary to viral infection were frequently observed in the buccal mucosa of our patients&#46; Candidiasis and recurrent herpetic infection are common lesions in COVID-19 patients&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> A causal relationship between viral infection and these lesions cannot be established&#58; their appearance seems to constitute a secondary response to drug treatment&#44; immune system alterations&#44; and high levels of stress caused by viral infection&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Caviar tongue and geographic tongue were also recorded in our COVID-19 patients&#44; although these entities are quite common in the general population&#46; A limitation of the present study is that it was impossible to accurately determine the moment of onset of these alterations and therefore to directly relate these changes to COVID-19&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Finally&#44; changes in taste perception and oral burning or pain were very frequent&#44; and were also associated with the appearance of oral lesions&#46; Taste disorders can be a significant and specific clinical sign of COVID-19&#44; and may even constitute an early marker of viral infection&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of Interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to describe oral lesions in a group of patients with COVID-19&#46; We recruited 55 patients&#44; 25 women &#40;45&#46;5&#37;&#41; and 30 men &#40;54&#46;5&#37;&#41;&#44; aged between 1 and 89 years with confirmed COVID-19 at different stages of severity&#46; After obtaining informed consent&#44; we examined their mouths and recorded clinical findings&#46; Forty percent of the patients had at least 1 oral lesion&#46; The most common lesions were candidiasis and ulcers &#40;7 patients each&#41;&#59; 2 patients had enanthems&#46; Geographic tongue and caviar tongue were also observed&#46; Altered taste&#44; dry mouth&#44; and painful&#47;burning mouth were noted in 60&#37;&#44; 27&#46;3&#37;&#44; and 36&#46;4&#37; of patients&#44; respectively&#46; Oral mucosal alterations and lesions were prevalent in this series of COVID-19 patients&#46; Altered taste and a painful&#47;burning mouth were common symptoms&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El prop&#243;sito de este trabajo fue caracterizar las alteraciones orales en un grupo de pacientes COVID-19&#46; Para ello se evaluaron 55 pacientes hospitalizados&#44; confirmados COVID-19 en distintos estadios de severidad&#46; Previo consentimiento informado&#44; se examin&#243; la cavidad oral y se registraron los hallazgos cl&#237;nicos&#46; El grupo de estudio estuvo conformado por 25 mujeres &#40;45&#44;5&#37;&#41; y 30 hombres &#40;54&#44;5&#37;&#41;&#44; con edades comprendidas entre 1 y 89 a&#241;os&#46; Un 40&#37; de los pacientes mostraron alguna lesi&#243;n bucal&#46; Las lesiones m&#225;s comunes fueron candidiasis y ulceraciones &#40;7 pacientes cada uno&#41; y en dos pacientes se observ&#243; enantema&#46; Tambi&#233;n se encontraron alteraciones de la normalidad como glositis migratoria y varicosidades linguales&#46; Asimismo&#44; se registraron alteraciones del gusto&#44; xerostom&#237;a y dolor&#47;ardor bucal en el 60&#37;&#44; 27&#44;3&#37; y 36&#44;4&#37; respectivamente&#46; En los pacientes COVID-19 se observaron con frecuencia alteraciones y lesiones en la mucosa bucal&#46; Finalmente&#44; la disgeusia y el dolor y&#47;o el ardor oral fueron s&#237;ntomas comunes en estos pacientes&#46;</p></span>"
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Article information
ISSN: 00017310
Original language: English
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Idiomas
Actas Dermo-Sifiliográficas
es en

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