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Enanthem during meningococcal septicemia. Erythematous macules on the hard and soft palate, papules, and petechie on the soft palate.
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Globalization entails several medical problems, along with economic and social complications. Migrations from the other continents, increasing numbers of tourists world-wide, importation of foreign parasites, Aedes albopictus for example, have made diseases so far unknown in Europe a reality. The rapid spread of the COVID-19 pandemic throughout the...
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Context 1
... eruption becomes apparent only in 26% of patients, evolving over time. Maculopapular lesions with a petechial component are usually present on the oral mucous membranes ( Figure 7 ) and conjunctiva. In patients with severe meningococcemia, complicated by disseminated intravascular coagulation, areas of cutaneous infarction can appear on the extremities. ...
Context 2
... eruption becomes apparent only in 26% of patients, evolving over time. Maculopapular lesions with a petechial component are usually present on the oral mucous membranes ( Figure 7 ) and conjunctiva. In patients with severe meningococcemia, complicated by disseminated intravascular coagulation, areas of cutaneous infarction can appear on the extremities. ...
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Citations
... 4,5 Furthermore, the authors did not perform the search for signs of human herpesvirus 6 (HHV-6) and/or human herpesvirus 7 (HHV-7) reactivation in the blood or tissues which would have been very helpful for the definitive diagnosis of PPR. [3][4][5] The persistence of the eruption and symptoms in PPR can be explained by the corresponding persistence of systemic HHV-6 and/or HHV-7 reactivation. Naturally, the importance of a definite diagnosis of PPR is crucial in judging therapeutic success with abrocitinib and before considering it as a hypothetical option for patients with PPR. ...
... Herpesvirus cytopathic damage of the keratinocytes consists of paleness and ballooning degeneration, ''steel grey'' aspect of the nuclei with chromatin margination, and eosinophilic nuclear inclusions; contrariwise, eosinophilic inclusion bodies (Guarnieri's bodies) in Orthopoxvirus infections do not take place in the nuclei but in the cytoplasm of infected keratinocytes [11,12]. In TEM studies, Herpesviruses show a dense core and a hexagonal capsid covered by a multilayer proteic coat, as described by Drago et al. in skin samples from patients with pityriasis rosea [21][22][23]. ...
... While skin lesions are uncommon, they may manifest as maculopapular and vesicular rashes on the hands, feet, buttocks, legs and arms. 32,33 Reports of localized maculopapular exanthems with petechiae have also been reported. 34 Atypical echovirus infections, like echovirus 9, are marked by a maculopapular and petechial eruption that starts on the face or neck and spreads cephalocaudally. ...
... 34 Atypical echovirus infections, like echovirus 9, are marked by a maculopapular and petechial eruption that starts on the face or neck and spreads cephalocaudally. 33 Additionally, punched-out ulcers on the soft palate or tonsils and greyish-white dots resembling Koplik spots can appear as a typical enanthem. 33 Two distinct types of vesicular rashes associated with SARS-CoV-2 have been previously established: the first is characterized by a localized monomorphic rash that primarily affects the trunk; the second is marked by widespread polymorphic vesicular rashes, distinguishing it from varicella-like lesions. ...
... 33 Additionally, punched-out ulcers on the soft palate or tonsils and greyish-white dots resembling Koplik spots can appear as a typical enanthem. 33 Two distinct types of vesicular rashes associated with SARS-CoV-2 have been previously established: the first is characterized by a localized monomorphic rash that primarily affects the trunk; the second is marked by widespread polymorphic vesicular rashes, distinguishing it from varicella-like lesions. 6 COVID-19 vesicular rashes are hypothesized to stem from an inflammatory reaction and cytokine storm triggered by ACE2 in the skin, or a direct cytopathic impact of SARS-CoV-2 on the endothelial cells of dermal vessels. ...
Background:
COVID-19, the widely recognized and highly contagious respiratory tract infection, has had a substantial impact on the field of dermatology since its emergence in 2019. Various skin-related symptoms have been reported in COVID-infected patients, most notably the distinctive purple-red acral rash resembling chilblain lesions, commonly referred to as "COVID toe." COVID-19 is classified within the viral RNA family category, and similarly, skin-related symptoms have been observed in connection with other RNA viruses.
Aim:
This review aims to explore the relationship between RNA viruses and their associated vascular cutaneous manifestations in comparison to those observed in SARS-CoV-2 infected patients.
Methods:
A systematic literature review was conducted using the PubMed database and MeSh terms regarding RNA viruses and related skin manifestations.
Results:
A total of 3,994 patients diagnosed with COVID-19 presenting with skin rashes were observed. Chilblain-like lesions (CLL) were most frequently observed (30.2%), followed by erythematous maculopapular/morbilliform rashes (9.1%) and urticarial rashes (4.7%). Out of 8,362 patients diagnosed with RNA viruses, more than half of the skin findings reported were erythematous/maculopapular/morbilliform rashes (52.3%), followed by unspecified rashes (11.3%) and purpuric rashes (10.6%).
Conclusion:
When comparing RNA viral infections to COVID-19 cases, we observed similarities in reported skin manifestations and their presumed pathways, with many implicated in the pro-inflammatory response. Due to the wide range of cutaneous symptoms associated with RNA viruses and our current limited understanding of their underlying mechanisms, additional research is warranted to investigate the pathology behind viral-induced skin lesions.
... Painful and recurrent ulcers characterize recurrent aphthous stomatitis (RAS). 20 Genetic, mechanical trauma, vitamin deficiencies, stress, food allergies, microbial factors, anxiety, hormonal and systemic diseases are Predisposing factors for RAS. Based on the clinical picture, herpetiform RAS is the least common in the population, with a 5-10% prevalence. ...
Background: Primary herpetic gingivostomatitis is a common condition of oral disease in children. Lesions are generally found on the mucous lips, tongue, cheeks, even on the palatal mucosa. Primary herpetic gingivostomatitis is triggered by infection with Herpes Simplex Virus (HSV) type 1. The diagnosis and treatment of this oral disease are often wrong because proper history is not explored and treatment seems successful due to the self-limiting nature of this lesion. Objective: This paper reports 2 cases of gingivostomatitis in different children, with the same diagnosis but different treatment. Materials and Methods: There were 2 cases, a 12-year- old and 10 year-old boy comes with his parents to the dentist, then introduces the patient to the case and performs a clinical examination followed by anamnesis and diagnosis. The examination results lead to a similar diagnosis but the clinical signs and treatment are slightly different. Results: Accurate history and clinical examination are necessary for appropriate therapy. In these two cases, one child only received palliative care and the other required supportive care. Education about viral transmission to parents is one of the keys to successful treatment. Conclusion: Primary herpetic gingivostomatitis affects youngsters. Vesicles and mouth ulcerations may precede this virus-caused sickness. Clinical factors and patient needs determine causal, symptomatic, palliative, and supportive therapy for this instance.
... This suggests that there is no single pathognomonic cutaneous manifestation of COVID-19 since the same clinical appearance can also be found in other viral infections. 139,140 We do not yet fully understood the reason and pathophysiology behind the cutaneous manifestation and the reason why a certain patient can develop certain skin manifestations while others do not. Angiotensin-converting enzyme receptor found ...
Cutaneous manifestations related to Coronavirus Disease-19 (COVID-19) have been reported over 2 years since the pandemic began. This research aimed to review articles published in English that describe cutaneous manifestations related to COVID-19/SARS-CoV-2. A data search for case reports, original studies, and review articles from the onset of the current COVID-19 pandemic to December 31, 2022, was performed using PUBMED, Cochrane Library, ResearchGate, and Google search engines. Keywords were "coronavirus", "novel coronavirus 2019", "COVID-19", "SARS-CoV-2", and "2019-nCoV" in combination with "cutaneous", "skin" and "dermatology" The extracted data included authors, region, sex, age, number of participants with skin signs, cutaneous signs, its location, symptoms, extracutaneous/associated symptoms, suspected or confirmed status for COVID-19, timeline, and healing duration. Six authors independently reviewed the abstracts and full-texts to identify publications providing these details concerning cutaneous manifestations related to COVID-19. A total of 139 publications with full text (122 case reports, 10 case series, and 7 review articles) that reported cutaneous manifestations were identified, and reviewed from 5 continents. The most common cutaneous manifestations of COVID-19 were maculopapular, followed by chilblain-like lesion, urticarial, livedoid/necrotic, vesicular, and other/non-descript rashes/skin lesions. After 2 years into the COVID-19 pandemic, we can conclude that there is no pathognomonic cutaneous manifestation of COVID-19, since it can be also found in other viral infections.
... All disagreements were resolved by consensus with a third researcher. Information about the enrolled studies is listed in Table 1, including: (1) the first author's name, (2) publication time, (3) country, (4) number of total patients diagnosed with COVID-19, (5) number of patients with cutaneous manifestations, and (6) type of cutaneous manifestations and their respective numbers. ...
The global epidemic of coronavirus disease 2019 (COVID‐19) endangers more and more people. Many studies on cutaneous manifestations related to COVID‐19 have emerged, but their prevalence has varied widely. The objective of this study was to conduct a meta‐analysis estimating the prevalence of skin manifestations in COVID‐19. Four databases PubMed, Web of Science, CBM, and CNKI were searched, and the results were screened by two reviewers. A random‐effects model was used to evaluate the overall prevalence. Heterogeneity was assessed by I2. Further subgroup analyses were conducted by region, sample size, sex, age, and severity of COVID‐19. A funnel plot and Egger's test were performed to assess publication bias. The pooled prevalence of cutaneous manifestation of 61 089 patients in 33 studies was 5.6% (95% confidence intervals [CI] = 0.040–0.076, I2 = 98.3%). Severity of COVID‐19 was probably the source of heterogeneity. Studies with sample size <200 report higher prevalence estimates (10.2%). The prevalence of detailed types was as follows: maculopapular rash 2%, livedoid lesions 1.4%, petechial lesions 1.1%, urticaria 0.8%, pernio‐like lesions 0.5%, vesicular lesions 0.3%. Petechial lesions and livedoid lesions contain a higher proportion of severe patients than other skin manifestations. The prevalence rates of pernio‐like lesions, urticaria and petechial lesions vary greatly in different regions.
... Within this demographic, viruses within the Herpes Virus family rise in prevalence, and the incidence of mucosal ulceration increases. Members of this family implicated in mucosal ulceration include Herpes Simplex Viruses 1 and 2, Cytomegalovirus, Varicella Zoster, Epstein -Barr virus, and Herpes Virus-8 [3]. Recurrence within this population can be as high as 40%. ...
Mucosal ulceration has been reported as a symptom temporally related to infection with COVID-19 and vaccination for COVID-19. In this article, we provide two cases supporting this association to understand and outline the breadth of effects that COVID-19 and its vaccines have on those who experience them. Mucosal ulceration is a less prevalent but highly impactful symptom that many patients experience after both infections with the virus itself as well as soon after receiving the vaccines developed to prevent it.
... A case in point is the enanthems observed by some that were categorized as petechial, erythematous, vesicular, macular, or macular with petechiae [4,61]. This is in contradistinction to enanthems in other viral infections such as herpangina, measles, human herpesvirus (HHV) infections, and roseola infantum that present with specific, pathognomonic characteristics identifiable with the disease entity [61]. ...
... A case in point is the enanthems observed by some that were categorized as petechial, erythematous, vesicular, macular, or macular with petechiae [4,61]. This is in contradistinction to enanthems in other viral infections such as herpangina, measles, human herpesvirus (HHV) infections, and roseola infantum that present with specific, pathognomonic characteristics identifiable with the disease entity [61]. Thus, for example, enanthem in herpangina appears as small vesicular or ulcerative lesions confined to the posterior oropharyngeal region, or in the case of roseola infantum, 'Nagayama spots' presenting as erythematous papules on the soft palate and at the base of the uvula [62]. ...
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 .
... Chen et al., 2020b;Chérif et al., 2020;Chern et al., 2020;Cirillo et al., 2021a;Coke et al., 2021a;Elibol, 2021;Fantozzi et al., 2020;Fathi et al., 2021;Freni et al., 2020;Halboub et al., 2020;Hocková et al., 2021;Karadas et al., 2020;Lechien et al., 2020b;Manzalawi et al., 2021;Moreira et al., 2020a;Morteza Mousavi-Hasanzadeh et al., 2020;Nitecki et al., 2021;Sheng et al., 2021;Tapia et al., 2020;Zarch & Hosseinzadeh, 2021), fatigue (Bao et al., 2020;L. Chen et al., 2020b;Manzalawi et al., 2020;Nitecki et al., 2021), cough (Bao et al., 2020;Biadsee et al., 2020;Brandao et al., 2021;Chérif et al., 2020;Cirillo et al., 2021a;Coke et al., 2021a;Fantozzi et al., 2020;Freni et al., 2020;Hocková et al., 2021;Jayasrikrupaa et al., 2020;Lechien et al., 2020b;Morteza Mousavi-Hasanzadeh et al., 2020;Nitecki et al., 2021;Pitak-Arnnop et al., 2021;Sheng et al., 2021;Tham et al., 2020;Zarch & Hosseinzadeh, 2021), dyspnea (Bao et al., 2020;Coke et al., 2021a), acute respiratory distress syndrome (Bao et al., 2020;Cruz Tapia et al., 2020;Jayasrikrupaa et al., 2020;Morteza Mousavi-Hasanzadeh et al., 2020;Mulcahy et al., 2020;Santos et al., 2021;Tham et al., 2020), multiple organ failure (Bao et al., 2020;Coke et al., 2021a;Mulcahy et al., 2020) (Brandao et al., 2021;Chérif et al., 2020;Coke et al., 2021a;dos Santos et al., 2021;Fathi et al., 2021;Freni et al., 2020;Lechien et al., 2020b;Maciel et al., 2020;Moreira et al., 2020a;Tham et al., 2020), cutaneous manifestations (Capocasale et al., 2021;Chérif et al., 2020;Drago et al., 2021;Fathi et al., 2021;Halboub et al., 2020;Hockova et al., 2021;Maciel et al., 2020), sore throat (Halboub et al., 2020;Kitakawa et al., 2020a), dyspnea (Brandao et al., 2021;dos Santos et al., 2021;Fantozzi et al., 2020;Halboub et al., 2020;Hockova et al., 2021;Moreira et al., 2020a;Ramires et al., 2021), conjunctivitis (Chérif et al., 2020;Maciel et al., 2020;Pitak-Arnnop et al., 2021), loss of appetite (Eghbali Zarch & Hosseinzadeh, 2021a). Other less mentioned manifestations can be found in the Supplementary Table 1. ...
... The majority of the included studies in this review investigates oral symptoms derived from taste/gustatory alterations (ageusia, hypogeusia or dysgeusia) (Ammar et al., 2020;Amorim Dos Santos et al., 2021;Amorim Dos Santos et al., 2020b;Biadsee et al., 2020;Brandao et al., 2021;Brandini et al., 2021;Capocasale et al., 2021;L. Chen et al., 2020b;Cirillo et al., 2021a;Coke et al., 2021a;Eghbali Zarch & Hosseinzadeh, 2021a;Elibol, 2021;Fantozzi et al., 2020;Jayasrikrupaa et al., 2020;Karadas et al., 2020;Maciel et al., 2020;Morteza Mousavi-Hasanzadeh et al., 2020;Nitecki et al., 2021;Padre & Mourao, 2020;Pitak-Arnnop et al., 2021;Risso et al., 2020;Saniasiaya et al., 2020;Sheng et al., 2021;Tanasa et al., 2020), xerostomia (Amorim Dos Biadsee et al., 2020; L. Chen et al., 2020b;Coke et al., 2021a;Eghbali Zarch & Hosseinzadeh, 2021a;Fantozzi et al., 2020;Freni et al., 2020;Gherlone et al., 2021;Halboub et al., 2020;Jayasrikrupaa et al., 2020;Lechien et al., 2020b;Maciel et al., 2020;Pitak-Arnnop et al., 2021;, as well the presence of ulcerative lesions in oral mucosa and lips (Amorim Dos Santos et al., 2021;Brandao et al., 2021;Brandini et al., 2021;Capocasale et al., 2021;Cebeci Kahraman, Ozen, et al., 2020;Chérif et al., 2020;Cruz Tapia et al., 2020;Drago et al., 2021;Eghbali Zarch & Hosseinzadeh, 2021a;Fathi et al., 2021;Fidan et al., 2021;Halboub et al., 2020;Hockova et al., 2021;Iranmanesh et al., 2021b;Jayasrikrupaa et al., 2020;Kitakawa et al., 2020a;La Rosa et al., 2020;Maciel et al., 2020;Mulcahy et al., 2020;Pitak-Arnnop et al., 2021;Ramires et al., 2021). A few studies also bring gingivitis and periodontal alterations as oral manifestations of COVID-19 though (Brandini et al., 2021;Coke et al., 2021a;Drago et al., 2021;Eghbali Zarch & Hosseinzadeh, 2021a;Elibol, 2021;Larvin et al., 2020a;Maciel et al., 2020;Manzalawi et al., 2020;Marouf et al., 2021;Pitak-Arnnop et al., 2021). ...
... Chen et al., 2020b;Cirillo et al., 2021a;Coke et al., 2021a;Eghbali Zarch & Hosseinzadeh, 2021a;Elibol, 2021;Fantozzi et al., 2020;Jayasrikrupaa et al., 2020;Karadas et al., 2020;Maciel et al., 2020;Morteza Mousavi-Hasanzadeh et al., 2020;Nitecki et al., 2021;Padre & Mourao, 2020;Pitak-Arnnop et al., 2021;Risso et al., 2020;Saniasiaya et al., 2020;Sheng et al., 2021;Tanasa et al., 2020), xerostomia (Amorim Dos Biadsee et al., 2020; L. Chen et al., 2020b;Coke et al., 2021a;Eghbali Zarch & Hosseinzadeh, 2021a;Fantozzi et al., 2020;Freni et al., 2020;Gherlone et al., 2021;Halboub et al., 2020;Jayasrikrupaa et al., 2020;Lechien et al., 2020b;Maciel et al., 2020;Pitak-Arnnop et al., 2021;, as well the presence of ulcerative lesions in oral mucosa and lips (Amorim Dos Santos et al., 2021;Brandao et al., 2021;Brandini et al., 2021;Capocasale et al., 2021;Cebeci Kahraman, Ozen, et al., 2020;Chérif et al., 2020;Cruz Tapia et al., 2020;Drago et al., 2021;Eghbali Zarch & Hosseinzadeh, 2021a;Fathi et al., 2021;Fidan et al., 2021;Halboub et al., 2020;Hockova et al., 2021;Iranmanesh et al., 2021b;Jayasrikrupaa et al., 2020;Kitakawa et al., 2020a;La Rosa et al., 2020;Maciel et al., 2020;Mulcahy et al., 2020;Pitak-Arnnop et al., 2021;Ramires et al., 2021). A few studies also bring gingivitis and periodontal alterations as oral manifestations of COVID-19 though (Brandini et al., 2021;Coke et al., 2021a;Drago et al., 2021;Eghbali Zarch & Hosseinzadeh, 2021a;Elibol, 2021;Larvin et al., 2020a;Maciel et al., 2020;Manzalawi et al., 2020;Marouf et al., 2021;Pitak-Arnnop et al., 2021). Minor reports of other lesions and affections are described in the Supplementary Table 1. ...
The aim of this integrative review consisted of verifying whether the oral manifestations detected in patients diagnosed with COVID-19 are useful in diagnosing the disease, whether they are a manifestation resulting from the disease, or whether there is evidence that there is no correlation between the pathologies. Therefore, articles in the PubMed, Lilacs, Scopus, Science Direct, Web of Science and Embase databases were searched, in addition to the search in gray literature. The terms used in the search were: “COVID-19” or “Sars-Cov-2” or “coronavirus” and “oral conditions” or “oral health” or “oral manifestations” and “diagnosis/complications” or “symptoms”. Thus, 1.305 articles were selected, of which 61 were selected to compose this review. Most of the included studies considered oral symptoms as taste changes, xerostomia and ulcerative lesions in the oral and labial mucosa. All symptoms related to this pathology still need further studies and investigations so that all mechanisms and manifestations related to it are completely elucidated.
... The patterns of occurrence of these manifestations are gradually emerging through case reports and other observational studies, and their probable causal relationship to SARS-CoV2 remains under study. Several groups of viruses, such as herpesviruses and human papillomaviruses, are known to cause oral lesions (11,92), and the potential of SARS-CoV2 coronavirus to cause oral lesions should be thoroughly investigated. However, the role of coincidence, comorbidities and opportunistic co-infections in the occurrence of some of these lesions cannot be ruled out at this time. ...
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.
