Exploring the relationship between cycle threshold values and oral manifestations in COVID-19: a comprehensive overview
DOI:
https://doi.org/10.2340/aos.v83.41390Keywords:
COVID-19, E gene, N gene, Ct values, Oral manifestationsAbstract
Objective: This cross-sectional study aimed to compare oral manifestations between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-positive and SARS-CoV-2-negative patients and to examine associations between oral symptoms, Ct values of E and N SARS-CoV-2 viral genes, and the implications of low Ct values indicating a high viral load, which is a predictive factor for the outcome of COVID-19.
Methods: A total of 353 participating patients were aged ≥18 years with clinical manifestations of COVID-19 infection and tested for SARS-CoV-2 carriage at the medical center, by reverse transcriptase polymerase chain reaction (RT-PCR). All patients filled out an anonymous digital questionnaire regarding oral and general symptoms and overall medical health.
Results: A significant association was found between SARS-CoV-2 carriage and dry mouth, unpleasant taste and changes in taste (p < 0.001); for example, 37.4% of the 147 SARS-CoV-2- positive participants had a dry mouth, compared to 18.9% of the 206 SARS-CoV-2- negative participants. Oral blisters were experienced by patients with an E gene Ct value of 10–20 (50%) or 21–30 (50%) (p = 0.041). Bad breath, dry mouth, unpleasant taste and changes in taste were mostly present in participants whose Ct values of both E and N genes were between 21 and 30.
Conclusions: This study found significant associations between low Ct values of E and N SARS-CoV-2 viral genes and high viral load, indicating that Ct values can serve as predictive factors for COVID-19 outcomes. The findings suggest that while oral symptoms are present, the Ct values and associated high viral loads are more critical indicators of disease severity and prognosis.
Downloads
References
Zu ZY, Jiang M Di, Xu PP, Chen W, Ni QQ, Lu GM, et al. Coronavirus disease 2019 (COVID-19): a perspective from China. Radiology. 2020;296:E15–25. https://doi.org/10.1148/radiol.2020200490 DOI: https://doi.org/10.1148/radiol.2020200490
Ciotti M, Angeletti S, Minieri M, Giovannetti M, Benvenuto D, Pascarella S, et al. COVID-19 outbreak: an overview. Chemotherapy. 2019;64:215–23. https://doi.org/10.1159/000507423 DOI: https://doi.org/10.1159/000507423
Velavan TP, Meyer CG. The COVID‐19 epidemic. Trop Med Int Health. 2020;25:278–80. https://doi.org/10.1111/tmi.13383 DOI: https://doi.org/10.1111/tmi.13383
Estébanez A, Pérez‐Santiago L, Silva E, Guillen‐Climent S, García‐Vázquez A, Ramón MD. Cutaneous manifestations in COVID‐19: a new contribution. J Eur Acad Dermatol Venereol. 2020;34: e250-e251 https://doi.org/10.1111/jdv.16474 DOI: https://doi.org/10.1111/jdv.16474
Iranmanesh B, Khalili M, Amiri R, Zartab H, Aflatoonian M. Oral manifestations of COVID‐19 disease: a review article. Dermatol Ther. 2021;34. https://doi.org/10.1111/dth.14578. DOI: https://doi.org/10.1111/dth.14578
Callaway E. The coronavirus is mutating – does it matter? Nature. 2020;585:174–7. https://doi.org/10.1038/d4158420-02544-6 DOI: https://doi.org/10.1038/d41586-020-02544-6
Yüce M, Filiztekin E, Özkaya KG. COVID-19 diagnosis – a review of current methods. Biosens Bioelectron. 2021;172:112752. https://doi.org/10.1016/j.bios.2020.112752 DOI: https://doi.org/10.1016/j.bios.2020.112752
Bouzid D, Vila J, Hansen G, Manissero D, Pareja J, Rao SN, et al. Systematic review on the association between respiratory virus real-time PCR cycle threshold values and clinical presentation or outcomes. J Antimicrob Chemother. 2021;76:iii33–49. https://doi.org/10.1093/jac/dkab246 DOI: https://doi.org/10.1093/jac/dkab246
Chang MC, Hur J, Park D. Interpreting the COVID-19 test results. Am J Phys Med Rehabil. 2020;99:583–5. https://doi.org/10.1097/PHM.0000000000001471 DOI: https://doi.org/10.1097/PHM.0000000000001471
Locker D, Miller Y. Evaluation of subjective oral health status indicators. J Public Health Dent. 1994;54:167–76. https://doi.org/10.1111/j.1752-7325.1994.tb01209.x DOI: https://doi.org/10.1111/j.1752-7325.1994.tb01209.x
Zhao Y, Cui C, Zhang K, Liu J, Xu J, Nisenbaum E, et al. COVID19: a systematic approach to early identification and healthcare worker protection. Front Public Health. 2020;8. https://doi.org/10.3389/fpubh.2020.00205 DOI: https://doi.org/10.3389/fpubh.2020.00205
Procop GW, Brock JE, Reineks EZ, Shrestha NK, Demkowicz R, Cook E, et al. A comparison of five SARS-CoV-2 molecular assays with clinical correlations. Am J Clin Pathol. 2021;155:69–78. https://doi.org/10.1093/ajcp/aqaa181 DOI: https://doi.org/10.1093/ajcp/aqaa181
To KK-W, Tsang OT-Y, Leung W-S, Tam AR, Wu T-C, Lung DC, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect Dis. 2020;20:565–74. https://doi.org/10.1016/S1473-3099(20)30196-1 DOI: https://doi.org/10.1016/S1473-3099(20)30196-1
Singanayagam A, Patel M, Charlett A, Lopez Bernal J, Saliba V, Ellis J, et al. Duration of infectiousness and correlation with RT-PCR cycle threshold values in cases of COVID-19, England, January to May 2020. Eurosurveillance. 2020;25. https://doi.org/10.2807/1560-7917.ES.2020.25.32.2001483 DOI: https://doi.org/10.2807/1560-7917.ES.2020.25.32.2001483
Pellegrino R, Cooper KW, Di Pizio A, Joseph PV, Bhutani S, Parma V. Coronaviruses and the chemical senses: past, present, and future. Chem Senses. 2020;45:415–22. https://doi.org/10.1093/chemse/bjaa031 DOI: https://doi.org/10.1093/chemse/bjaa031
Chen L, Zhao J, Peng J, Li X, Deng X, Geng Z, et al. Detection of SARS‐CoV‐2 in saliva and characterization of oral symptoms in COVID‐19 patients. Cell Prolif. 2020;53. https://doi.org/10.1111/cpr.12923 DOI: https://doi.org/10.1111/cpr.12923
Fathi Y, Hoseini EG, Atoof F, Mottaghi R. Xerostomia (dry mouth) in patients with COVID-19: a case series. Future Virol. 2021;16:315–9. https://doi.org/10.2217/fvl-2020-0334 DOI: https://doi.org/10.2217/fvl-2020-0334
Carrillo-Larco RM, Altez-Fernandez C. Anosmia and dysgeusia in COVID-19: a systematic review. Wellcome Open Res. 2020;5:94. https://doi.org/10.12688/wellcomeopenres.15917.1 DOI: https://doi.org/10.12688/wellcomeopenres.15917.1
Brandão TB, Gueiros LA, Melo TS, Prado-Ribeiro AC, Nesrallah ACFA, Prado GVB, et al. Oral lesions in patients with SARS-CoV-2 infection: could the oral cavity be a target organ? Oral Surg Oral Med Oral Pathol Oral Radiol. 2021;131:e45–51. https://doi.org/10.1016/j.oooo.2020.07.014 DOI: https://doi.org/10.1016/j.oooo.2020.07.014
Abdul Hussein TA, Fadhil HY. Impact of inflammatory markers, dread diseases and cycle threshold (Ct) Values in COVID-19 progression. Bionatura. 2023;8:1–8. https://doi.org/10.21931/RB/2023.08.01.33 DOI: https://doi.org/10.21931/RB/2023.08.01.33
Yu X, Sun S, Shi Y, Wang H, Zhao R, Sheng J. SARS-CoV-2 viral load in sputum correlates with risk of COVID-19 progression. Crit Care. 2020;24:170. https://doi.org/10.1186/s13054-020-02893-8 DOI: https://doi.org/10.1186/s13054-020-02893-8
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Dalit Porat Ben Amy, Hanan Rohana, Maya Azrad, Michael V. Joachim, Ori Bar, Imad Abu El-Naaj, Avi Peretz
This work is licensed under a Creative Commons Attribution 4.0 International License.