코로나바이러스감염증-19 환자의 구강증상과 병리학적 기전

Abstract

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is rapidly spreading worldwide. Oral manifestations of COVID-19, including sore throat, loss of taste, dry mouth, and ulceration have been widely reported. SARS-CoV-2 enters host cells using angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2). Therefore, high levels of expression of ACE2 and TMPRSS2 may enhance SARS-CoV-2 invasion. ACE2 and TMPRSS2 were expressed in the taste bud and intermediate layer of the squamous epithelia of tongue papillae. Additionally, ACE2 and TMPRSS2 were co-expressed in the ductal epithelium and acinar cells of salivary glands and in the neuronal cell body of trigeminal ganglia. SARS-CoV-2 directly invades the oral taste buds, causing loss of taste. Additionally, the possibility of neuroinvasion innervation of taste bud cells cannot be excluded. SARS-CoV-2 spreads around the suprabasal areas of the oral squamous epithelia, and invades the trigeminal nerve, resulting in oral manifestations. SARS-CoV-2 can directly invade the parotid and submandibular glands, as well as minor salivary glands, through the duct orifice. This may lead to sialadenitis and salivary contamination. (J Clinical Otolaryngol 2021;32:163-169)