Analysis of Tongue Color-Associated Features among Patients with PCR-Confirmed COVID-19 Infection in Ukraine

Liudmyla Horzov,Myroslav Goncharuk-Khomyn,Volodymyr Melnyk,Natalia Hema-Bahyna,Anastasia Yurzhenko

doi:10.1590/pboci.2021.109

Liudmyla Horzov, Myroslav Goncharuk-Khomyn + Show 3 more

Open Access

https://doi.org/10.1590/pboci.2021.109

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Abstract

Objective: To evaluate and systematize tongue color-related manifestations among patients with PCR-confirmed COVID-19 infection. Material and Methods: This retrospective study included analysis of tongue images obtained from patients with PCR-confirmed COVID-19 infection. Evaluation of coronavirus disease severity (mild, moderate, severe, critical) was provided, considering clinical symptomatology and results of laboratorial and instrumental diagnostic methods. Each picture was analyzed considering the parameters of color of the tongue and color of the tongue plaque by two dental specialists. Cochran-Armitage test for trend was used to evaluate associations between the tongue color and tongue plaque color, and coronavirus disease severity. Results: The most prevalent tongue colors were pale pink, red and dark red (burgundy color). A total of 64.29% of patients with mild disease demonstrated pale pink color of the tongue. Patients with moderate coronavirus disease were characterized with the adverse trend: 62.35% of them presented with red-colored tongue, while in 37.64% of cases, the tongue was pale pink. Severe COVID-19 patients, almost in 90% of the cases, had either red or burgundy color of the tongue. Conclusion: SARS-COV-2 infection is not manifested by tongue-targeted or tongue-specific signs and features; however, coronavirus disease itself provokes changes within the tongue color and tongue plaque color similar to those registered during other internal pathologies.

Highlights

State of health could be indirectly evaluated by the analysis of the tongue color and the color of plaque accumulated on it before and during the clinical course of different internal diseases [1,2,3,4,5]
SARS-COV-2 infection is not manifested by tongue-targeted or tongue-specific signs and features; coronavirus disease itself provokes changes within the tongue color and tongue plaque color similar to those registered during other internal pathologies
In 8 described cases of COVID-19 infection, Brandão et al [34] collected next tongue-related manifestations: clinical case 1 – painful ulcerations and necrotic ulceration of anterior dorsal tongue surface; clinical case 2 – shallow necrotic lesions of anterior dorsal tongue part; clinical case 3 – painful ulcer lesion projected at the right margin of the tongue; clinical case 4 – no specific tongue changes were described; clinical case 5 – multiple ulceration elements located at the apex and lateral border of tongue; clinical case 6 – no specific tongue changes were described; clinical case 7 – ulcer located at ventral part of tongue; clinical case 8 - aphthous-like ulceration with necrotic crust localized above it projected at lateral tongue surface

Summary

Introduction

State of health could be indirectly evaluated by the analysis of the tongue color and the color of plaque accumulated on it before and during the clinical course of different internal diseases [1,2,3,4,5]. A clean tongue without plaque is a sign of a healthy person, while some of the somatopathologies are characterized with adjacent tongue manifestations, which either could be pathognomonic or included within the set of general symptoms [6]. Tongue-related features could be used as valuable diagnostic signs for health evaluation purposes under the machine learning processing approach, which includes the implementation of multi-modal algorithms to relate tongue changes (as image biomarkers) with other symptoms and pathological conditions (including coronavirus disease) [7,8,9,10]. At the date of 13th of January 2021, there have been more than 90 million confirmed cases of COVID-19 reported to WHO, including 1,954,336 deaths [16]. The most common oral symptoms among persons who have suffered from a coronavirus infection include punctate hemorrhages in the form of red bumps, candidiasis, ulcers and various other lesions of the tongue and mucous membranes [17,18,19]

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