Periodontal tissues are targets for Sars-Cov-2: a post-mortem study

ABSTRACT

Background: The ability of coronavirus SARS-CoV-2 to spread is one of the determinants of the COVID-19 pandemic status. Until June 2020, global COVID-19 cases surpassed 10 million. Asymptomatic patients, with no respiratory impairment, are believed to be responsible for more than 80% of the transmission. Other viruses have been consistently detected in periodontal tissues.

Objective: The aim of this study was to investigate the presence of SARS-CoV-2 in periodontal tissue.

Methods: We conducted video-endoscope minimally invasive post-mortem biopsy in seven fatal cases of COVID-19, using a regular endoscope video system associated with a smartphone to locate periodontal tissue. We analyzed the samples using RT-PCR, to identify the SARS-CoV-2 RNA and histopathological analysis.

Results: The seven studied autopsies with positive laboratory tests for COVID-19 included 57.14% of female patients at the average age of 47.4 (range 8 to 74). In five cases, periodontal tissue was positive for SARS-CoV-2 (RT-PCR). Histopathologic analyses showed morphologic alterations in the keratinocytes of the junctional epithelium, a vacuolization of the cytoplasm and nucleus and nuclear pleomorphism.

Conclusion: We presented a biomolecular analysis obtained from minimally invasive autopsies. This is the first study to demonstrate the presence of SARS-CoV-2 in periodontal tissue in COVID-19 positive patients.

KEYWORDS:

• COVID-19
• autopsy
• infection control
• oral manifestation
• RT-PCR

Acknowledgments

The authors wish to thank Mrs. Kely Cristina Soares Bispo, Mr. Gustavo Linari Rodrigues, Mrs. Angela B G dos Santos, Ms. Sandra de Moraes Fernezlian, Mr. Reginaldo Silva do Nascimento, Ms. Glaucia Aparecida dos Santos Bento, Mrs. Thábata Larissa Luciano Ferreira Leite and Ms. Catia Sales de Moura for their technical support. To all involved in the care for the patients with COVID-19 and to all hospital workers who take part in the HC-FMUSP-Coronavirus Crisis Committee during the epidemic season. To all relatives and legal representatives who agreed with the post-mortem examination of COVID-19 victims. The authors declare no potential conflicts of interest with respect to the authorship and/or publication of this article. Funding sources: Fundação de Amparo à Pesquisa do Estado de São Paulo 2013/17159-2. FunderDOI: 10.13039/501100001807; Bill and Melinda Gates Foundation INV-002396. FunderDOI: 10.13039/100000865. Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) 401825/2020-5.

Disclosure statement

No potential conflict of interest was reported by the authors.

Authors contributions

Matuck B.: contributed to conception, design, acquisition, interpretation, data analysis, drafted and critically revised the manuscript.

Dolhnikoff M.: contributed to conception, design, acquisition, interpretation, data analysis and critically revised the manuscript.

Maia G. and Gomes S. C.: Contributed to design, acquisition, drafted the manuscript.

Sendyk D.: Contributed to analysis, interpretation, drafted and critically revised the manuscript.

Zarpellon A.: Contributed to acquisition, analysis, interpretation, drafted and critically revised the manuscript.

Duarte-Neto AN: Contributed to conception, acquisition, analysis and critically revised the manuscript.

Pinho J.R. and Gomes-Gouvêa M.: Contributed to design, analysis, interpretation and critically revised the manuscript.

Machado S.: Contributed to design, analysis, interpretation, drafted and critically revised the manuscript.

Mauad T.: Contributed to conception, design, interpretation and critically revised the manuscript.

Saldiva P.: Contributed to conception, design and critically revised the manuscript.

Braz-Silva P.: Contributed to conception, analysis, interpretation and critically revised the manuscript.

Silva L.F.: Contributed to conception, design, acquisition, analysis, interpretation and critically revised the manuscript.

All authors gave final approval and agree to be accountable for all aspects of the work.

Additional information

Funding

This work was supported by the Bill and Melinda Gates Foundation [10.13039/100000865]; Fundação de Amparo à Pesquisa do Estado de São Paulo [2013/17159-2]; Conselho Nacional de Desenvolvimento Científico e Tecnológico [401825/2020-5].