Analysis of Tongue Color-Associated Features among Patients with PCR-Confirmed COVID-19 Infection in Ukraine
Keywords:Coronavirus Infections, Severe Acute Respiratory Syndrome, Tongue
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.
Seerangaiyan K, Jüch F, Winkel EG. Tongue coating: its characteristics and role in intra-oral halitosis and general health - a review. J Breath Res 2018; 12(3):034001. https://doi.org/10.1088/1752-7163/aaa3a1
Wang X, Zhang B, Yang Z, Wang H, Zhang D. Statistical analysis of tongue images for feature extraction and diagnostics. IEEE Trans Image Process 2013; 22(12):5336-47. https://doi.org/10.1109/TIP.2013.2284070
Jung CJ, Jeon YJ, Kim JY, Kim KH. Review on the current trends in tongue diagnosis systems. Integr Med Res 2012; 1(1):13-20. https://doi.org/10.1016/j.imr.2012.09.001
Anastasi JK, Chang M, Quinn J, Capili B. Tongue inspection in TCM: observations in a study sample of patients living with HIV. Med Acupunct 2014; 26(1):15-22. https://doi.org/10.1089/acu.2013.1011
Zhang B, Kumar BV, Zhang D. Detecting diabetes mellitus and nonproliferative diabetic retinopathy using tongue color, texture, and geometry features. IEEE Trans Biomed Eng 2013; 61(2):491-501. https://doi.org/10.1109/TBME.2013.2282625
Gaddey HL. Oral manifestations of systemic disease. Gen Dent 2017; 65(6):23-9.
Zhang B, Wang X, You J, Zhang D. Tongue color analysis for medical application. Evid-Based Complement Alternat Med 2013; 2013:1-11. https://doi.org/10.1155/2013/264742
Kawanabe T, Kamarudin ND, Ooi CY, Kobayashi F, Mi X, Sekine M, et al. Quantification of tongue colour using machine learning in Kampo medicine. Eur J Integr Med 2016; 8(6):932-41. https://doi.org/10.1016/j.eujim.2016.04.002
Velasco J, Rojas J, Ramos JP, Muaña HM, Salazar KL. Health evaluation device using tongue analysis based on sequential image analysis. IJATCSE 2019; 8(3):451-7. https://doi.org/10.30534/ijatcse/2019/19832019
Wang ZC, Zhang SP, Yuen PC, Chan KW, Chan YY, Cheung CH, et al. Intra-rater and inter-rater reliability of tongue coating diagnosis in traditional chinese medicine using smartphones: Quasi-delphi study. JMU 2020; 8(7):e16018. https://doi.org/10.2196/16018
Tania MH, Lwin K, Hossain MA. Advances in automated tongue diagnosis techniques. Integr Med Res 2019; 8(1):42-56. https://doi.org/10.1016/j.imr.2018.03.001
Kim SY, Byun JS, Choi JK, Jung JK. A case report of a tongue ulcer presented as the first sign of occult tuberculosis. BMC Oral Health 2019; 19(1):1-5. https://doi.org/10.1186/s12903-019-0764-y
Jain P, Jain I. Oral manifestations of tuberculosis: step towards early diagnosis. J Clin Diag Res 2014; 8(12):ZE18. https://doi.org/10.7860/JCDR/2014/10080.5281
Souza PV, Pinto WB, Oliveira AS. Bright tongue sign: a diagnostic marker for amyotrophic lateral sclerosis. Arq Neuro-Psiquiatr 2014; 72(7):572. https://doi.org/10.1590/0004-282X20140077
Ayinampudi BK, Gannepalli A, Pacha VB, Kumar JV, Khaled S, Naveed MA. Association between oral manifestations and inhaler use in asthmatic and chronic obstructive pulmonary disease patients. J Dr NTR Univ Health Sci 2016; 5(1):17. https://doi.org/10.4103/2277-8632.178950
World Health Organization. Coronavirus Disease (COVID-19) Dashboard. 2021. Available from: https://covid19.who.int/. [Accessed on January 13, 2020].
Halboub E, Al-Maweri SA, Alanazi RH, Qaid NM, Abdulrab S. Orofacial manifestations of COVID-19: a brief review of the published literature. Braz Oral Res 2020; 34:e124. https://doi.org/10.1590/1807-3107bor-2020.vol34.0124
Chaux-Bodard AG, Deneuve S, Desoutter A. Oral manifestation of Covid-19 as an inaugural symptom?. J Oral Med Oral Surg 2020; 26(2):18. https://doi.org/10.1051/mbcb/2020011
dos Santos JA, Normando AG, da Silva RL, De Paula RM, Cembranel AC, Santos-Silva AR, et al. Oral mucosal lesions in a COVID-19 patient: new signs or secondary manifestations?. Int J Infect Dis 2020; 97:326-8. https://doi.org/10.1016/j.ijid.2020.06.012
Horzov L, Goncharuk-Khomyn M, Kostenko Y, Melnyk V. Dental Patient Management in the Context of the COVID-19 Pandemic: Current Literature Mini-Review. Open Public Health J 2020; 13(1):459-63. https://doi.org/10.2174/1874944502013010459
da Silva Pedrosa M, Sipert CR, Nogueira FN. Altered taste in patients with COVID-19: the potential role of salivary glands. Oral Dis 2020; Suppl 3:798-800. https://doi.org/10.1111/odi.13496
da Silva Pedrosa M, Sipert CR, Nogueira FN. Salivary glands, saliva and oral findings in COVID-19 infection. Pesqui Bras Odontopediatria Clín Integr 2020; 20:e0104. https://doi.org/10.1590/pboci.2020.112
Yan CH, Faraji F, Prajapati DP, Boone CE, De Conde AS. Association of chemosensory dysfunction and Covid-19 in patients presenting with influenza-like symptoms. Int Forum Allergy Rhinol 2020; 10(7):806-13. https://doi.org/10.1002/alr.22579
Wang B, Pang K, Chen S, Gong J, Deng J, Liu J. A preliminary study of tongue image in 78 patients with COVID-19. Jiangsu Tradit Chin Med 2020; 53:84-6. https://doi.org/10.19844/j.cnki.1672-397X.2020.04.014
Zhou G, Huang D, Cai Y, Huang K, Xie D. Relationship between tongue characteristics and clinical typing in COVID-19 patients. J Tradit Chin Med 2020:1-4.
Pang W, Zhang D, Zhang J, Li N, Zheng W, Wang H, et al. Tongue features of patients with coronavirus disease 2019: a retrospective cross-sectional study. Integr Med Res 2020; 9(3):100493. https://doi.org/10.1016/j.imr.2020.100493
World Health Organization. Clinical management of COVID-19 (interim guidance). 2021. Available from: https://www.who.int/publications/i/item/clinical-management-of-covid-19. [Accessed on January 13, 2020].
Tatem KS. Comparing prevalence estimates from population-based surveys to inform surveillance using electronic health records. Prev Chronic Dis 2017; 14:E44. https://doi.org/10.5888/pcd14.160516
van Baal PH, Engelfriet PM, Hoogenveen RT, Poos MJ, van den Dungen C, Boshuizen HC. Estimating and comparing incidence and prevalence of chronic diseases by combining GP registry data: the role of uncertainty. BMC Public Health 2011; 11(1):163. https://doi.org/10.1186/1471-2458-11-163
Tekindal MA, Gullu O, Yazici AC, Yavuz Y. The Cochran-Armitage test to estimate the sample size for trend of proportions for biological data. Turk J Field Crops 2016; 21(2):286-97. https://doi.org/10.17557/tjfc.33765
Buonaccorsi JP, Laake P, Veierød MB. On the power of the Cochran–Armitage test for trend in the presence of misclassification. Stat Methods Med Res 2014; 23(3):218-43. https://doi.org/10.1177/0962280211406424
McHugh ML. Interrater reliability: the Kappa statistic. Biochem Med 2012; 22(3):276-82.
Hsu LM, Field R. Interrater agreement measures: Comments on Kappan, Cohen's Kappa, Scott's π, and Aickin's α. Understanding Statistics 2003; 2(3):205-19. https://doi.org/10.1207/S15328031US0203_03
Brandão TB, Gueiros LA, Melo TS, Prado-Ribeiro AC, Nesrallah AC, Prado GV, 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 Endod 2020; S2212-4403(20)31119-6. https://doi.org/10.1016/j.oooo.2020.07.014
Nemeth-Kohanszky ME, Matus-Abásolo CP, Carrasco-Soto RR. Manifestaciones orales de la infección por COVID-19. Int J Odontostomat 2020; 14(4):555-60. https://doi.org/10.4067/S0718-381X2020000400555
Biadsee A, Biadsee A, Kassem F, Dagan O, Masarwa S, Ormianer Z. Olfactory and oral manifestations of COVID-19: sex-related symptoms — a potential pathway to early diagnosis. Otolaryngol Head Neck Surg 2020; 163(4):722-8. https://doi.org/10.1177/0194599820934380
Rodríguez MD, Romera AJ, Villarroel M. Oral manifestations associated with COVID-19. Oral Dis 2020; 1-3. https://doi.org/10.1111/odi.13555
Liang K, Huang X, Chen H, Qiu L, Zhuang Y, Zou C, et al. Tongue diagnosis and treatment in traditional Chinese medicine for severe COVID-19: a case report. Ann Palliat Med 2020; 9(4):2400-7. https://doi.org/10.21037/apm-20-1330
Cruz Tapia RO, Peraza Labrador AJ, Guimaraes DM, Matos Valdez LH. Oral mucosal lesions in patients with SARS-CoV-2 infection. Report of four cases. Are they a true sign of COVID-19 disease?. Spec Care Dent 2020; 40(6):555-60. https://doi.org/10.1111/scd.12520
Riad A, Klugar M, Krsek M. COVID-19-related oral manifestations: early disease features?. Oral Dis 2020. https://doi.org/10.1111/odi.13516
Corchuelo J, Ulloa FC. Oral manifestations in a patient with a history of asymptomatic COVID-19: Case report. Int J Infect Dis 2020; 100:154-7. https://doi.org/10.1016/j.ijid.2020.08.071
Guerini-Rocco E, Taormina SV, Vacirca D, Ranghiero A, Rappa A, Fumagalli C, et al. SARS-CoV-2 detection in formalin-fixed paraffin-embedded tissue specimens from surgical resection of tongue squamous cell carcinoma. J Clin Pathol 2020; 73(11):754-7. https://doi.org/10.1136/jclinpath-2020-206635
Tu YP, Jennings R, Hart B, Cangelosi GA, Wood RC, Wehber K, et al. Swabs collected by patients or health care workers for SARS-CoV-2 testing. N Engl J Med 2020; 383(5):494-6. https://doi.org/10.1056/NEJMc2016321
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