Manifestações bucais e cutâneas da covid-19 em pacientes pediátricos

MORAES, Mayara Faria de; NATALINO, Yasmim dos Reis; HOLANDA, Andressa Feller; SOUZA SOBRINHO, Hellen Ferreira de; SARMENTO, Lilian Citty; GOMES, Ana Paula Martins; SANGLARD, Luciana Faria

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Sumário

REVIEW • Rev Gaúch. Odontol. 69 • 2021 • https://doi.org/10.1590/1981-86372021000520200136 copiar

Manifestações bucais e cutâneas da covid-19 em pacientes pediátricos

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

A COVID-19 iniciou em dezembro de 2019, na cidade de Wuhan na China e em 11 de março de 2020 foi classificada pela Organização Mundial de Saúde como pandemia. Trata-se de uma infecção assintomática que pode evoluir para quadros respiratórios graves. Em adultos é mais prevalente, mas também é observada em crianças, com ocorrência de sintomatologias extra respiratórias, como as manifestações bucais e cutâneas. Esta revisão de literatura objetiva relatar as manifestações bucais e cutâneas da COVID-19 em pacientes pediátricos. A estratégia de busca bibliográfica foi realizada nas bases de dados PubMed, SciELO e Bireme em 01/Agosto/2020, utilizando MeSH Terms “COVID-19”; “Child”; “Oral Manifestations”; “Skin Manifestations”; “Ageusia”; “Dysgeusia” e Decs correspondentes, e ainda busca manual, sem restrição de idiomas. As etapas de busca, triagem, seleção, avaliação dos estudos e extração dos dados foram realizadas por quatro revisores independentes. Foram identificados nove estudos que atenderam aos critérios de elegibilidade. As manifestações bucais e cutâneas mais citadas foram, respectivamente, a disfunção gustativa em adolescentes e a erupção eritematosa em extremidades e tronco. Os profissionais de saúde devem ficar atentos às referidas manifestações, entretanto, trata-se de um tema recente na literatura, estudos mais criteriosos, com maior força de evidência ainda precisam ser realizados.

Termos de indexação
Infecções por coronavirus; Criança; Manifestações bucais

Data base	Search strategies	Number of articles
PubMed	((COVID-19 [All Fields]) AND (Child [All Fields]) AND (Skin Manifestations [All Fields]))	3
	((COVID-19 [All Fields]) AND (Child [All Fields]) AND (Skin Manifestations [All Fields]))	11^* * 1 duplicate.
	((COVID-19 [All Fields]) AND (Child [All Fields]) AND (Dysgeusia [All Fields]))	3
	((COVID-19 [All Fields]) AND (Child [All Fields]) AND (Ageusia [All Fields]))	3
SciELO	((COVID-19) AND (Child) AND (Oral Manifestations))	1
	((COVID-19) AND (Child) AND (Skin Manifestations))	0
	((COVID-19) AND (Child) AND (Dysgeusia))	0
	((COVID-19) AND (Child) AND (Ageusia))	0
Bireme	(tw:(COVID-19)) AND (tw:(Child)) AND (tw:(Oral Manifestations))	2
	tw:(COVID-19)) AND (tw:(Child)) AND (tw:(Skin Manifestations))	6
	(tw:(COVID-19)) AND (tw:(Child)) AND (tw:(Dysgeusia))	0
	(tw:(COVID-19)) AND (tw:(Child)) AND (tw:(Ageusia))	0
	Total of articles identified:	29
	Manual search	05
	Excluded	25
	Total of articles included	09

Author	Study design	Sample	Age (years)	Objectives / Methods	Oral manifestations	Skin manifestations	Conclusions
Tang et al. [²⁹29 Tang K, Wang Y, Zhang H, Zheng Q, Fang R, Sun Q. Cutaneous manifestations of the coronavirus disease 2019 (COVID-19): A brief review. Dermatol Ther. 2020;33(4):e13528. http://dx.doi.org/10.1111/dth.13528 https://doi.org/10.1111/dth.13528... ]	Literature review.	88 patients (Does not separate children and adults)	8-84	They reviewed 16 studies (case reports, case series, prospective and retrospective observational studies). A total of 256 confirmed cases of COVID-19	Not reported	Erythematous lesions Vesicular lesions Urticarias Livedo Petechiae - Location: Non-synthesized	Highly variable and heterogeneous manifestations.
Qiu et al. [²²22 Qiu C, Cui C, Hautefort C, Haehner A, Zhao J, Yao Q, et al. Olfactory and gustatory dysfunction as an early identifier of covid-19 in adults and children: an international multicenter study. Otolaryngol Head Neck Surg. 2020;163(4):714-721. http://dx.doi.org/0194599820934376]	Case Series	161 patients (10 adolescents)	15-17	Multicenter study evaluated characteristics and prevalence of olfactory and gustatory symptoms in adult and pediatric patients related to COVID-19. Three hospitals in China, 1 in France, 1 in Germany participated	Gustatory dysfunction, hypogeusia	Not reported	Olfactory and / or taste disorders may represent early or isolated symptoms of COVID-19. They can serve as a useful additional screening criterion, primarily for identifying patients in the early stages of infection.
Mak et al. [²⁵25 Mak PQ, Chung KS, Wong JS, Shek CC, Kwan MY. Anosmia and ageusia: not an uncommon presentation of covid-19 infection in children and adolescents. Pediatr Infect Dis J. 2020;39(8):e199-e200. http://dx.doi.org/10.1097/INF.0000000000002718 https://doi.org/10.1097/INF.000000000000... ]	Case report	3 patients	14 15 17	Report 3 cases of pediatric patients with COVID-19 who had anosmia and / or ageusia	Gustatory dysfunction, ageusia	Not reported	Children and adolescents with COVID-19 infection may present only anosmia or ageusia in the absence of other respiratory symptoms
Klimach et al. [¹⁵15 Klimach A, Evans J, Stevens J, Creasey N. Rash as a presenting complaint in a child with COVID-19. Pediatr Dermatol. 2020;37(5):966-967. http://dx.doi.org/10.1111/pde.14257 https://doi.org/10.1111/pde.14257... ]	Case report	1 patient	13	Report 1 case of a patient (13 years old) with COVID-19 who presented cutaneous lesions located in the armpits, lower limbs and soles	Not reported	Multiple erythematous papular eruptions Erythematous macules associated with petechiae - Location: Foot soles and legs	The morphology was predominantly maculopapular, but also included petechiae and annular lesions. This suggests that the professional should consider the possibility of diagnosing COVID-19 in the presence of these lesions
Kaya et al. [¹³13 Kaya G, Kaya A, Saurat JH. Clinical and histopathological features and potential pathological mechanisms of skin lesions in covid-19: review of the literature. Dermatopathology. 2020;7(1):3-16. http://dx.doi.org/10.3390/dermatopathology7010002 https://doi.org/10.3390/dermatopathology... ]	Literature review.	57 studies (9 studies with children and adolescents, n = 48 patients)	7,5 - 17	To present a review of the clinical and histopathological characteristics and the potential pathological mechanisms of skin lesions in patients with COVID-19 - from 57 studies (case reports or case series)	Not reported	Erythematous, multiform rash Purpuric lesions Urticarias - Location: Torso, feet Hands, elbows scalp	The minority of patients included in the studies were children with acral lesions, papular vesicular rashes or pediatric multisystem inflammatory syndrome similar to Kawasaki disease
Ortiz et al. [³⁰30 Ortiz MS, Peñalver PR, Romero GR, Serrano MML. Lesiones cutáneas en paciente con infección por SARS-COV-2 [Skin lesions in a patient with SARS-COV-2 infection]. An Pediatr. 2020;93(2):144-145. http://dx.doi.org/10.1016/j.anpedi.2020.04.020 https://doi.org/10.1016/j.anpedi.2020.04... ]	Case report	1 patient	9	To report a clinical case of skin lesions (pruritic rash) associated with COVID-19 in a 9-year-old girl	Not reported	Erythematous micropapular rash Edematous lesions - Location: The entire surface of the body, most visible at the lower extremities, toes	Micropapular rashes spread throughout the body
Papa et al. [³¹31 Papa A, Salzano AM, Di Dato MT, Varrassi G. Images in practice: painful cutaneous vasculitis in a sars-cov-2 igg-positive child. Pain Ther. 2020;9(2):805-807. http://dx.doi.org/10.1007/s40122-020-00174-4 https://doi.org/10.1007/s40122-020-00174... ]	Case report	1 patient	11	Report a clinical case of a child (11 years old) with foot lesions, after having observed it in 10 more patients who tested positive Sars-CoV-2, from a sample of 44,000 patients	Not reported	Erythematous cutaneous lesions similar to chilblains on the toes and various ulcerative lesions with nail dyschromia - Location: Feet and nails	The child had painful vasculitic skin lesions on his/her feet
Genovese et al. [³²32 Genovese G, Colonna C, Marzano AV. Varicella-like exanthem associated with COVID-19 in an 8-year-old girl: A diagnostic clue?. Pediatr Dermatol. 2020;37(3):435-436. http://dx.doi.org/10.1111/pde.14201 https://doi.org/10.1111/pde.14201... ]	Case report	1 patient	8	Report a clinical case of a child (8 years old) with mild systemic symptoms of chickenpox associated with COVID-19	Not reported	Erythematous papules and vesicles - Location: Torso (bilaterally and symmetrically)	Although the data does not prove that this rash is caused or is definitely associated with COVID-19, the authors suggest that papulovesicular rashes are included in the spectrum of rashes possibly associated with COVID-19
Marzano et al. [³³33 Marzano AV, Cassano N, Genovese G, Moltrasio C, Vena GA. Cutaneous manifestations in patients with COVID-19: a preliminary review of an emerging issue. Br J Dermatol. 2020 Sep;183(3):431-442. https://doi.org/10.1111/bjd.19264 https://doi.org/10.1111/bjd.19264... ]	Literature review.	33 patients (3 children)	6 8 2 months	Provide an overview of the cutaneous manifestations associated with COVID-19.	Not reported	Erythema, non-purulent maculopapular rash, urticaria, asymptomatic papulovesicular lesions, skin lesion similar to chickenpox - Location: Torso Upper and lower limbs	Skin manifestations associated with COVID-19 can be prognostic markers that need to be studied in-depth, due to the heterogeneity of the lesions and other systemic factors involved

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[1] Correspondence to: LF SANGLARD. E-mail: lusanglard@gmail.com.