Reactive infectious mucocutaneous eruption (RIME) associated with COVID-19 infection

A 24-year-old man presented with a 7-day history of oral ulceration and 3-day history of erythema at the urethral meatus with one erythematous papule on the scrotum. The patient had tested positive for COVID-19 on polymerase chain reaction test. The patient had not eaten for 6 days, managing only sips of water. There were no new medications and no recent vaccinations. On examination his lips were ulcerated with haemorrhagic crust. His tongue had significant swelling and ulceration. There was erythema and superficial ulceration surrounding the urethral meatus. Thus, the patient had mucosal involvement only, with no target lesions, blisters or epidermal detachment. Inflammatory markers were raised. The initial impression was that of reactive infectious mucocutaneous eruption (RIME) associated with COVID-19 infection, given the likely viral cause, in a systemically well, young patient. The differential included erythema multiforme major, Stevens-Johnson syndrome and pemphigus vulgaris. Bacterial and viral swabs, septic screen, sexually transmitted infection screen including HIV, circulating skin antibodies were all negative. The patient was treated with topical and systemic steroids, with a catheter to prevent urethral stenosis, intravenous Pabrinex®, oral nutritional supplements, analgesia, Difflam™ mouthwash, betamethasone mouth rinse and lidocaine mouth spray. The patient's symptoms had resolved after 6 weeks. This case demonstrates the multispecialty management of a patient presenting acutely with RIME secondary to COVID-19, who was treated successfully with oral and topical steroids.

Physicochemical indicators of dental patient saliva who have undergone an uncomplicated coronavirus infection

Today, it has been proven that saliva is the main medium through which the new COVID-19 coronavirus infection spreads. Since the oral cavity is the gateway for the SARS-CoV-2 virus, the degree of change in the physicochemical parameters of the saliva of people who have had coronavirus infection compared to people who have not had COVID-19 is of interest. This study involved dental patients of the first and second health groups with a history of chronic generalized periodontitis of moderate degree in the stage of remission. We studied physicochemical parameters of saliva such as pH, surface tension and base buffering capacity. The results of this stage of the study showed saliva acidification, that is a decrease in pH in people who had had a new coronavirus infection compared to the indicators of people from the control group. The average values of the surface tension of saliva in patients of the control group are 30% less than in those who have had COVID-19. This indicates that the saliva of people who have not been sick with the new coronavirus contains more surface-active agents (surfactants). Surfactants provide rinsing and disinfecting functions of saliva, therefore, it can be concluded that these functions are less pronounced in patients who have recovered from COVID-19. The base buffering capacity of the saliva of patients who have had COVID-19 is, on average, 35% higher than that of people from the control group. Thus, the pH and the base buffering capacity are in correlation: the lower the pH value, the higher the acidity of the saliva and the higher the base buffering capacity is. At the second stage of the study, similar physicochemical parameters of patients’ saliva were measured after the application of an oral spray containing a synthetic peptide (ZP2) of the active center of granulo-cyte-macrophage colony-stimulating factor. This spray was used as an antibacterial therapy for the oral cavity after professional hygiene of patients. In 5 minutes after spray irrigation, an increase in saliva pH was observed in all test subjects within the physiological norm. In patients, regardless of their anamnesis, the surface tension of saliva changed in different ways. In a number of people, it increased, which indicates an increase in the concentration of surfactants in saliva, while in others it decreased, which can be explained by the high rate of penetration of surfactants from saliva through the gums into the blood. After the application of the ZP-2 peptide, the base buffering capacity of saliva decreases or remains unchanged. In patients of the control group, the indicators of the base buffering capacity of saliva change less than in patients who have undergone COVID-19. All the studied physicochemical parameters of saliva in patients who had had uncomplicated COVID-19, three months after receiving two negative results for the SARS-CoV-2 virus, remained within the physiological norm.

Virucidal activity of nasal sprays against severe acute respiratory syndrome coronavirus-2.

The highest viral loads of severe acute respiratory syndrome coronavirus-2 are detectable in the oral cavity, so a potential reduction of infectious virus by nasal and oral sprays could reduce transmission. Therefore, the inactivation capacity of nine nasal and oral sprays was evaluated according to EN 14476. One nasal spray based on sodium hypochlorite and one oral spray containing essential oils reduced viral titres by two to three orders of magnitude. Although clinical data are still sparse, nasal and oral sprays display a more convenient application for elderly people or those who are unable to rinse/gargle.

Does Trypsin Oral Spray (Viruprotect®/ColdZyme®) Protect against COVID-19 and Common Colds or Induce Mutation? Caveats in Medical Device Regulations in the European Union.

BACKGROUND: nasal or oral sprays are often marketed as medical devices (MDs) in the European Union to prevent common cold (CC), with ColdZyme®/Viruprotect® (trypsin/glycerol) mouth spray claiming to prevent colds and the COVID-19 virus from infecting host cells and to shorten/reduce CC symptoms as an example. We analyzed the published (pre)-clinical evidence. METHODS: preclinical: comparison of in vitro tests with validated host cell models to determine viral infectivity. Clinical: efficacy, proportion of users protected against virus (compared with non-users) and safety associated with trypsin/glycerol. RESULTS: preclinical data showed that exogenous trypsin enhances SARS-CoV-2 infectivity and syncytia formation in host models, while culture passages in trypsin presence induce spike protein mutants. The manufacturer claims >98% SARS-CoV-2 deactivation, although clinically irrelevant as based on a tryptic viral digest, inserting trypsin inactivation before host cells exposure. Efficacy and safety were not adequately addressed in clinical studies or leaflets (no COVID-19 data). Protection was obtained among 9-39% of users, comparable to or lower than placebo-treated or non-users. Several potential safety risks (tissue digestion, bronchoconstriction) were identified. CONCLUSIONS: the current European MD regulations may result in insufficient exploration of (pre)clinical proof of action. Exogenous trypsin exposure even raises concerns (higher SARS-CoV-2 infectivity, mutations), whereas its clinical protective performance against respiratory viruses as published remains poor and substandard.