RESUMO
Cranial nerve involvement is a finding often observed in patients infected with severe acute respiratory syndrome coronavirus 2 during the pandemic outbreak of coronavirus disease 2019 (COVID-19). To our knowledge, this is the first report of oropharyngeal dysphagia associated with COVID-19. A 70-year-old male developed dysphagia and consequent aspiration pneumonia during recovery from severe COVID-19. He had altered sense of taste and absent gag reflex. Videoendoscopy, videofluorography, and high-resolution manometry revealed impaired pharyngolaryngeal sensation, silent aspiration, and mesopharyngeal contractile dysfunction. These findings suggested that glossopharyngeal and vagal neuropathy might have elicited dysphagia following COVID-19. The current case emphasizes the importance of presuming neurologic involvement and concurrent dysphagia, and that subsequent aspiration pneumonia might be overlooked in severe respiratory infection during COVID-19.
Assuntos
Infecções por Coronavirus/complicações , Transtornos de Deglutição/etiologia , Pneumonia Aspirativa/etiologia , Pneumonia Viral/complicações , Idoso , COVID-19 , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/patologia , Transtornos de Deglutição/virologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/virologia , Masculino , Orofaringe/patologia , Orofaringe/virologia , Pandemias , Pneumonia Aspirativa/virologia , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/patologia , Tomografia Computadorizada por Raios XAssuntos
Bluetongue/complicações , Surtos de Doenças/veterinária , Doenças do Esôfago/veterinária , Pneumonia Aspirativa/veterinária , Doenças dos Ovinos/epidemiologia , Animais , Brasil/epidemiologia , Doenças do Esôfago/epidemiologia , Doenças do Esôfago/patologia , Doenças do Esôfago/virologia , Músculo Esquelético/patologia , Pneumonia Aspirativa/epidemiologia , Pneumonia Aspirativa/patologia , Pneumonia Aspirativa/virologia , Ovinos , Doenças dos Ovinos/patologia , Doenças dos Ovinos/virologiaRESUMO
To examine the role of disturbed upper airway reflexes in aspiration, we administered 20 microliters of the adenovirus (Ad) vector Ad-CMV-LacZ or 20 microliters of phosphate buffered saline (PBS) intranasally to C57 black mice. We investigated expression of the LacZ gene by this Ad vector in the nostrils of each mouse, with or without anesthesia. Under anesthesia, LacZ gene expression was detected in the lungs of every mouse given the Ad vector. However, no LacZ gene expression was found in the trachea or lungs of mice given the Ad vector without anesthesia. In mice given PBS or wild-type adenovirus transnasally during anesthesia, there was no LacZ gene expression in the nostrils, trachea, or lungs, suggesting that with 5-bromo-4-chloro-3-indolyl-beta-D-galactopyranoside (X-gal) staining, blue-stained cells indicated transferred LacZ gene expression. These results suggested that aspiration of intranasal solution into lower airways was caused by disturbed upper airway reflexes during anesthesia. This process can be analyzed by the distribution of LacZ gene expression in airways. We next examined the effect of age on anesthesia-induced aspiration. Twenty-six-mo-old mice exhibited more LacZ gene expression in their lungs than did 6-mo-old mice at a concentration of 0.5 to 4.0% halothane in 100% oxygen. This suggests that light anesthesia may depress upper airway reflexes and cause aspiration in older animals. This novel model of aspiration, generated with the Ad-CMV-LacZ vector, may be useful for elucidating the mechanism of development of aspiration pneumonia in relation to age-related impairment of upper airway reflexes.