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\begin{document}

\title{Oral lesion and microbiome diversity in COVID-19 hospitalized patients.}



\author[1]{Silvia Costa}%
\author[1]{Joyce Vanessa Da Silva Fonseca}%
\author[1]{Nazareno Scaccia}%
\author[2]{Sumatra Melo Da Costa Pereira Jales}%
\author[1]{Pablo Andres Munoz Torres}%
\author[1]{Lucas Augusto Moyses Franco}%
\author[3]{Cesar Augusto Migliorati}%
\author[4]{Bernal Stewart}%
\author[1]{Alessandra Lunis}%
\author[5]{Rodrigo Melim Zerbinati}%
\author[3]{Roberta Pilleggii}%
\author[5]{Paulo Henrique Braz-Silva}%
\author[1]{Ester C. Sabino}%
\affil[1]{Unilever Brasil Sao Paulo}%
\affil[2]{Universidade de Sao Paulo Hospital das Clinicas}%
\affil[3]{University of Florida}%
\affil[4]{Colgate Palmolive Co}%
\affil[5]{Universidade de Sao Paulo Instituto de Medicina Tropical de Sao Paulo}%


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  \date{May 25, 2024}


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\begin{abstract}
\textbf{Introduction}: The oral cavity is an important site for the
entry and multiplication of respiratory viruses, and the immune system
and oral microbiome act as antiviral barriers. Data regarding oral
microbiome and COVID-19 is scarce. Therefore, a prospective cohort was
conducted at the Hospital das Cl\selectlanguage{ngerman}ínicas of FMUSP to evaluate the
frequency of oral lesions associated with COVID-19 and the diversity of
the oral microbiome on disease severity. \textbf{Methods}: Oral samples
from SARS-CoV-2 positive patients were collected. After DNA extraction
from the whole saliva samples, sequencing of the 16S rRNA gene using the
Ion Torrent PGM platform was performed. Alpha and beta diversity
analyses were conducted using the R program. Clinical data from
electronic medical records were collected and multiple logistic
regression model was constructed to assess the association between oral
microbiome diversity and COVID-19 severity (oxygen therapy, mechanical
ventilation). \textbf{Results}: The study included a total of 115
samples from 125 patients, 14 had oral lesions, the majority were female
(54.8\%), with a mean age of 55.4 years old. Around 59.1\% of patients
were in intensive care units(ICUs), 87.2\% were using antibiotics, and
18.3\% died. The most frequently antibiotics used were third-generation
cephalosporins(35.7\%), piperacillin/tazobactam(27\%), and
glycopeptides(21.7\%). In general, the most abundant phyla were
\emph{Firmicutes}, \emph{Proteobacteria}, and \emph{Bacteroidetes},
representing 86.3\% of the oral microbiome. Oral microbiome diversity
analysis revealed statistical differences in COVID-19 severity (Shannon
p=0.05), presence of oral lesions Shannon p=0.05), antibiotic
use(Shannon p=0.04), and oxygen therapy Observed p=0.04). Differential
abundance analysis identified specific taxa related to each variable,
such as \emph{Prevotella} in severe patients and \emph{Staphylococcus}
in individuals with oral lesions. Multivariable logistic regression
pointed out that the SARS-CoV-2 PCR positive on the oral cavity and the
age (above 60 years) were risk factors for disease severity.
\textbf{Conclusion}: Despite the small number of participants with oral
cavity lesions, we found significant differences in the microbial
communities, particularly in the genus \emph{Staphylococcus}d associated
with oral lesions. Although the abundance of \emph{Prevotella} was
associated with severity of COVID-19 on the microbiome analysis, the
multivariate model showed that only age and RT-PCR positive for
SARS-CoV-2 on the oral cavity were independent risk factors for
severity.%
\end{abstract}\selectlanguage{ngerman}%



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\textbf{Hosted file}

\verb`MicrobiomeOralCOVID-19.docx`  available at \url{https://authorea.com/users/666162/articles/667143-oral-lesion-and-microbiome-diversity-in-covid-19-hospitalized-patients}

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