Rajeev Chitguppi MDS Profile picture
Jun 30, 2020 9 tweets 4 min read Read on X
All early studies on Chlorhexidine (CHX) had used

1. very low concentration of CHX (0.01- 0.02% w/v)
2. only as a surface disinfectant
3. Tested against viruses other than SARS-COV-2.

This had given an erroneous impression that CHX may not be useful against SARS-COV-2.
But that was only till March 2020.

Latest evidence 1:

1. Lancet journal study (in vitro) published (April 2020) by Hong Kong university researchers showed that Chlorhexidine inactivated the virus at 0.05% w/v

thelancet.com/journals/lanmi…
2. Korean study (clinical study in patients as a mouthwash, May 2020) showed that Chlorhexidine reduced #SARSCOV2 viral load in saliva for 2 hrs. After 2 hrs viral load in saliva began to rise. This low viral load phase is important in clinic & community.

ncbi.nlm.nih.gov/pmc/articles/P…
Real world implications:
1. Doctors can complete their check up & clinical procedures in 2 hrs.
2. People getting into domestic flights can use CHX mouthwash & prevent spread inside the aircraft.
3. People who are in home quarantine can prevent spread to family members.
#COVID19
#COVID19 spreads by droplets in close contact. It can spread via coughing, sneezing & even talking because Saliva contains high viral loads #SARSCOV2. A single rinse with Chlorhexidine can reduce this viral load in saliva. 10 ml of 0.20% CHX mouthwash be used for 30 sec.
Analysis of all early studies done on Chlorhexidine that gave an erroneous impression that CHX may not be effective against #nCoV2019 #SARSCoV2 plus the latest Lancet study (Apr 2020) showing CHX to be effective against SARS-COV-2. My Researchgate article
researchgate.net/publication/34…
It's time to add Chlorhexidine to the #COVID19 prevention protocols

Before moving out of your home
1. Use Chlorhexidine mouthwash. 10 ml of 0.20% w/v CHX rinsed for 30 sec (10- 20- 30 rule)
2. Wear the right mask the right way
3. Well fitting Eyewear
4. Physical distancing
Can we give the same confidence with other mouth rinses like Povidone Iodine, Essential oil mouthwashes, Hydrogen peroxide, Hypochlorous acid?

The answer is NOT YET.

None of them has been tested clinically against SARS-COV-2 to show how long they can reduce the viral loads.
Chlorhexidine in OT: Dexter et al (July 2020)
Infection control in Operation Theatres during COVID-19

1. Alcohol hand rubs
2. Wipes with Quarternary Ammonium Compounds & Alcohol for equipment
surfaces
3. Preprocedural Chlorhexidine wipes & mouth rinses
journals.lww.com/anesthesia-ana…

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More from @chitguppi

Jan 8, 2022
1/ Who gets severe COVID-19?

COVID-19 is a double-defect disease:

1. A defective early control of the virus by type I / III Interferons (IFN)

2. An impaired ability to control proinflammatory activities.

Only when both these checkpoints fail will critical disease develop.
2/ Interferons (IFN)

SARS-CoV-2 is a poor inducer of IFN:

Triggers limited & delayed type I / III IFN responses.

On the other hand, the virus is highly sensitive to IFN treatment similar to other coronaviruses.
3/ Despite modest IFN induction, this innate antiviral response is critical for infection control. #COVID19

@SciImmunology 7 Jan 2022

science.org/doi/10.1126/sc…
Read 6 tweets
Jan 8, 2022
Neutralizing antibodies are a good indicator of protection,
- not only against severe disease
- but also (if amounts are very high) against viral replication in the mucosa (with or without symptoms), thereby reducing transmission. #COVID19

However... 1/n science.org/doi/10.1126/sc…
However, this does not mean that it is circulating antibody that is causing protection:

- Antibody in the serum does not normally diffuse (or get transported) into mucosal fluids.

- Also... (2/n)
science.org/doi/10.1126/sc…
Also, protection against superficial infection depends on

- mucosal antibodies [including immunoglobulin A (IgA)],

and possibly on

- antiviral T cells that reside within the linings of the respiratory tract. (3/n)
science.org/doi/10.1126/sc…
Read 5 tweets
Jan 4, 2022
1/ Which oral/ periodontal pathogen acts similar to viruses when it comes to suppressing host immunity?

Background:

Anatomical (mucosal/ epithelial) barriers confer antiviral immunity via interferon (IFN) production.

IFNs function like antiviral cytokines...
2/ IFNs function as antiviral cytokines and restrict viral infection, replication, and release.

Oral epithelial cells fight viral infections by inducing Type III IFNs (IFN-λ) preferentially.

Latest evidence:

Recent study PNAS, 21 Dec 2021
3/ A recent study showed that IFN production and antiviral immunity are severely compromised by one oral bacterial pathogen.

And that is Porphyromonas gingivalis (Pg).

Molecular pathways employed by Pg are strikingly parallel to those utilized by viruses for IFN suppression.
Read 4 tweets
Jan 4, 2022
1/ Delta variant was highly pathogenic due to its ability to cause cell-cell fusion & syncytia formation.

But this pathogenicity came with Terms & Conditions.

"S1/2 cleavage should be optimal for cells expressing TMPRSS2 (lower airway)"

Omicron #COVID19 story is different.
2/ Cell-cell fusion mediated by spike glycoprotein requires S1/S2 cleavage, but is also dependent on TMPRSS2 presence.

Omicron spike is relatively poorly cleaved.

Way suboptimal compared to Delta

Due to this suboptimal cleavage lower airway infection is less with Omicron.
3/ So, Omicron shows impaired entry & replication in lung cells that express TMPRSS2 (a serine protease enriched in lung alveolar type 1 & 2 cells).

This reduced cleavage is also associated with poorer cell-cell fusion and syncytia formation.

This tells us about upper airway
Read 5 tweets
Jan 3, 2022
1/ Omicron's 3 mutations (P681H, H655Y, N679K) in furin cleavage site region were initially predicted to favor its pathogenicity: cell-cell fusion & syncytia formation.

But reality is different.

Omicron's cleavage efficiency is substantially lower than Delta variant. #COVID19
2/ Omicron spike is relatively poorly cleaved.

It shows impaired entry & replication in lung cells that express TMPRSS2, a serine protease enriched in lung alveolar type 1 & 2 cells.

This reduced cleavage is also associated with poorer cell-cell fusion and syncytia formation.
3/ Cell-cell fusion mediated by spike glycoprotein requires S1/S2 cleavage, but is also dependent on TMPRSS2 presence.

Fusogenicity of Omicron spike was severely impaired despite TMPRSS2 expression, leading to marked reduction in syncytium formation compared to Delta spike.
Read 4 tweets
Jan 3, 2022
Omicron infects throat more & lungs less compared to earlier variants.

Simple strategy: As soon as you get sore throat start with Chlorhexidine (CHX) mouthwash for throat gargling

Study: 4 day CHX use eliminated #SARSCOV2 virus from oropharynx. #COVID19
All studies done on Chlorhexidine and its antiviral actions esp. against SARS-COV-2 summarized in my blog

"Chlorhexidine gluconate — the most effective antiviral mouthwash in COVID-19 pandemic"

chitguppi.medium.com/chlorhexidine-…
My earlier thread on Chlorhexidine mouthwash and its antiviral effects against SARS-COV-2

Read 5 tweets

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