251
|
Kang YJ, Cho JH, Lee MH, Kim YJ, Park CS. The diagnostic value of detecting sudden smell loss among asymptomatic COVID-19 patients in early stage: The possible early sign of COVID-19. Auris Nasus Larynx 2020; 47:565-573. [PMID: 32553562 PMCID: PMC7282761 DOI: 10.1016/j.anl.2020.05.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/12/2020] [Accepted: 05/27/2020] [Indexed: 12/13/2022]
Abstract
IMPORTANCE The newly emerged coronavirus disease 19 (COVID-19), is threatening the world. Olfactory or gustatory dysfunction is reported as one of the symptoms worldwide. As reported so far, different clinical features have been reported according to outbreak sites and gender; most of the patients, who complained of anosmia or hyposmia, were Europeans. We had a fast review for novel articles about COVID-19 infection and olfactory function. OBSERVATIONS Rapid reviews for COVID-19 or other viral infection and olfactory and/or gustatory dysfunctions were done in this review. Up to date, a lot of reports have shown that olfactory dysfunction is related to viral infections but no exact mechanism, clinical course, and definite treatment have been discovered, which is also same in COVID-19. In general, intranasal steroid (INS) and oral steroid for short time help improve the recovery of the olfactory function in case of olfactory dysfunction after virus infection. Considering severe respiratory complications and immunocompromised state of COVID-19, the use of steroid should be limited and cautious because we do not have enough data to support the usage of steroid to treat olfactory dysfunction in the clinical course of COVID-19. CONCLUSIONS AND RELEVANCE In the days of pandemic COVID-19, we should keep in mind that olfactory dysfunctions, even without other upper respiratory infection or otolaryngologic symptoms, might be the early signs of COVID-19.
Collapse
Affiliation(s)
- Yun Jin Kang
- Department of Otolaryngology-Head and Neck Surgery, St. Vincent's hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Jin Hee Cho
- Department of Otolaryngology-Head and Neck Surgery, Yeouido St. Mary's hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Min Hyeong Lee
- Department of Otolaryngology-Head and Neck Surgery, St. Vincent's hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Yeon Ji Kim
- Department of Otolaryngology-Head and Neck Surgery, St. Vincent's hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Chan-Soon Park
- Department of Otolaryngology-Head and Neck Surgery, St. Vincent's hospital, College of Medicine, The Catholic University of Korea, Republic of Korea.
| |
Collapse
|
252
|
Carpenter CR, Mudd PA, West CP, Wilber E, Wilber ST. Diagnosing COVID-19 in the Emergency Department: A Scoping Review of Clinical Examinations, Laboratory Tests, Imaging Accuracy, and Biases. Acad Emerg Med 2020; 27:653-670. [PMID: 32542934 PMCID: PMC7323136 DOI: 10.1111/acem.14048] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 12/13/2022]
Abstract
Objective Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) emerged as a global pandemic in early 2020 with rapidly evolving approaches to diagnosing the clinical illness called coronavirus disease (COVID‐19). The primary objective of this scoping review is to synthesize current research of the diagnostic accuracy of history, physical examination, routine laboratory tests, real‐time reverse transcription–polymerase chain reaction (rRT‐PCR), immunology tests, and computed tomography (CT) for the emergency department (ED) diagnosis of COVID‐19. Secondary objectives included a synopsis of diagnostic biases likely with current COVID‐19 research as well as corresponding implications of false‐negative and false‐positive results for clinicians and investigators. Methods A Preferred Reporting Items for Systematic Reviews and Meta‐Analyses–Scoping Review (PRISMA‐ScR)–adherent synthesis of COVID‐19 diagnostic accuracy through May 5, 2020, was conducted. The search strategy was designed by a medical librarian and included studies indexed by PubMed and Embase since January 2020. Results A total of 1,907 citations were screened for relevance. Patients without COVID‐19 are rarely reported, so specificity and likelihood ratios were generally unavailable. Fever is the most common finding, while hyposmia and hypogeusia appear useful to rule in COVID‐19. Cough is not consistently present. Lymphopenia is the mostly commonly reported laboratory abnormality and occurs in over 50% of COVID‐19 patients. rRT‐PCR is currently considered the COVID‐19 criterion standard for most diagnostic studies, but a single test sensitivity ranges from 60% to 78%. Multiple reasons for false‐negatives rRT‐PCR exist, including sample site tested and disease stage during which sample was obtained. CT may increase COVID‐19 sensitivity in conjunction with rRT‐PCR, but guidelines for imaging patients most likely to benefit are emerging. IgM and IgG serology levels are undetectable in the first week of COVID‐19, but sensitivity (range = 82% to 100%) and specificity (range = 87% to 100%) are promising. Whether detectable COVID‐19 antibodies correspond to immunity remains unanswered. Current studies do not adhere to accepted diagnostic accuracy reporting standards and likely report significantly biased results if the same tests were to be applied to general ED populations with suspected COVID‐19. Conclusions With the exception of fever and disorders of smell/taste, history and physical examination findings are unhelpful to distinguish COVID‐19 from other infectious conditions that mimic SARS‐CoV‐2 like influenza. Routine laboratory tests are also nondiagnostic, although lymphopenia is a common finding and other abnormalities may predict severe disease. Although rRT‐PCR is the current criterion standard, more inclusive consensus‐based criteria will likely emerge because of the high false‐negative rate of PCR tests. The role of serology and CT in ED assessments remains undefined.
Collapse
Affiliation(s)
- Christopher R. Carpenter
- From the Department of Emergency Medicine Washington University in St. Louis School of MedicineEmergency Care Research Core St. Louis MO USA
| | - Philip A. Mudd
- From the Department of Emergency Medicine Washington University in St. Louis School of MedicineEmergency Care Research Core St. Louis MO USA
| | - Colin P. West
- the Division of General Internal Medicine Department of Medicine Division of Biomedical Statistics and Informatics Mayo Clinic Rochester MN USA
| | | | | |
Collapse
|
253
|
Elmashala A, Chopra S, Garg A. The Neurologic Manifestations of Coronavirus Disease 2019. JOURNAL OF NEUROLOGY RESEARCH 2020; 10:107-112. [PMID: 33984103 PMCID: PMC8040454 DOI: 10.14740/jnr603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/15/2020] [Indexed: 12/29/2022]
Abstract
The coronavirus disease 2019 (COVID-19) is an ongoing global pandemic that has so far affected 216 countries and more than 5 million individuals worldwide. The infection is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While pulmonary manifestations are the most common, neurological features are increasingly being recognized as common manifestations of the COVID-19, especially in the cases of severe infection. These include acute cerebrovascular disease, encephalitis, and Guillain-Barre syndrome (GBS). Here, we review the neuropathogenesis of SARS-CoV-2 and the central and peripheral nervous system manifestations of COVID-19.
Collapse
Affiliation(s)
- Amjad Elmashala
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Saurav Chopra
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Aayushi Garg
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| |
Collapse
|
254
|
Mishra P, Gowda V, Dixit S, Kaushik M. Prevalence of New Onset Anosmia in COVID-19 Patients: Is The Trend Different Between European and Indian Population? Indian J Otolaryngol Head Neck Surg 2020; 72:484-487. [PMID: 32837939 PMCID: PMC7373335 DOI: 10.1007/s12070-020-01986-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 outbreak is major pandemic affecting lakhs of people all across the globe. Along with other nonspecific clinical features, reports mention anosmia to be an important symptom in COVID-19 positive patients. To study the prevalence of anosmia in confirmed COVID-19 patients, in Indian population and to ascertain its significance as a symptom of COVID 19. Study was done at a tertiary care COVID treating hospital. While eliciting detailed history from Covid-19 positive patients, all patients were asked about symptom of anosmia. Same was asked from control group of subjects who were COVID-19 negative. The history of anosmia was also elicited on discharge after the patients tested negative for COVID-19. 74 patients formed part of the study. 11 of 74 (14.8%) patients had anosmia. On using the chi square test for significance the difference was significant (p < .01), suggesting anosmia to be a significant clinical feature in COVID-19 patients. On comparing with world literature it was observed that the prevalence of anosmia is higher in European population as compared to Indian Also the symptom of anosmia improved when the patient recovered from the disease. Prevalence of new onset anosmia in Indian population with COVID-19 is 14.8%. Symptom of anosmia in present times should be considered as a important clinical feature and should raise a suspicion of COVID-19. The prevalence of anosmia in Indian population is much lesser than that reported in European population.
Collapse
Affiliation(s)
- Prasun Mishra
- Department of ENT, Bharati Vidyapeeth Medical College, Pune, 411046 India
| | - Vishwanath Gowda
- Department of ENT, Bharati Vidyapeeth Medical College, Pune, 411046 India
| | - Shivani Dixit
- Department of ENT, Bharati Vidyapeeth Medical College, Pune, 411046 India
| | - Maitri Kaushik
- Department of ENT, Bharati Vidyapeeth Medical College, Pune, 411046 India
| |
Collapse
|
255
|
Sayin I, Yazici ZM. Taste and Smell Impairment in SARS-CoV-2 Recovers Early and Spontaneously: Experimental Data Strongly Linked to Clinical Data. ACS Chem Neurosci 2020; 11:2031-2033. [PMID: 32539346 PMCID: PMC7328466 DOI: 10.1021/acschemneuro.0c00296] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/15/2020] [Indexed: 01/05/2023] Open
Abstract
A growing body of literature indicates that smell and taste impairment has frequently occurred during the Severe Acute Respiratory Syndrome (SARS)-like Coronavirus (SARS-CoV-2) outbreak. Experimental studies have mostly found that non-neural-type cells are responsible for SARS-CoV-2-related taste and smell impairment. If this is the case, smell/taste impairment needs to recover early. Literature data from clinical studies indicated a strong correlation between experimental and clinical findings. This article presents clinical studies related to SARS-CoV-2-induced smell/taste impairment that reported recovery rates. Experimental researchers may use these data to observe the dynamics of smell impairment and implement these findings in their research (e.g., correct timing of sampling) to perform further studies.
Collapse
Affiliation(s)
- Ibrahim Sayin
- Department of Otolaryngology Head and Neck Surgery,
Bakırköy Dr. Sadi Konuk Teaching and
Research Hospital, 34147 Istanbul,
Turkey
| | - Zahide Mine Yazici
- Department of Otolaryngology Head and Neck Surgery,
Bakırköy Dr. Sadi Konuk Teaching and
Research Hospital, 34147 Istanbul,
Turkey
| |
Collapse
|
256
|
Keita A, Bacharou HA, Diallo I, Camara A. [Anosmia without aguesia in COVID-19 patients: about 2 cases]. Pan Afr Med J 2020; 36:176. [PMID: 32952820 PMCID: PMC7467895 DOI: 10.11604/pamj.2020.36.176.24027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/11/2020] [Indexed: 11/11/2022] Open
Abstract
During the ongoing pandemic, anosmia, whether or not associated with aguesia, has been a common symptom in patients with SARS-CoV-2 infection causing COVID-19. We here report two cases of anosemia without aguesia in adults with COVID-19. The onset was brutal and symptomsa persisted for a few weeks after healing. The patients presented to the ENT Department where they received no therapy and underwent outpatient surveillance. After 5 weeks, patients reported they had recovered the sense of smell. This study highlights that anosmia can occur without aguesia and persist after healing in COVID-19 patients. Recovery of the smell is possible after a few weeks without medical treatment. That is why, patients follow-up is essential in subjects recovered from COVID-19 to better understand the course of persistent symptoms.
Collapse
Affiliation(s)
- Abdoulaye Keita
- Service Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital National Donka, CHU de Conakry, Guinée
| | - Hamza Abdou Bacharou
- Service Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, CHU Yalgado Ouédraogo, Burkina Faso
| | - Ibrahima Diallo
- Service Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital National Donka, CHU de Conakry, Guinée
| | - Alseny Camara
- Service Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital National Donka, CHU de Conakry, Guinée
| |
Collapse
|
257
|
Does COVID-19 cause permanent damage to olfactory and gustatory function? Med Hypotheses 2020; 143:110086. [PMID: 32721795 PMCID: PMC7346823 DOI: 10.1016/j.mehy.2020.110086] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/01/2020] [Accepted: 07/04/2020] [Indexed: 01/05/2023]
Abstract
The objective of this study was to investigate the status of COVID-19 patients with sudden anosmia and dysgeusia using an olfactory dysfunction questionnaire highlighting recovery times. This prospective study included 75 patients who completed a patient-reported outcome questionnaire. Among these, 46 patients completed an olfactory evaluation based on the duration of anosmia and dysgeusia. The olfactory evaluation revealed that 24% (N = 18) of patients had mild hyposmia, 13% (N = 10) had moderate hyposmia, 30% (N = 23) had severe hyposmia, 32% (N = 24) had anosmia, and 100% had dysgeusia (N = 75). The viral load significantly decreased throughout the 17 days following the onset of the olfactory disorder. The purpose of this study was to understand whether patients with COVID-19 can recover olfactory and gustatory function, in contrast to patients with other rhinoviruses and inflammatory diseases such as rhinosinusitis chronic and rhinosinusitis with polyps. These preliminary clinical findings indicate that the relatively rapid recovery of olfactory and gustative function can mean a resolution of viral infection in most patients. The present study suggests that coronavirus can induce olfactory dysfunction but not permanent damage. Olfactory and gustatory functional impairment has been recognized as a hallmark of COVID-19 and may be an important predictor of clinical outcome. Our study supports the need to add anosmia and dysgeusia to the list of symptoms used in screening tools for possible COVID-19 infection.
Collapse
|
258
|
Hannum ME, Ramirez VA, Lipson SJ, Herriman RD, Toskala AK, Lin C, Joseph PV, Reed DR. Objective sensory testing methods reveal a higher prevalence of olfactory loss in COVID-19-positive patients compared to subjective methods: A systematic review and meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.07.04.20145870. [PMID: 32676608 PMCID: PMC7359533 DOI: 10.1101/2020.07.04.20145870] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has currently infected over 6.5 million people worldwide. In response to the pandemic, numerous studies have tried to identify causes and symptoms of the disease. Emerging evidence supports recently acquired anosmia (complete loss of smell) and hyposmia (partial loss of smell) as symptoms of COVID-19, but studies of olfactory dysfunction show a wide range of prevalence, from 5% to 98%. We undertook a search of Pubmed/Medline and Google Scholar with the keywords "COVID-19," "smell," and/or "olfaction." We included any study that quantified olfactory loss as a symptom of COVID-19. Studies were grouped and compared based on the type of method used to measure smell loss-subjective measures such as self-reported smell loss versus objective measures using rated stimuli-to determine if prevalence rate differed by method type. For each study, 95% confidence intervals (CIs) were calculated from point estimates of olfactory disturbance rates. We identified 34 articles quantifying anosmia as a symptom of COVID-19, collected from cases identified from January 16 to April 30, 2020. The pooled prevalence estimate of smell loss was 77% when assessed through objective measurements (95% CI of 61.4-89.2%) and 45% with subjective measurements (95% CI of 31.1-58.5%). Objective measures are a more sensitive method to identify smell loss as a result of infection with SARS-CoV-2; the use of subjective measures, while expedient during the early stages of the pandemic, underestimates the true prevalence of smell loss.
Collapse
Affiliation(s)
| | | | - Sarah J. Lipson
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104
| | - Riley D. Herriman
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104
| | - Aurora K. Toskala
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104
| | - Cailu Lin
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104
| | - Paule V. Joseph
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
- Division of Intramural Research, National Institute of Nursing Research & National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Danielle R. Reed
- Monell Chemical Senses Center, 3500 Market St, Philadelphia PA 19104
| |
Collapse
|
259
|
Ibekwe TS, Fasunla AJ, Orimadegun AE. Systematic Review and Meta-analysis of Smell and Taste Disorders in COVID-19. OTO Open 2020; 4:2473974X20957975. [PMID: 32964177 PMCID: PMC7488903 DOI: 10.1177/2473974x20957975] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/19/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Loss of smell and taste are considered potential discriminatory symptoms indicating triaging for coronavirus disease 2019 (COVID-19) and early case identification. However, the estimated prevalence essential to guide public health policy varies in published literature. This meta-analysis aimed to estimate prevalence of smell and taste loss among COVID-19 patients. DATA SOURCES We conducted systematic searches of PubMed, Embase, Web of Science, and Google Scholar databases for studies published on the prevalence of smell and taste loss in COVID-19 patients. REVIEW METHODS Two authors extracted data on study characteristics and the prevalence of smell and taste loss. Random-effects modeling was used to estimate pooled prevalence. Subgroup analysis and meta-regression were conducted to explore potential heterogeneity sources. This study used PRISMA and MOOSE guidelines. RESULTS Twenty-seven of 32 studies reported a prevalence of loss of smell, taste, or both from a combined sample of 20,451 COVID-19 patients. The estimated global pooled prevalence of loss of smell among 19,424 COVID-19 patients from 27 studies was 48.47% (95% CI, 33.78%-63.29%). Loss of taste was reported in 20 studies and 8001 patients with an estimated pooled prevalence of 41.47% (95% CI, 3.13%-31.03%), while 13 studies that reported combined loss of smell and taste in 5977 COVID-19 patients indicated a pooled prevalence of 35.04% (95% CI, 22.03%-49.26%). CONCLUSIONS The prevalence of smell and taste loss among COVID-19 patients was high globally, and regional differences supported the relevance of these symptoms as important markers. Health workers must consider them as suspicion indices for empirical diagnosis of severe acute respiratory syndrome coronavirus 2 infection.
Collapse
Affiliation(s)
- Titus Sunday Ibekwe
- Department of Otorhinolaryngology, University of Abuja and University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Ayotunde James Fasunla
- Department of Otorhinolaryngology, University College Hospital and College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | | |
Collapse
|
260
|
Vaira LA, Hopkins C, Salzano G, Petrocelli M, Melis A, Cucurullo M, Ferrari M, Gagliardini L, Pipolo C, Deiana G, Fiore V, De Vito A, Turra N, Canu S, Maglio A, Serra A, Bussu F, Madeddu G, Babudieri S, Giuseppe Fois A, Pirina P, Salzano FA, De Riu P, Biglioli F, De Riu G. Olfactory and gustatory function impairment in COVID-19 patients: Italian objective multicenter-study. Head Neck 2020; 42:1560-1569. [PMID: 32437022 PMCID: PMC7280583 DOI: 10.1002/hed.26269] [Citation(s) in RCA: 200] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Objective data on chemosensitive disorders during COVID-19 are lacking in the Literature. METHODS Multicenter cohort study that involved four Italian hospitals. Three hundred and forty-five COVID-19 patients underwent objective chemosensitive evaluation. RESULTS Chemosensitive disorders self-reported by 256 patients (74.2%) but the 30.1% of the 89 patients who did not report dysfunctions proved objectively hyposmic. Twenty-five percentage of patients were seen serious long-lasting complaints. All asymptomatic patients had a slight lowering of the olfactory threshold. No significant correlations were found between the presence and severity of chemosensitive disorders and the severity of the clinical course. On the contrary, there is a significant correlation between the duration of the olfactory and gustatory symptoms and the development of severe COVID-19. CONCLUSIONS Patients under-report the frequency of chemosensitive disorders. Contrary to recent reports, such objective testing refutes the proposal that the presence of olfactory and gustatory dysfunction may predict a milder course, but instead suggests that those with more severe disease neglect such symptoms in the setting of severe respiratory disease.
Collapse
Affiliation(s)
- Luigi Angelo Vaira
- Maxillofacial Surgery Operative UnitUniversity Hospital of SassariSassariItaly
| | | | - Giovanni Salzano
- Maxillofacial Surgery UnitUniversity Hospital of Naples “Federico II”NaplesItaly
| | - Marzia Petrocelli
- Maxillofacial Surgery Operative Unit; Bellaria and Maggiore Hospital, AUSLBolognaItaly
| | - Andrea Melis
- Otolaryngology Operative UnitUniversity Hospital of SassariSassariItaly
| | - Marco Cucurullo
- Maxillofacial Surgery Department, San Paolo Hospital, ASST Santi Paolo e CarloUniversity of MilanMilanItaly
| | - Mario Ferrari
- Maxillofacial Surgery Department, San Paolo Hospital, ASST Santi Paolo e CarloUniversity of MilanMilanItaly
| | - Laura Gagliardini
- Otolaryngology Operative Unit, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health SciencesUniversity of MilanMilanItaly
| | - Carlotta Pipolo
- Otolaryngology Operative Unit, San Paolo Hospital, ASST Santi Paolo e Carlo, Department of Health SciencesUniversity of MilanMilanItaly
| | - Giovanna Deiana
- Department of Medical, Surgical and Experimental SciencesUniversity of SassariSassariItaly
| | - Vito Fiore
- Infectious Diseases Operative UnitUniversity Hospital of SassariSassariItaly
| | - Andrea De Vito
- Infectious Diseases Operative UnitUniversity Hospital of SassariSassariItaly
| | - Nicola Turra
- Otolaryngology Operative UnitUniversity Hospital of SassariSassariItaly
| | - Sara Canu
- Respiratory Diseases Operative UnitUniversity Hospital of SassariSassariItaly
| | - Angelantonio Maglio
- Respiratory Diseases Operative Unit, Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”University of SalernoBaronissiSalernoItaly
| | - Antonello Serra
- Surveillance and Prevention DepartmentUniversity Hospital of SassariSassariItaly
| | - Francesco Bussu
- Otolaryngology Operative UnitUniversity Hospital of SassariSassariItaly
| | - Giordano Madeddu
- Infectious Diseases Operative UnitUniversity Hospital of SassariSassariItaly
| | - Sergio Babudieri
- Infectious Diseases Operative UnitUniversity Hospital of SassariSassariItaly
| | | | - Pietro Pirina
- Respiratory Diseases Operative UnitUniversity Hospital of SassariSassariItaly
| | - Francesco A. Salzano
- Otolaryngology Operative Unit, Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”University of SalernoBaronissiSalernoItaly
| | | | - Federico Biglioli
- Maxillofacial Surgery Department, San Paolo Hospital, ASST Santi Paolo e CarloUniversity of MilanMilanItaly
| | - Giacomo De Riu
- Maxillofacial Surgery Operative UnitUniversity Hospital of SassariSassariItaly
| |
Collapse
|
261
|
Debnath M, Banerjee M, Berk M. Genetic gateways to COVID-19 infection: Implications for risk, severity, and outcomes. FASEB J 2020; 34:8787-8795. [PMID: 32525600 PMCID: PMC7300732 DOI: 10.1096/fj.202001115r] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/10/2020] [Accepted: 05/12/2020] [Indexed: 01/05/2023]
Abstract
The dynamics, such as transmission, spatial epidemiology, and clinical course of Coronavirus Disease-2019 (COVID-19) have emerged as the most intriguing features and remain incompletely understood. The genetic landscape of an individual in particular, and a population in general seems to play a pivotal role in shaping the above COVID-19 dynamics. Considering the implications of host genes in the entry and replication of SARS-CoV-2 and in mounting the host immune response, it appears that multiple genes might be crucially involved in the above processes. Herein, we propose three potentially important genetic gateways to COVID-19 infection; these could explain at least in part the discrepancies of its spread, severity, and mortality. The variations within Angiotensin-converting enzyme 2 (ACE2) gene might constitute the first genetic gateway, influencing the spatial transmission dynamics of COVID-19. The Human Leukocyte Antigen locus, a master regulator of immunity against infection seems to be crucial in influencing susceptibility and severity of COVID-19 and can be the second genetic gateway. The genes regulating Toll-like receptor and complement pathways and subsequently cytokine storm induced exaggerated inflammatory pathways seem to underlie the severity of COVID-19, and such genes might represent the third genetic gateway. Host-pathogen interaction is a complex event and some additional genes might also contribute to the dynamics of COVID-19. Overall, these three genetic gateways proposed here might be the critical host determinants governing the risk, severity, and outcome of COVID-19. Genetic variations within these gateways could be key in influencing geographical discrepancies of COVID-19.
Collapse
Affiliation(s)
- Monojit Debnath
- Department of Human GeneticsNational Institute of Mental Health and NeurosciencesBangaloreIndia
| | - Moinak Banerjee
- Human Molecular Genetics LaboratoryRajiv Gandhi Centre for BiotechnologyThiruvanathapuramIndia
| | - Michael Berk
- IMPACT ‐ the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon HealthDeakin UniversityGeelongVICAustralia
- Florey Institute for Neuroscience and Mental Health, Department of Psychiatry and Orygen, The National Centre of Excellence in Youth Mental HealthThe University of MelbourneMelbourneVICAustralia
| |
Collapse
|
262
|
Hura N, Xie DX, Choby GW, Schlosser RJ, Orlov CP, Seal SM, Rowan NR. Treatment of post-viral olfactory dysfunction: an evidence-based review with recommendations. Int Forum Allergy Rhinol 2020; 10:1065-1086. [PMID: 32567798 PMCID: PMC7361320 DOI: 10.1002/alr.22624] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 12/29/2022]
Abstract
Background Post‐viral olfactory dysfunction (PVOD) is one of the most common causes of olfactory loss. Despite its prevalence, optimal treatment strategies remain unclear. This article provides a comprehensive review of PVOD treatment options and provides evidence‐based recommendations for their use. Methods A systematic review of the Medline, Embase, Cochrane, Web of Science, Scopus, and Google Scholar databases was completed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Studies with defined olfactory outcomes of patients treated for PVOD following medical, surgical, acupuncture, or olfactory training interventions were included. The Clinical Practice Guideline Development Manual and Conference on Guideline Standardization (COGS) instrument recommendations were followed in accordance with a previously described, rigorous, iterative process to create an evidence‐based review with recommendations. Results From 552 initial candidate articles, 36 studies with data for 2183 patients with PVOD were ultimately included. The most common method to assess olfactory outcomes was Sniffin’ Sticks. Broad treatment categories included: olfactory training, systemic steroids, topical therapies, a variety of heterogeneous non‐steroidal oral medications, and acupuncture. Conclusion Based on the available evidence, olfactory training is a recommendation for the treatment of PVOD. The use of short‐term systemic and/or topical steroids is an option in select patients after careful consideration of potential risks of oral steroids. Though some pharmacological investigations offer promising preliminary results for systemic and topical medications alike, a paucity of high‐quality studies limits the ability to make meaningful evidence‐based recommendations for the use of these therapies for the treatment of PVOD.
Collapse
Affiliation(s)
- Nanki Hura
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Deborah X Xie
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Garret W Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic College of Medicine, Rochester, MN
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Cinthia P Orlov
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stella M Seal
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
263
|
Altin F, Cingi C, Uzun T, Bal C. Olfactory and gustatory abnormalities in COVID-19 cases. Eur Arch Otorhinolaryngol 2020; 277:2775-2781. [PMID: 32577902 PMCID: PMC7309687 DOI: 10.1007/s00405-020-06155-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022]
Abstract
Purpose At the time of writing, there is a pandemic affecting virtually every country on Earth. There is considerable discussion amongst clinicians as well as lay people about anosmia and ageusia in COVID-19 sufferers. We aimed to report the results from comprehensive olfactory and gustatory testing in a series of hospital in-patients. Methods The prospective study evaluated 81 individuals with a COVID-19 infection, as confirmed by 2019 n-cov Real-Time PCR laboratory testing. The control group consisted of forty individuals with COVID-19 negative. Olfactory and gustatory testings were carried out by an examiner utilizing stringent safety standards and wearing full personal protective equipment. The results obtained in the case group were then compared with those obtained for the controls. Results In the case group, 41(50.6%) of patients were male and 40 (49.4%) were female, mean age of 54.16 ± 16.98 years (18–95). In the control group, 21 (52.5%) of subjects were male and 19 (47.5%) were female, and mean age was 55 ± 15.39 years (18–90). Fifty (61.7%) COVID-19-positive patients had complaints related to olfaction. The distribution of olfactory symptoms in the case group differed at the level of statistical significance from the control group (p < 0.001). Turning to gustatory abnormalities, within the case group, 22 individuals (27.2%) had taste malfunction. A statistically significant difference was found in the distribution of gustatory abnormalities between cases and controls (p < 0.001). Conclusions Olfactory and gustatory dysfunctions are strongly associated with SARS-CoV-2 infection. Hyposmia with or without hypogeusia is potentially a reliable indicator of latent COVID-19.
Collapse
Affiliation(s)
- Fazilet Altin
- Department of Otorhinolaryngology, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Cemal Cingi
- Medical Faculty, ENT Department, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Tankut Uzun
- Medical Faculty, ENT Department, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Cengiz Bal
- Medical Faculty, Biostatistics Department, Eskişehir Osmangazi University, Eskişehir, Turkey
| |
Collapse
|
264
|
von Bartheld CS, Hagen MM, Butowt R. Prevalence of Chemosensory Dysfunction in COVID-19 Patients: A Systematic Review and Meta-analysis Reveals Significant Ethnic Differences. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.06.15.20132134. [PMID: 32587993 PMCID: PMC7310651 DOI: 10.1101/2020.06.15.20132134] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A significant fraction of people who test positive for COVID-19 have chemosensory deficits. However, the reported prevalence of these deficits in smell and/or taste varies widely, and the reason for the differences between studies is unclear. We determined the pooled prevalence of such chemosensory deficits in a systematic review. We searched the COVID-19 portfolio of the National Institutes of Health for all studies that reported the prevalence of smell and/or taste deficits in patients diagnosed with COVID-19. Forty-two studies reporting on 23,353 patients qualified and were subjected to a systematic review and meta-analysis. Estimated random prevalence of olfactory dysfunction was 38.5%, of taste dysfunction was 30.4% and of overall chemosensory dysfunction was 50.2%. We examined the effects of age, disease severity, and ethnicity on chemosensory dysfunction. The effect of age did not reach significance, but anosmia/hypogeusia decreased with disease severity, and ethnicity was highly significant: Caucasians had a 3-6 times higher prevalence of chemosensory deficits than East Asians. The finding of ethnic differences points to genetic, ethnicity-specific differences of the virus-binding entry proteins in the olfactory epithelium and taste buds as the most likely explanation, with major implications for infectivity, diagnosis and management of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Christopher S. von Bartheld
- Center of Biomedical Research Excellence in Cell Biology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | - Molly M. Hagen
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Rafal Butowt
- Department of Molecular Cell Genetics, L. Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| |
Collapse
|
265
|
Izquierdo-Domínguez A, Rojas-Lechuga MJ, Mullol J, Alobid I. [Olfactory dysfunction during COVID-19 pandemic]. Med Clin (Barc) 2020; 155:403-408. [PMID: 32600982 PMCID: PMC7290212 DOI: 10.1016/j.medcli.2020.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Adriana Izquierdo-Domínguez
- Servicio de Alergología, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España; Unidad Alergo Rino, Centro Médico Teknon, Barcelona, España; Unidad de Alergología, Clínica Diagonal, Barcelona, España
| | - María Jesús Rojas-Lechuga
- Unidad de Rinología y Clínica del Olfato, Servicio de Otorrinolaringología, Hospital Clínic, Universitat de Barcelona, Barcelona, España; Immunoal·lèrgia Respiratòria Clínica i Experimental, IDIBAPS, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), España
| | - Joaquim Mullol
- Unidad de Rinología y Clínica del Olfato, Servicio de Otorrinolaringología, Hospital Clínic, Universitat de Barcelona, Barcelona, España; Immunoal·lèrgia Respiratòria Clínica i Experimental, IDIBAPS, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), España
| | - Isam Alobid
- Unidad de Rinología y Clínica del Olfato, Servicio de Otorrinolaringología, Hospital Clínic, Universitat de Barcelona, Barcelona, España; Immunoal·lèrgia Respiratòria Clínica i Experimental, IDIBAPS, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), España.
| |
Collapse
|
266
|
Clinical manifestations and evidence of neurological involvement in 2019 novel coronavirus SARS-CoV-2: a systematic review and meta-analysis. J Neurol 2020; 267:2777-2789. [PMID: 32529575 PMCID: PMC7288253 DOI: 10.1007/s00415-020-09974-2] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 12/15/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) has become a global pandemic, affecting millions of people. However, clinical research on its neurological manifestations is thus far limited. In this study, we aimed to systematically collect and investigate the clinical manifestations and evidence of neurological involvement in COVID-19. Methods Three medical (Medline, Embase, and Scopus) and two preprints (BioRxiv and MedRxiv) databases were systematically searched for all published articles on neurological involvement in COVID-19 since the outbreak. All included studies were systematically reviewed, and selected clinical data were collected for meta-analysis via random-effects. Results A total of 41 articles were eligible and included in this review, showing a wide spectrum of neurological manifestations in COVID-19. The meta-analysis for unspecific neurological symptoms revealed that the most common manifestations were fatigue (33.2% [23.1–43.3]), anorexia (30.0% [23.2–36.9]), dyspnea/shortness of breath (26.9% [19.2–34.6]), and malaise (26.7% [13.3–40.1]). The common specific neurological symptoms included olfactory (35.7–85.6%) and gustatory (33.3–88.8%) disorders, especially in mild cases. Guillain–Barré syndrome and acute inflammation of the brain, spinal cord, and meninges were repeatedly reported after COVID-19. Laboratory, electrophysiological, radiological, and pathological evidence supported neurologic involvement of COVID-19. Conclusions Neurological manifestations are various and prevalent in COVID-19. Emerging clinical evidence suggests neurological involvement is an important aspect of the disease. The underlying mechanisms can include both direct invasion and maladaptive inflammatory responses. More studies should be conducted to explore the role of neurological manifestations in COVID-19 progression and to verify their underlying mechanisms. Electronic supplementary material The online version of this article (10.1007/s00415-020-09974-2) contains supplementary material, which is available to authorized users.
Collapse
|
267
|
Chung TWH, Sridhar S, Zhang AJ, Chan KH, Li HL, Wong FKC, Ng MY, Tsang RKY, Lee ACY, Fan Z, Ho RSL, Luk SY, Kan WK, Lam SHY, Wu AKL, Leung SM, Chan WM, Ng PY, To KKW, Cheng VCC, Lung KC, Hung IFN, Yuen KY. Olfactory Dysfunction in Coronavirus Disease 2019 Patients: Observational Cohort Study and Systematic Review. Open Forum Infect Dis 2020; 7:ofaa199. [PMID: 32548209 PMCID: PMC7284010 DOI: 10.1093/ofid/ofaa199] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023] Open
Abstract
Background Olfactory dysfunction (OD) has been reported in coronavirus disease 2019 (COVID-19). However, there are knowledge gaps about the severity, prevalence, etiology, and duration of OD in COVID-19 patients. Methods Olfactory function was assessed in all participants using questionnaires and the butanol threshold test (BTT). Patients with COVID-19 and abnormal olfaction were further evaluated using the smell identification test (SIT), sinus imaging, and nasoendoscopy. Selected patients received nasal biopsies. Systematic review was performed according to PRISMA guidelines. PubMed items from January 1, 2020 to April 23, 2020 were searched. Studies that reported clinical data on olfactory disturbances in COVID-19 patients were analyzed. Results We included 18 COVID-19 patients and 18 controls. Among COVID-19 patients, 12 of 18 (67%) reported olfactory symptoms and OD was confirmed in 6 patients by BTT and SIT. Olfactory dysfunction was the only symptom in 2 patients. Mean BTT score of patients was worse than controls (P = .004, difference in means = 1.8; 95% confidence interval, 0.6–2.9). Sinusitis and olfactory cleft obstruction were absent in most patients. Immunohistochemical analysis of nasal biopsy revealed the presence of infiltrative CD68+ macrophages harboring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen in the stroma. Olfactory dysfunction persisted in 2 patients despite clinical recovery. Systematic review showed that the prevalence of olfactory disturbances in COVID-19 ranged from 5% to 98%. Most studies did not assess olfaction quantitatively. Conclusions Olfactory dysfunction is common in COVID-19 and may be the only symptom. Coronavirus disease 2019-related OD can be severe and prolonged. Mucosal infiltration by CD68+ macrophages expressing SARS-CoV-2 viral antigen may contribute to COVID-19-related OD.
Collapse
Affiliation(s)
- Tom Wai-Hin Chung
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Siddharth Sridhar
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China.,Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | - Anna Jinxia Zhang
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kwok-Hung Chan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hang-Long Li
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Fergus Kai-Chuen Wong
- Department of Ear, Nose and Throat Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, China
| | - Raymond King-Yin Tsang
- Division of Otolaryngology, Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Andrew Chak-Yiu Lee
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Zhimeng Fan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Shiobhon Yiu Luk
- Department of Diagnostic Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Wai-Kuen Kan
- Department of Diagnostic Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Sonia Hiu-Yin Lam
- Department of Diagnostic Radiology, Queen Mary Hospital, Hong Kong, China
| | - Alan Ka-Lun Wu
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Sau-Man Leung
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wai-Ming Chan
- Department of Adult Intensive Care, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Pauline Yeung Ng
- Department of Adult Intensive Care, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kelvin Kai-Wang To
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China.,Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China
| | - Vincent Chi-Chung Cheng
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kwok-Cheung Lung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Ivan Fan-Ngai Hung
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China.,Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kwok-Yung Yuen
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China.,Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China.,The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
268
|
Meini S, Suardi LR, Busoni M, Roberts AT, Fortini A. Olfactory and gustatory dysfunctions in 100 patients hospitalized for COVID-19: sex differences and recovery time in real-life. Eur Arch Otorhinolaryngol 2020; 277:3519-3523. [PMID: 32500326 PMCID: PMC7271634 DOI: 10.1007/s00405-020-06102-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/29/2020] [Indexed: 12/12/2022]
Abstract
Purpose COVID-19 displays a variety of clinical manifestations; in pauci-symptomatic patients olfactory (OD) and gustatory dysfunctions (GD) may represent the first or only symptom. This topic is currently arousing great interest, and a growing number of papers are being published. Aim of this study is to investigate the timing of recovery from OD and GD in a real-life population hospitalized for COVID-19. Methods We followed up by a phone interview the first 100 patients discharged a month earlier from three Italian non-intensive care wards. Results All 100 patients were Caucasian, mean age was 65 years, 60% were males. Forty-two patients (mean age 63 years) experienced subjective chemosensory dysfunctions (29 OD and 41 GD): the male/female ratio was 2:1; 83% reported a complete or near complete recovery at follow-up. The recovery rate was not significantly different between males and females. The mean duration of OD and GD was 18 and 16 days, respectively. The mean recovery time from OD or GD resulted significantly longer for females than for males (26 vs 14 days, P = 0.009). Among the 42 symptomatic, the mean age of males was significantly higher than that of females (66 vs 57 years, P = 0.04), while the opposite was observed in the 58 asymptomatic patients (60 vs 73 years, P = 0.0018). Conclusions Recovery from OD or GD was rapid, occurring within 4 weeks in most patients. Chemosensory dysfunctions in women was less frequent, but longer lasting. The value of our study is its focus on a population of hospitalized patients significantly older than those previously described, and the additional data on gender differences.
Collapse
Affiliation(s)
- Simone Meini
- Internal Medicine Unit, Santa Maria Annunziata Hospital, Florence, Italy.
| | | | - Michele Busoni
- Otolaryngology-Head and Neck Surgery Unit, Santa Maria Nuova Hospital, Florence, Italy
| | | | - Alberto Fortini
- Internal Medicine Unit, Nuovo San Giovanni Di Dio Hospital, Florence, Italy
| |
Collapse
|
269
|
Ahmed MU, Hanif M, Ali MJ, Haider MA, Kherani D, Memon GM, Karim AH, Sattar A. Neurological Manifestations of COVID-19 (SARS-CoV-2): A Review. Front Neurol 2020; 11:518. [PMID: 32574248 PMCID: PMC7257377 DOI: 10.3389/fneur.2020.00518] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/11/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been associated with many neurological symptoms but there is a little evidence-based published material on the neurological manifestations of COVID-19. The purpose of this article is to review the spectrum of the various neurological manifestations and underlying associated pathophysiology in COVID-19 patients. Method: We conducted a review of the various case reports and retrospective clinical studies published on the neurological manifestations, associated literature, and related pathophysiology of COVID-19 using PUBMED and subsequent proceedings. A total of 118 articles were thoroughly reviewed in order to highlight the plausible spectrum of neurological manifestations of COVID 19. Every article was either based on descriptive analysis, clinical scenarios, correspondence, and editorials emphasizing the neurological manifestations either directly or indirectly. We then tried to highlight the significant plausible manifestations and complications that could be related to the pandemic. With little known about the dynamics and the presentation spectrum of the virus apart from the respiratory symptoms, this area needs further consideration. Conclusion: The neurological manifestations associated with COVID-19 such as Encephalitis, Meningitis, acute cerebrovascular disease, and Guillain Barré Syndrome (GBS) are of great concern. But in the presence of life-threatening abnormal vitals in severely ill COVID-19 patients, these are not usually underscored. There is a need to diagnose these manifestations at the earliest to limit long term sequelae. Much research is needed to explore the role of SARS-CoV-2 in causing these neurological manifestations by isolating it either from cerebrospinal fluid or brain tissues of the deceased on autopsy. We also recommend exploring the risk factors that lead to the development of these neurological manifestations.
Collapse
Affiliation(s)
- Muhammad Umer Ahmed
- Ziauddin University and Hospital, Ziauddin Medical College, Karachi, Pakistan
| | - Muhammad Hanif
- Khyber Medical College Peshawar, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Mukarram Jamat Ali
- Department of Internal Medicine, King Edward Medical University Lahore, Lahore, Pakistan
| | | | | | | | - Amin H Karim
- Houston Methodist Hospital, Houston, TX, United States.,Baylor College of Medicine, Houston, TX, United States
| | - Abdul Sattar
- Southside Hospital Northwell Health, New York, NY, United States
| |
Collapse
|
270
|
Lehrich BM, Goshtasbi K, Raad RA, Ganti A, Papagiannopoulos P, Tajudeen BA, Kuan EC. Aggregate Prevalence of Chemosensory and Sinonasal Dysfunction in SARS-CoV-2 and Related Coronaviruses. Otolaryngol Head Neck Surg 2020; 163:156-161. [PMID: 32423285 DOI: 10.1177/0194599820929278] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Much of the published literature regarding the novel coronavirus disease 2019 (COVID-19) constitutes lower respiratory system symptomatology, while there exists a paucity of data describing the complicated sequelae of the upper respiratory system, including chemosensory and/or sinonasal dysfunction. This study utilized the National Library of Medicine's PubMed/MEDLINE database to query for articles describing COVID-19, SARS-CoV-2, SARS-CoV-1, MERS-CoV, and other coronaviruses, with any mention of smell, taste, or other chemosensory or sinonasal dysfunction. Aggregate analysis demonstrated an incidence of 49.6% (n = 497 of 1002; 95% CI, 46.5%-52.7%), 47.9% (n = 480 of 1002; 95% CI, 44.8%-51.0%), and 17.9% (n = 880 of 4909; 95% CI, 16.9%-19.0%) for smell loss, taste loss, and smell or taste loss, respectively, in patients infected with SARS-CoV-2. Additionally, there were significantly higher incidences of runny nose/rhinorrhea/rhinitis and nasal congestion/obstruction/blockage in other coronaviruses as compared with SARS-CoV-2 (P < .001). Understanding these less well-characterized symptoms may help develop measures for estimating early markers of disease prevalence and/or resolution. Level of evidence: 4.
Collapse
Affiliation(s)
- Brandon M Lehrich
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Richard A Raad
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ashwin Ganti
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| |
Collapse
|
271
|
Ofori-Asenso R, Ogundipe O, Agyeman AA, Chin KL, Mazidi M, Ademi Z, De Bruin ML, Liew D. Cancer is associated with severe disease in COVID-19 patients: a systematic review and meta-analysis. Ecancermedicalscience 2020; 14:1047. [PMID: 32565900 PMCID: PMC7289619 DOI: 10.3332/ecancer.2020.1047] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Indexed: 12/13/2022] Open
Abstract
Cancer patients are vulnerable to complications of respiratory viruses. This systematic review and meta-analysis sought to examine the prevalence of cancer and its association with disease severity in patients with novel coronavirus disease 2019 (COVID-19). Searches were performed in MEDLINE, EMBASE and ScienceDirect from their inception until 28 April 2020. Severe disease was considered to encompass cases resulting in death or as defined by the primary study authors. Meta-analysis was performed using random-effect models. We included 20 studies involving 32,404 patients from China, the United Kingdom, the United States, Italy, Singapore, Thailand, France, India and South Korea. The pooled prevalence of cancer was 3.50% (95% confidence interval (CI) 1.70 to 5.80). The pooled prevalence was not moderated by study mean age, proportion of females or whether the study was conducted in/outside of China. Patients with cancer were more likely to experience severe COVID-19 disease compared to patients without cancer (pooled risk ratio 1.76, 95% CI 1.39 to 2.23). Our findings reiterate the need for additional precautionary measures to ensure that patients with cancer are not exposed to COVID-19, and if they become infected, extra attention should be provided to minimise their risk of adverse outcomes.
Collapse
Affiliation(s)
- Richard Ofori-Asenso
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, VIC 3004, Australia.,Copenhagen Centre for Regulatory Science, Department of Pharmacy, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Oyepeju Ogundipe
- Cardiac Renal and Vascular Associates PC, Jackson, MS 39204, USA
| | - Akosua Adom Agyeman
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Victoria, VIC 3052, Australia
| | - Ken Lee Chin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, VIC 3004, Australia.,Melbourne Medical School, University of Melbourne, Victoria, VIC 3010, Australia
| | - Mohsen Mazidi
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, SE1 7EH, UK
| | - Zanfina Ademi
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, VIC 3004, Australia
| | - Marie Louise De Bruin
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, VIC 3004, Australia
| |
Collapse
|
272
|
Zayet S, Klopfenstein T, Mercier J, Kadiane-Oussou NJ, Lan Cheong Wah L, Royer PY, Toko L, Gendrin V. Contribution of anosmia and dysgeusia for diagnostic of COVID-19 in outpatients. Infection 2020; 49:361-365. [PMID: 32410112 PMCID: PMC7221233 DOI: 10.1007/s15010-020-01442-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/07/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Souheil Zayet
- Department of Infectious Diseases, Nord Franche-Comte Hospital, 90400, Trévenans, France.
| | - Timothee Klopfenstein
- Department of Infectious Diseases, Nord Franche-Comte Hospital, 90400, Trévenans, France
| | - Julien Mercier
- Department of Infectious Diseases, Nord Franche-Comte Hospital, 90400, Trévenans, France
| | | | - Ludovic Lan Cheong Wah
- Department of Infectious Diseases, Nord Franche-Comte Hospital, 90400, Trévenans, France
| | - Pierre-Yves Royer
- Department of Infectious Diseases, Nord Franche-Comte Hospital, 90400, Trévenans, France
| | - Lynda Toko
- Department of Infectious Diseases, Nord Franche-Comte Hospital, 90400, Trévenans, France
| | - Vincent Gendrin
- Department of Infectious Diseases, Nord Franche-Comte Hospital, 90400, Trévenans, France
| |
Collapse
|
273
|
Tong JY, Wong A, Zhu D, Fastenberg JH, Tham T. The Prevalence of Olfactory and Gustatory Dysfunction in COVID-19 Patients: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 163:3-11. [PMID: 32369429 DOI: 10.1177/0194599820926473] [Citation(s) in RCA: 355] [Impact Index Per Article: 88.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine the pooled global prevalence of olfactory and gustatory dysfunction in patients with the 2019 novel coronavirus (COVID-19). DATA SOURCES Literature searches of PubMed, Embase, and Scopus were conducted on April 19, 2020, to include articles written in English that reported the prevalence of olfactory or gustatory dysfunction in COVID-19 patients. REVIEW METHODS Search strategies developed for each database contained keywords such as anosmia, dysgeusia, and COVID-19. Resulting articles were imported into a systematic review software and underwent screening. Data from articles that met inclusion criteria were extracted and analyzed. Meta-analysis using pooled prevalence estimates in a random-effects model were calculated. RESULTS Ten studies were analyzed for olfactory dysfunction (n = 1627), demonstrating 52.73% (95% CI, 29.64%-75.23%) prevalence among patients with COVID-19. Nine studies were analyzed for gustatory dysfunction (n = 1390), demonstrating 43.93% (95% CI, 20.46%-68.95%) prevalence. Subgroup analyses were conducted for studies evaluating olfactory dysfunction using nonvalidated and validated instruments and demonstrated 36.64% (95% CI, 18.31%-57.24%) and 86.60% (95% CI, 72.95%-95.95%) prevalence, respectively. CONCLUSIONS Olfactory and gustatory dysfunction are common symptoms in patients with COVID-19 and may represent early symptoms in the clinical course of infection. Increased awareness of this fact may encourage earlier diagnosis and treatment, as well as heighten vigilance for viral transmission. To our knowledge, this is the first meta-analysis to report on the prevalence of these symptoms in COVID-19 patients.
Collapse
Affiliation(s)
- Jane Y Tong
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Amanda Wong
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Daniel Zhu
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Judd H Fastenberg
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Hempstead, New York, USA
| | - Tristan Tham
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Hempstead, New York, USA
| |
Collapse
|
274
|
An Overview of Otorhinolaryngology and Head and Neck Surgery Practice in COVID-19 Pandemic. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2020. [DOI: 10.21673/anadoluklin.733565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
|
275
|
Milone I, Vento R, Ippolito L, Paroni S, Vento MG. Therapeutic support protocol for patient with dysosmia with or without dysgeusia related to the SARS-CoV2 virus infection. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020130. [PMID: 33525239 PMCID: PMC7927461 DOI: 10.23750/abm.v91i4.10840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Ignazio Milone
- Dipartimento di Chirurgia AUSL Parma, U.O.s. Dipartimentale ORL P.O. Fidenza AUSL Parma
| | | | - Luigi Ippolito
- Dipartimento Medicina Diagnostica, U.O.s. Dipartimentale Laboratorio P.O. Fidenza AUSL Parma
| | | | | |
Collapse
|
276
|
Karapetyan LS, Svistushkin VM. [Olfactory dysfunction and COVID-19 - current state of the problem]. Vestn Otorinolaringol 2020; 85:100-104. [PMID: 33474926 DOI: 10.17116/otorino202085061100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
According to data from China, Italy, South Korea, Iran, USA, France, from 17 to 87% of patients with confirmed COVID-19 have a violation of smell and taste. Acute sudden anosmia may precede symptoms such as cough and shortness of breath. Also, hypo/anosmia may be the only symptom of mild COVID-19. European, American and domestic associations of otorhinolaryngologists warn that, these patients may be hidden carriers that contribute to the spread of COVID-19 infection, because they have no indications for testing for the virus and self-isolation. Including anosmia in the criteria for self-isolation can help prevent the spread of COVID-19 infection. In addition, it would signal the medical staff to use full personal protection when dealing with these patients and help reduce the number of infected doctors. It is known that olfactory disorders can be conductive, perceptual or mixed. Olfactory disturbances in COVID-19 are most likely of a perceptual nature. Although, at the moment, there is insufficient data to determine the exact mechanisms of the onset of anosmia in patients diagnosed with COVID-19, however, there are studies that confirm these or those theories. The article provides an overview of the data available in the literature on this topic.
Collapse
Affiliation(s)
- L S Karapetyan
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - V M Svistushkin
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|