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Cecchini MP, Pizzini FB, Boschi F, Marcon A, Moro L, Gordon E, Guizard N, Cavedo E, Ricatti MJ, Veronese S, Tamburin S, Tinazzi M, Mansueto G, Sbarbati A. Long-term effects of SARS-CoV-2 infection in patients with and without chemosensory disorders at disease onset: a psychophysical and magnetic resonance imaging exploratory study. Neurol Sci 2024; 45:2409-2418. [PMID: 38441790 PMCID: PMC11082021 DOI: 10.1007/s10072-024-07429-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/28/2024] [Indexed: 05/12/2024]
Abstract
A preserved sense of smell and taste allows us to understand many environmental "messages" and results in meaningfully improvements to quality of life. With the COVID-19 pandemic, it became clear how important these senses are for social and nutritional status and catapulted this niche chemosensory research area towards widespread interest. In the current exploratory work, we assessed two groups of post-COVID-19 patients who reported having had (Group 1) or not (Group 2) a smell/taste impairment at the disease onset. The aim was to compare them using validated smell and taste tests as well as with brain magnetic resonance imaging volumetric analysis. Normative data were used for smell scores comparison and a pool of healthy subjects, recruited before the pandemic, served as controls for taste scores. The majority of patients in both groups showed an olfactory impairment, which was more severe in Group 1 (median UPSIT scores: 24.5 Group 1 vs 31.0 Group 2, p = 0.008), particularly among women (p = 0.014). No significant differences emerged comparing taste scores between Group 1 and Group 2, but dysgeusia was only present in Group 1 patients. However, for taste scores, a significant difference was found between Group 1 and controls (p = 0.005). No MRI anatomical abnormalities emerged in any patients while brain volumetric analysis suggested a significant difference among groups for the right caudate nucleus (p = 0.028), although this was not retained following Benjamini-Hochberg correction. This exploratory study could add new information in COVID-19 chemosensory long-lasting impairment and address future investigations on the post-COVID-19 patients' research.
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Affiliation(s)
- Maria Paola Cecchini
- Department of Neurosciences, Biomedicines and Movement Sciences, Anatomy and Histology Section, Verona University, Strada Le Grazie 8, 37134, Verona, Italy.
| | | | - Federico Boschi
- Department of Engineering for Innovation Medicine, Engineering and Physics Section, Verona University, Verona, Italy
| | - Alessandro Marcon
- Department of Diagnostics and Public Heath, Unit of Epidemiology and Medical Statistics, Verona University, Verona, Italy
| | - Lucia Moro
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore, Negrar, Italy
| | | | | | | | - Maria Jimena Ricatti
- Department of Neurosciences, Biomedicines and Movement Sciences, Anatomy and Histology Section, Verona University, Strada Le Grazie 8, 37134, Verona, Italy
| | - Sheila Veronese
- Department of Neurosciences, Biomedicines and Movement Sciences, Anatomy and Histology Section, Verona University, Strada Le Grazie 8, 37134, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicines and Movement Sciences, Neurology Unit, Verona University, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicines and Movement Sciences, Neurology Unit, Verona University, Verona, Italy
| | - Giancarlo Mansueto
- Department of Engineering for Innovation Medicine, Radiology Unit, Verona University, Verona, Italy
| | - Andrea Sbarbati
- Department of Neurosciences, Biomedicines and Movement Sciences, Anatomy and Histology Section, Verona University, Strada Le Grazie 8, 37134, Verona, Italy
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Abstract
OBJECTIVES The pandemic has affected over 182 million coronavirus disease 2019 (COVID-19) cases worldwide. Accumulated evidence indicates that anosmia is one of the significant characteristics of COVID-19 with a high prevalence. However, many aspects of COVID-19-induced anosmia are still far from being fully understood. The purpose of this review is to summarize recent developments in COVID-19-induced anosmia to increase awareness of the condition. METHODS A literature search was carried out using the PubMed, Embase, Web of Science, and Scopus. We reviewed the latest literature on COVID-19-induced anosmia, including mechanisms of pathogenesis, olfactory testing, anosmia as predictive tool, pathological examinations, imaging findings, affected factors, co-existing diseases, treatments, prognosis, hypothesis theories, and future directions. RESULTS The possible pathogenesis of COVID-19-induced anosmia may involve inflammation of the olfactory clefts and damage to the olfactory epithelium or olfactory central nervous system by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The D614G spike variant may also play a role in the increased number of anosmia patients. Anosmia may also be an essential indicator of COVID-19 spread and an early indicator of the effectiveness of political decisions. The occurrence and development of COVID-19-induced anosmia may be influenced by smoking behaviors and underlying diseases such as type 2 diabetes, gastroesophageal disorders, and rhinitis. Most patients with COVID-19-induced anosmia can fully or partially recover their olfactory function for varying durations. COVID-19-induced anosmia can be treated with various approaches such as glucocorticoids and olfactory training. CONCLUSION Anosmia is one of the main features of COVID-19 and the underlying disease of the patient may also influence its occurrence and development. The possible pathogenesis of COVID-19-induced anosmia is very complicated, which may involve inflammation of the olfactory clefts and damage to the olfactory epithelium or olfactory central nervous system.
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Affiliation(s)
- Xiangming Meng
- Department of Otolaryngology, Wuxi Huishan District People's Hospital, Wuxi, P.R. China
| | - Yuandan Pan
- Department of Respiratory Medicine, Wuxi Huishan District People's Hospital, Wuxi, P.R. China
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3
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Prusinski C, Yan D, Klasova J, McVeigh KH, Shah SZ, Fermo OP, Kubrova E, Farr EM, Williams LC, Gerardo-Manrique G, Bergquist TF, Pham SM, Engelberg-Cook E, Hare JM, March KL, Caplan AI, Qu W. Multidisciplinary Management Strategies for Long COVID: A Narrative Review. Cureus 2024; 16:e59478. [PMID: 38826995 PMCID: PMC11142761 DOI: 10.7759/cureus.59478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 06/04/2024] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused millions of infections to date and has led to a worldwide pandemic. Most patients had a complete recovery from the acute infection, however, a large number of the affected individuals experienced symptoms that persisted more than 3 months after diagnosis. These symptoms most commonly include fatigue, memory difficulties, brain fog, dyspnea, cough, and other less common ones such as headache, chest pain, paresthesias, mood changes, muscle pain, and weakness, skin rashes, and cardiac, endocrine, renal and hepatic manifestations. The treatment of this syndrome remains challenging. A multidisciplinary approach to address combinations of symptoms affecting multiple organ systems has been widely adopted. This narrative review aims to bridge the gap surrounding the broad treatment approaches by providing an overview of multidisciplinary management strategies for the most common long COVID conditions.
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Affiliation(s)
| | - Dan Yan
- Department of Pain Medicine, Mayo Clinic, Jacksonville, USA
| | - Johana Klasova
- Department of Pain Medicine, Mayo Clinic, Jacksonville, USA
| | | | - Sadia Z Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, USA
| | - Olga P Fermo
- Department of Neurology, Mayo Clinic, Jacksonville, USA
| | - Eva Kubrova
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, USA
| | - Ellen M Farr
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, USA
| | - Linus C Williams
- Department of Pain Medicine, Mayo Clinic, Jacksonville, USA
- Department of Internal Medicine, Lahey Hospital & Medical Center, Burlington, USA
| | | | - Thomas F Bergquist
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, USA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, USA
| | | | - Joshua M Hare
- Department of Medicine, Cardiovascular Division and the Interdisciplinary Stem Cell Institute, Miami, USA
| | - Keith L March
- Division of Cardiovascular Medicine, Center for Regenerative Medicine, University of Florida, Gainesville, USA
| | - Arnold I Caplan
- Department of Biology, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Wenchun Qu
- Department of Pain Medicine, Mayo Clinic, Jacksonville, USA
- Center for Regenerative Biotherapeutics, Mayo Clinic, Jacksonville, USA
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4
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Power Guerra N, Bierkämper M, Pablik J, Hummel T, Witt M. Histochemical Evidence for Reduced Immune Response in Nasal Mucosa of Patients with COVID-19. Int J Mol Sci 2024; 25:4427. [PMID: 38674011 PMCID: PMC11050322 DOI: 10.3390/ijms25084427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
The primary entry point of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the nasal mucosa, where viral-induced inflammation occurs. When the immune response fails against SARS-CoV-2, understanding the altered response becomes crucial. This study aimed to compare SARS-CoV-2 immunological responses in the olfactory and respiratory mucosa by focusing on epithelia and nerves. Between 2020 and 2022, we obtained post mortem tissues from the olfactory cleft from 10 patients with histologically intact olfactory epithelia (OE) who died with or from COVID-19, along with four age-matched controls. These tissues were subjected to immunohistochemical reactions using antibodies against T cell antigens CD3, CD8, CD68, and SARS spike protein for viral evidence. Deceased patients with COVID-19 exhibited peripheral lymphopenia accompanied by a local decrease in CD3+ cells in the OE. However, SARS-CoV-2 spike protein was sparsely detectable in the OE. With regard to the involvement of nerve fibers, the present analysis suggested that SARS-CoV-2 did not significantly alter the immune response in olfactory or trigeminal fibers. On the other hand, SARS spike protein was detectable in both nerves. In summary, the post mortem investigation demonstrated a decreased T cell response in patients with COVID-19 and signs of SARS-CoV-2 presence in olfactory and trigeminal fibers.
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Affiliation(s)
- Nicole Power Guerra
- Smell & Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01309 Dresden, Germany; (N.P.G.); (M.B.); (T.H.)
| | - Martin Bierkämper
- Smell & Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01309 Dresden, Germany; (N.P.G.); (M.B.); (T.H.)
| | - Jessica Pablik
- Department of Pathology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01309 Dresden, Germany;
| | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01309 Dresden, Germany; (N.P.G.); (M.B.); (T.H.)
| | - Martin Witt
- Department of Anatomy, Institute of Biostructural Foundations of Medical Sciences, Poznań University of Medical Sciences, 61-781 Poznań, Poland
- Department of Anatomy, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01309 Dresden, Germany
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Zaidi AK, Singh RB, A A Rizvi S, Dehgani-Mobaraki P, Palladino N. COVID-19 pathogenesis. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2024; 202:67-112. [PMID: 38237991 DOI: 10.1016/bs.pmbts.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
The pathogenesis of COVID-19 involves a complex interplay between host factors and the SARS-CoV-2 virus, leading to a multitude of clinical manifestations beyond the respiratory system. This chapter provides an overview of the risk factors, genetic predisposition, and multisystem manifestations of COVID-19, shedding light on the underlying mechanisms that contribute to extrapulmonary manifestations. The chapter discusses the direct invasion of SARS-CoV-2 into various organs as well as the indirect mechanisms such as dysregulation of the renin-angiotensin-aldosterone system (RAAS), immune response dysfunctions within the innate and adaptive immune systems, endothelial damage, and immunothrombosis. Furthermore, the multisystem manifestations of COVID-19 across different organ systems, including the cardiovascular, renal, gastrointestinal, hepatobiliary, nervous, endocrine and metabolic, ophthalmic, ear-nose-throat, reproductive, hematopoietic, and immune systems are discussed in detail. Each system exhibits unique manifestations that contribute to the complexity of the disease.
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Affiliation(s)
| | - Rohan Bir Singh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States; Department of Population, Policy and Practice, Greater Ormond Street Institute of Child Health, University College London, United Kingdom; Discipline of Ophthalmology and Visual Sciences, Adelaide Medical School, University of Adelaide, Australia
| | - Syed A A Rizvi
- College of Biomedical Sciences, Larkin University, Miami, Florida, United States.
| | - Puya Dehgani-Mobaraki
- Founder and President, Associazione Naso Sano, Ringgold Institution ID 567754, San Mariano, Italy.
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Magaki S, Zhang T, Han K, Hilda M, Yong WH, Achim C, Fishbein G, Fishbein MC, Garner O, Salamon N, Williams CK, Valdes-Sueiras MA, Hsu JJ, Kelesidis T, Mathisen GE, Lavretsky H, Singer EJ, Vinters HV. HIV and COVID-19: two pandemics with significant (but different) central nervous system complications. FREE NEUROPATHOLOGY 2024; 5:5-5. [PMID: 38469363 PMCID: PMC10925920 DOI: 10.17879/freeneuropathology-2024-5343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/02/2024] [Indexed: 03/13/2024]
Abstract
Human immunodeficiency virus (HIV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cause significant neurologic disease. Central nervous system (CNS) involvement of HIV has been extensively studied, with well-documented invasion of HIV into the brain in the initial stage of infection, while the acute effects of SARS-CoV-2 in the brain are unclear. Neuropathologic features of active HIV infection in the brain are well characterized whereas neuropathologic findings in acute COVID-19 are largely non-specific. On the other hand, neuropathologic substrates of chronic dysfunction in both infections, as HIV-associated neurocognitive disorders (HAND) and post-COVID conditions (PCC)/long COVID are unknown. Thus far, neuropathologic studies on patients with HAND in the era of combined antiretroviral therapy have been inconclusive, and autopsy studies on patients diagnosed with PCC have yet to be published. Further longitudinal, multidisciplinary studies on patients with HAND and PCC and neuropathologic studies in comparison to controls are warranted to help elucidate the mechanisms of CNS dysfunction in both conditions.
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Affiliation(s)
- Shino Magaki
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA, USA
| | - Ting Zhang
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA, USA
| | - Karam Han
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA, USA
| | - Mirbaha Hilda
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA, USA
| | - William H. Yong
- Department of Pathology and Laboratory Medicine, University of California-Irvine School of Medicine, Irvine, CA, USA
| | - Cristian Achim
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Gregory Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael C. Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Omai Garner
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Noriko Salamon
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Christopher K. Williams
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA, USA
| | - Miguel A. Valdes-Sueiras
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jeffrey J. Hsu
- Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Theodoros Kelesidis
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Glenn E. Mathisen
- Department of Infectious Diseases, Olive View-University of California Los Angeles Medical Center, Sylmar, CA, USA
| | - Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Elyse J. Singer
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Harry V. Vinters
- Section of Neuropathology, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA, USA
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Brain Research Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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7
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Hu B, Gong M, Xiang Y, Qu S, Zhu H, Ye D. Mechanism and treatment of olfactory dysfunction caused by coronavirus disease 2019. J Transl Med 2023; 21:829. [PMID: 37978386 PMCID: PMC10657033 DOI: 10.1186/s12967-023-04719-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the start of the pandemic, olfactory dysfunction (OD) has been reported as a common symptom of COVID-19. In some asymptomatic carriers, OD is often the first and even the only symptom. At the same time, persistent OD is also a long-term sequela seen after COVID-19 that can have a serious impact on the quality of life of patients. However, the pathogenesis of post-COVID-19 OD is still unclear, and there is no specific treatment for its patients. The aim of this paper was to review the research on OD caused by SARS-CoV-2 infection and to summarize the mechanism of action, the pathogenesis, and current treatments.
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Affiliation(s)
- Bian Hu
- Department of Otorhinolaryngology-Head and Neck Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315040, Zhejiang, China
- Department of Otorhinolaryngology-Head and Neck Surgery, Ninghai First Hospital, Ningbo, 315600, Zhejiang, China
| | - Mengdan Gong
- Department of Otorhinolaryngology-Head and Neck Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315040, Zhejiang, China
| | - Yizhen Xiang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315040, Zhejiang, China
| | - Siyuan Qu
- Department of Otorhinolaryngology-Head and Neck Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315040, Zhejiang, China
| | - Hai Zhu
- Department of Otorhinolaryngology-Head and Neck Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315040, Zhejiang, China
| | - Dong Ye
- Department of Otorhinolaryngology-Head and Neck Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315040, Zhejiang, China.
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Chung TWH, Zhang H, Wong FKC, Sridhar S, Lee TMC, Leung GKK, Chan KH, Lau KK, Tam AR, Ho DTY, Cheng VCC, Yuen KY, Hung IFN, Mak HKF. A Pilot Study of Short-Course Oral Vitamin A and Aerosolised Diffuser Olfactory Training for the Treatment of Smell Loss in Long COVID. Brain Sci 2023; 13:1014. [PMID: 37508945 PMCID: PMC10377650 DOI: 10.3390/brainsci13071014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
Background: Olfactory dysfunction (OD) is a common neurosensory manifestation in long COVID. An effective and safe treatment against COVID-19-related OD is needed. Methods: This pilot trial recruited long COVID patients with persistent OD. Participants were randomly assigned to receive short-course (14 days) oral vitamin A (VitA; 25,000 IU per day) and aerosolised diffuser olfactory training (OT) thrice daily (combination), OT alone (standard care), or observation (control) for 4 weeks. The primary outcome was differences in olfactory function by butanol threshold tests (BTT) between baseline and end-of-treatment. Secondary outcomes included smell identification tests (SIT), structural MRI brain, and serial seed-based functional connectivity (FC) analyses in the olfactory cortical network by resting-state functional MRI (rs-fMRI). Results: A total of 24 participants were randomly assigned to receive either combination treatment (n = 10), standard care (n = 9), or control (n = 5). Median OD duration was 157 days (IQR 127-175). Mean baseline BTT score was 2.3 (SD 1.1). At end-of-treatment, mean BTT scores were significantly higher for the combination group than control (p < 0.001, MD = 4.4, 95% CI 1.7 to 7.2) and standard care (p = 0.009) groups. Interval SIT scores increased significantly (p = 0.009) in the combination group. rs-fMRI showed significantly higher FC in the combination group when compared to other groups. At end-of-treatment, positive correlations were found in the increased FC at left inferior frontal gyrus and clinically significant improvements in measured BTT (r = 0.858, p < 0.001) and SIT (r = 0.548, p = 0.042) scores for the combination group. Conclusions: Short-course oral VitA and aerosolised diffuser OT was effective as a combination treatment for persistent OD in long COVID.
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Affiliation(s)
- Tom Wai-Hin Chung
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hui Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Intelligent Wearable Systems, The Hong Kong Polytechnic University, Hong Kong, China
| | - Fergus Kai-Chuen Wong
- Department of Ear, Nose and Throat, Pamela Youde Nethersole Eastern Hospital, 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
| | - Tatia Mei-Chun Lee
- Department of Psychology, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Gilberto Ka-Kit Leung
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Koon-Ho Chan
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kui-Kai Lau
- State Key Laboratory of Brain and Cognitive Sciences, 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
| | - Anthony Raymond Tam
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Deborah Tip-Yin Ho
- Department of Medicine, Li Ka Shing Faculty of Medicine, 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-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
| | - Ivan Fan-Ngai Hung
- Carol Yu Centre for Infection, 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
- The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong, China
| | - Henry Ka-Fung Mak
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Alzheimer's Disease Research Network, The University of Hong Kong, Hong Kong, China
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9
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Hummel T, Power Guerra N, Gunder N, Hähner A, Menzel S. Olfactory Function and Olfactory Disorders. Laryngorhinootologie 2023; 102:S67-S92. [PMID: 37130532 PMCID: PMC10184680 DOI: 10.1055/a-1957-3267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The sense of smell is important. This became especially clear to patients with infection-related olfactory loss during the SARS-CoV-2 pandemic. We react, for example, to the body odors of other humans. The sense of smell warns us of danger, and it allows us to perceive flavors when eating and drinking. In essence, this means quality of life. Therefore, anosmia must be taken seriously. Although olfactory receptor neurons are characterized by regenerative capacity, anosmia is relatively common with about 5 % of anosmic people in the general population. Olfactory disorders are classified according to their causes (e. g., infections of the upper respiratory tract, traumatic brain injury, chronic rhinosinusitis, age) with the resulting different therapeutic options and prognoses. Thorough history taking is therefore important. A wide variety of tools are available for diagnosis, ranging from short screening tests and detailed multidimensional test procedures to electrophysiological and imaging methods. Thus, quantitative olfactory disorders are easily assessable and traceable. For qualitative olfactory disorders such as parosmia, however, no objectifying diagnostic procedures are currently available. Therapeutic options for olfactory disorders are limited. Nevertheless, there are effective options consisting of olfactory training as well as various additive drug therapies. The consultation and the competent discussion with the patients are of major importance.
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Affiliation(s)
- T Hummel
- Interdisziplinäres Zentrum Riechen und Schmecken, HNO Klinik, TU Dresden
| | - N Power Guerra
- Rudolf-Zenker-Institut für Experimentelle Chirurgie, Medizinische Universität Rostock, Rostock
| | - N Gunder
- Universitäts-HNO Klinik Dresden, Dresden
| | - A Hähner
- Interdisziplinäres Zentrum Riechen und Schmecken, HNO Klinik, TU Dresden
| | - S Menzel
- Interdisziplinäres Zentrum Riechen und Schmecken, HNO Klinik, TU Dresden
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Vaira LA, De Riu G, Boscolo-Rizzo P, Hopkins C, Lechien JR. In reference to Intranasal Corticosteroid Treatment on Recovery of Long-Term Olfactory Dysfunction Due to COVID-19. Laryngoscope 2023; 133:E29-E30. [PMID: 36495301 PMCID: PMC9877991 DOI: 10.1002/lary.30505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 12/14/2022]
Abstract
This is a commentary on the article by Hosseinpoor et al. Laryngoscope, 2022
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Affiliation(s)
- Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.,Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, Sassari, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Claire Hopkins
- Department of otorhinolaryngology, King's College, London, UK.,British Rhinological Society, London, UK
| | - Jerome R Lechien
- Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otolaryngology-Head Neck Surgery, Elsan Polyclinic of Poitiers, Poitiers, France
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11
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Abdou EHE, Ebada HA, Salem MA, Ghoneim MMR, Sherif F, Kamal E. Clinical and Imaging Evaluation of COVID-19-Related Olfactory Dysfunction. Am J Rhinol Allergy 2023:19458924231163969. [PMID: 36945746 PMCID: PMC10034563 DOI: 10.1177/19458924231163969] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Olfactory dysfunction has been reported in 47.85% of COVID patients. It can be broadly categorized into conductive or sensorineural olfactory loss. Conductive loss occurs due to impaired nasal air flow, while sensorineural loss implies dysfunction of the olfactory epithelium or central olfactory pathways. OBJECTIVES The aim of this study was to analyze the clinical and imaging findings in patients with COVID-related olfactory dysfunction. Additionally, the study aimed to investigate the possible mechanisms of COVID-related olfactory dysfunction. METHODS The study included 110 patients with post-COVID-19 olfactory dysfunction, and a control group of 50 COVID-negative subjects with normal olfactory function. Endoscopic nasal examination was performed for all participants with special focus on the olfactory cleft. Smell testing was performed for all participants by using a smell diskettes test. Olfactory pathway magnetic resonance imaging (MRI) was done to assess the condition of the olfactory cleft and the dimensions and volume of the olfactory bulb. RESULTS Olfactory dysfunction was not associated with nasal symptoms in 51.8% of patients. MRI showed significantly increased olfactory bulb dimensions and volume competed to controls. Additionally, it revealed olfactory cleft edema in 57.3% of patients. On the other hand, radiological evidence of sinusitis was detected in only 15.5% of patients. CONCLUSION The average olfactory bulb volumes were significantly higher in the patients' group compared to the control group, indicating significant edema and swelling in the olfactory bulb in patients with COVID-related olfactory dysfunction. Furthermore, in most patients, no sinonasal symptoms such as nasal congestion or rhinorrhea were reported, and similarly, no radiological evidence of sinusitis was detected. Consequently, the most probable mechanism of COVID-related olfactory dysfunction is sensorineural loss through virus spread and damage to the olfactory epithelium and pathways.
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Affiliation(s)
| | - Hisham Atef Ebada
- Department of Otorhinolaryngology, Mansoura University, Mansoura, Egypt
| | | | | | - Fatma Sherif
- Radio-diagnosis and Interventional Radiology, Faculty of medicine, Mansoura University, Mansoura, Egypt
| | - Elsharawy Kamal
- Department of Otorhinolaryngology, Mansoura University, Mansoura, Egypt
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12
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Quantitative assessment of the effect of SARS-CoV-2 on the corneal sub-basal nerve plexus of post-COVID-19 patients using in vivo confocal microscopy. Eye (Lond) 2023; 37:660-664. [PMID: 35322211 PMCID: PMC8941366 DOI: 10.1038/s41433-022-02018-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/15/2022] [Accepted: 03/09/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To investigate whether SARS-CoV-2 causes morphological changes in the corneal sub-basal nerve plexus (CSNP) of post-COVID-19 patients using in vivo confocal microscopy (IVCM). METHODS A total of 70 participants were included in the study and were divided into three groups. Post-COVID-19 patients with neurological manifestations were considered Group 1 (n = 24), and post-COVID-19 patients without neurological manifestations were considered Group 2 (n = 24). Healthy control participants were considered Group 3 (n = 22). The parameters of the CSNP, including nerve fibre density (NFD), nerve branch density (NBD), and nerve fibre length (NFL), were investigated in all participants using IVCM. Additionally, corneal sensitivity was tested by corneal esthesiometry. RESULTS The mean NFD, NBD, and NFL values of Group 1 (16.12 ± 4.84 fibre/mm2, 27.97 ± 9.62 branch/mm2, and 11.60 ± 2.89 mm/mm2) were significantly lower than those of Group 2 (19.55 ± 3.01 fibre/mm2, 40.44 ± 7.16 branch/mm2, and 15.92 ± 2.08 mm/mm2) and Group 3 (25.24 ± 3.75 fibre/mm2, 44.61 ± 11.80 branch/mm2, and 17.76 ± 3.32 mm/mm2) (p < 0.05 for all). Except the mean NFD value (p < 0.001), there were no significant differences in terms of the mean NBD and NFL values between Group 2 and Group 3 (p = 0.445, p = 0.085). The value of the mean corneal sensitivity was significantly higher in Group 3 (59.09 ± 1.97 mm) compared to Group 1 (55.21 ± 1.02 mm) and Group 2 (55.28 ± 1.18 mm) (p < 0.001, p < 0.001) but there was no significant difference between Group 1 and Group 2 (p = 1.000). CONCLUSION In post-COVID-19 patients, the mean parameters of CSNP were lower than in the control group. These differences were more pronounced in patients who had neurological manifestations of COVID-19.
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13
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Bremer J, Friemann J, von Stillfried S, Boor P, Weis J. Reduced T-cell densities in cranial nerves of patients who died with SARS-CoV-2 infection. Acta Neuropathol Commun 2023; 11:10. [PMID: 36641524 PMCID: PMC9839948 DOI: 10.1186/s40478-022-01502-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/16/2023] Open
Affiliation(s)
- Juliane Bremer
- grid.412301.50000 0000 8653 1507Institute of Neuropathology, Uniklinik RWTH Aachen, Aachen, Germany
| | - Johannes Friemann
- grid.500061.20000 0004 0390 4873Institute of Pathology, Märkische Kliniken GmbH, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - Saskia von Stillfried
- grid.412301.50000 0000 8653 1507Institute of Pathology, Uniklinik RWTH Aachen, Aachen, Germany
| | - Peter Boor
- grid.412301.50000 0000 8653 1507Institute of Pathology, Uniklinik RWTH Aachen, Aachen, Germany
| | - Joachim Weis
- grid.412301.50000 0000 8653 1507Institute of Neuropathology, Uniklinik RWTH Aachen, Aachen, Germany
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14
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Medina-Pérez JJ, Balderas-Juárez JA, Vega-Rosas A, Ballesteros-Penedo PG, Coubert-Pelayo SG. Acute Phrenic Neuropathy and Diaphragmatic Dysfunction as a Complication of COVID-19: A Report of Four Cases. Cureus 2023; 15:e34419. [PMID: 36874724 PMCID: PMC9978167 DOI: 10.7759/cureus.34419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Among the neurological manifestations associated with coronavirus disease 2019 (COVID-19), neuropathies are rare. They have been associated with prolonged prostration and metabolic failure in a seriously ill patient. We present a case series of four Mexican patients diagnosed with diaphragmatic dysfunction due to phrenic neuropathy during acute COVID-19, documented by conduction velocities of the phrenic nerves. Blood tests, chest computed tomography (CT), and nerve conduction velocities of the phrenic nerves were performed. COVID-19 patients with phrenic nerve neuropathy represent a therapeutic challenge since they have high oxygen requirements due to the malfunction of ventilatory mechanics secondary to neuromuscular damage, as well as the damage that pneumonia generates in lung tissue. We confirm and extend the neurological manifestations of COVID-19, the impact on the neuromuscular dysfunction of the diaphragm, and its consequences such as the difficulty of weaning from mechanical ventilation.
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Affiliation(s)
| | - José A Balderas-Juárez
- Neurology, IMSS (Instituto Mexicano del Seguro Social) Venados Hospital, Mexico City, MEX
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15
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Chee J, Chern B, Loh WS, Mullol J, Wang DY. Pathophysiology of SARS-CoV-2 Infection of Nasal Respiratory and Olfactory Epithelia and Its Clinical Impact. Curr Allergy Asthma Rep 2023; 23:121-131. [PMID: 36598732 PMCID: PMC9811886 DOI: 10.1007/s11882-022-01059-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW While the predominant cause for morbidity and mortality with SARS-CoV-2 infection is the lower respiratory tract manifestations of the disease, the effects of SARS-CoV-2 infection on the sinonasal tract have also come to the forefront especially with the increased recognition of olfactory symptom. This review presents a comprehensive summary of the mechanisms of action of the SARS-CoV-2 virus, sinonasal pathophysiology of COVID-19, and the correlation with the clinical and epidemiological impact on olfactory dysfunction. RECENT FINDINGS ACE2 and TMPRSS2 receptors are key players in the mechanism of infection of SARS-CoV-2. They are present within both the nasal respiratory as well as olfactory epithelia. There are however differences in susceptibility between different groups of individuals, as well as between the different SARS-CoV-2 variants. The sinonasal cavity is an important route for SARS-CoV-2 infection. While the mechanism of infection of SARS-CoV-2 in nasal respiratory and olfactory epithelia is similar, there exist small but significant differences in the susceptibility of these epithelia and consequently clinical manifestations of the disease. Understanding the differences and nuances in sinonasal pathophysiology in COVID-19 would allow the clinician to predict and counsel patients suffering from COVID-19. Future research into molecular pathways and cytokine responses at different stages of infection and different variants of SARS-CoV-2 would evaluate the individual clinical phenotype, prognosis, and possibly response to vaccines and therapeutics.
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Affiliation(s)
- Jeremy Chee
- grid.410759.e0000 0004 0451 6143Department of Otolaryngology - Head & Neck Surgery, National University Health System, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Beverlyn Chern
- grid.410759.e0000 0004 0451 6143Department of Otolaryngology - Head & Neck Surgery, National University Health System, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Woei Shyang Loh
- grid.410759.e0000 0004 0451 6143Department of Otolaryngology - Head & Neck Surgery, National University Health System, 1E Kent Ridge Road, Singapore, 119228 Singapore ,grid.4280.e0000 0001 2180 6431Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joaquim Mullol
- grid.10403.360000000091771775Rhinology Unit & Smell Clinic, Department of Otorhinolaryngology, Hospital Clinic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERES, Barcelona, Catalonia Spain
| | - De Yun Wang
- Department of Otolaryngology - Head & Neck Surgery, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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16
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Červený K, Janoušková K, Vaněčková K, Zavázalová Š, Funda D, Astl J, Holy R. Olfactory Evaluation in Clinical Medical Practice. J Clin Med 2022; 11:jcm11226628. [PMID: 36431104 PMCID: PMC9698169 DOI: 10.3390/jcm11226628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 11/10/2022] Open
Abstract
The subjective and demanding nature of olfactory testing means that it is often neglected in clinic despite loss of smell leading to significant limitations in everyday life. The list of diseases associated with loss of olfaction far exceeds the field of otorhinolaryngology and can also be seen in neurodegenerative disorders. Knowledge of possible clinical testing is essential to determine a proper differential diagnosis for the loss of olfactory sense. Causes of olfactory impairment can be divided into either failure in transferring odour to the organ of perception or damage to the olfactory pathway structure itself. Examination should therefore include methods evaluating cross-sectional area and patency of the nasal cavity as well as subjective or objective assessment of olfactory function. In this report we summarize several articles, studies, and our own experiences to provide a comprehensive review of their current clinical usage including their benefits, limitations, and possible outcomes. We also discuss the mechanism of olfaction step by step to provide a full understanding of the possible errors depending on the localization in the pathway and the methods designed for their detection. We discuss the correlation of the microbiome in nasal polyposis and chronic rhinitis with olfactory impairment using objective olfactometry. The topic of objective olfactometry and the examination of olfactory event-related potentials (OERP) is commented upon in detail.
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Affiliation(s)
- Květoslav Červený
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Motol, First Faculty of Medicine, Charles University, 15006 Prague, Czech Republic
- Institute of Anatomy, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Karla Janoušková
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
| | - Kristýna Vaněčková
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
| | - Šárka Zavázalová
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
| | - David Funda
- Laboratory of Cellular and Molecular Immunology, Institute of Microbiology of the CAS, v. v. i., 14220 Prague, Czech Republic
| | - Jaromír Astl
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
| | - Richard Holy
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic
- Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
- Correspondence:
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17
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Shen J, Wu L, Wang P, Shen X, Jiang Y, Liu J, Chen W. Clinical characteristics and short-term recovery of hyposmia in hospitalized non-severe COVID-19 patients with Omicron variant in Shanghai, China. Front Med (Lausanne) 2022; 9:1038938. [PMID: 36419783 PMCID: PMC9676490 DOI: 10.3389/fmed.2022.1038938] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/24/2022] [Indexed: 08/03/2023] Open
Abstract
Background Olfactory dysfunction is a common neurological symptom of Corona Virus Disease 2019(COVID-19). Little is known about hyposmia after COVID-19 infection with Omicron variant in Chinese population. Objective To investigate the incidence, clinical characteristics and recovery of hyposmia in hospitalized non-severe COVID-19 patients with Omicron variant in Shanghai, China. Methods Three hundred and forty-nine Chinese non-severe COVID-19 patients with Omicron variant were consecutively enrolled in a designated hospital to investigate the incidence of hyposmia in hospitalization and the recovery rate 1 month later. The visual assessment scale (VAS) was used to evaluate the severity of hyposmia. We compared the demographic, clinical features and treatment outcomes, as well as laboratory parameters between patients with and without hyposmia. Results The cross-sectional survey showed that 22 (6.3%) hospitalized patients with non-severe COVID-19 had hyposmia. Patients with hyposmia were younger (61.5 vs. 72.0, p = 0.002), had more related clinical symptoms (sore throat, cough, poor appetite, diarrhea, myalgia and taste impairment, etc.), a higher proportion of moderate clinical type (31.8 vs. 13.5%, p = 0.028) and longer duration of hospitalization (11 vs. 8 days, p = 0.027) than those without hyposmia. Whereas, there were no significant differences regarding gender, comorbidity and nucleic acid conversion time between the two groups. Laboratory subgroup analyses demonstrated that patients with hyposmia had slightly low serum IL-6 and TNF-α levels. However, both of the levels were not associated with hyposmia occurrence in multivariate regression analyses. Further follow-up study disclosed that 16 of 22 (72.7%) hyposmia patients had recovered olfaction 1 month later. Serum IL-6 and TNF-α levels were similar between hyposmia recovered patients and those with persistent hyposmia. Conclusion Although the incidence of hyposmia after Omicron variant infection is relatively low and the short-term recovery rate is quite high, patients with hyposmia are prone to have a higher proportion of both upper and lower respiratory tract involvements, gastrointestinal and neurological symptoms, contributing to a longer duration of hospitalization.
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Affiliation(s)
| | | | | | | | | | - Jianren Liu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Chen
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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18
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Olfactory and gustatory disorders in COVID-19. ALLERGO JOURNAL INTERNATIONAL 2022; 31:243-250. [PMID: 35755859 PMCID: PMC9208356 DOI: 10.1007/s40629-022-00216-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/28/2022] [Indexed: 12/05/2022]
Abstract
Loss of olfaction is one of the symptoms most commonly reported by patients with coronavirus disease 2019 (COVID-19). Although the spontaneous recovery rate is high, recent studies have shown that up to 7% of patients remain anosmic for more than 12 months after the onset of infection, leaving millions of people worldwide suffering from severe olfactory impairment. Olfactory training remains the first recommended treatment. With the continued lack of approved drug treatments, new therapeutic options are being explored. This article reviews the current state of science on COVID-19-related olfactory disorders, focusing on epidemiology, pathophysiology, cure rates, currently available treatment options, and research on new treatments.
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19
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Illéš R, Chochol J, Džubera A, Chocholová A, Zemková E. COVID-19 Worsens Chronic Lumbosacral Radicular Pain—Case Series Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116410. [PMID: 35681993 PMCID: PMC9180125 DOI: 10.3390/ijerph19116410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 01/08/2023]
Abstract
The knowledge of the COVID-19 symptomatology has increased since the beginning of the SARS-CoV-2 pandemic. The symptoms of nervous system involvement have been observed across the spectrum of COVID-19 severity. Reports describing difficulties of nerve roots are rare; the affection of brain and spinal cord by SARS-CoV-2 is of leading interest. Our aim therefore is to describe the radicular pain deterioration in the group of nine chronic lumbosacral radicular syndrome sufferers in acute COVID-19. The intensity of radicular pain was evaluated by the Visual Analogue Scale (VAS). The VAS score in acute infection increased from 5.6 ± 1.1 to 8.0 ± 1.3 (Cohen’s d = 1.99) over the course of COVID-19, indicating dramatic aggravation of pain intensity. However, the VAS score decreased spontaneously to pre-infection levels after 4 weeks of COVID-19 recovery (5.8 ± 1.1). The acute SARS-CoV-2 infection worsened the pre-existing neural root irritation symptomatology, which may be ascribed to SARS-CoV-2 radiculitis of neural roots already compressed by the previous disc herniation. These findings based on clinical observations indicate that the neurotropism of novel coronavirus infection can play an important role in the neural root irritation symptomatology deterioration in patients with chronic pre-existing lumbosacral radicular syndrome.
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Affiliation(s)
- Róbert Illéš
- Department of Neurosurgery, Slovak Medical University and University Hospital—St. Michael’s Hospital, Satinského 1, 811 08 Bratislava, Slovakia; (R.I.); (A.D.)
- Faculty of Medicine, Slovak Medical University in Bratislava, Limbová 12, 833 03 Bratislava, Slovakia
| | - Juraj Chochol
- Department of Neurosurgery, Slovak Medical University and University Hospital—St. Michael’s Hospital, Satinského 1, 811 08 Bratislava, Slovakia; (R.I.); (A.D.)
- Faculty of Medicine, Slovak Medical University in Bratislava, Limbová 12, 833 03 Bratislava, Slovakia
- Correspondence: ; Tel.: +421-2-3261-2305
| | - Andrej Džubera
- Department of Neurosurgery, Slovak Medical University and University Hospital—St. Michael’s Hospital, Satinského 1, 811 08 Bratislava, Slovakia; (R.I.); (A.D.)
- Faculty of Medicine, Slovak Medical University in Bratislava, Limbová 12, 833 03 Bratislava, Slovakia
| | - Alica Chocholová
- Department of Paediatric Haematology and Oncology, National Institute of Children’s Diseases, Limbova 1, 833 40 Bratislava, Slovakia;
| | - Erika Zemková
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sport, Comenius University in Bratislava, Nábrežie Armádneho Generála Ludvíka Svobodu 9, 814 69 Bratislava, Slovakia;
- Sports Technology Institute, Faculty of Electrical Engineering and Information Technology, Slovak University of Technology, Ilkovičova 3, 812 19 Bratislava, Slovakia
- Faculty of Health Sciences, University of Ss. Cyril and Methodius in Trnava, Rázusova 14, 921 01 Trnava, Slovakia
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20
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Käufer C, Schreiber CS, Hartke AS, Denden I, Stanelle-Bertram S, Beck S, Kouassi NM, Beythien G, Becker K, Schreiner T, Schaumburg B, Beineke A, Baumgärtner W, Gabriel G, Richter F. Microgliosis and neuronal proteinopathy in brain persist beyond viral clearance in SARS-CoV-2 hamster model. EBioMedicine 2022; 79:103999. [PMID: 35439679 PMCID: PMC9013202 DOI: 10.1016/j.ebiom.2022.103999] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Neurological symptoms such as cognitive decline and depression contribute substantially to post-COVID-19 syndrome, defined as lasting symptoms several weeks after initial SARS-CoV-2 infection. The pathogenesis is still elusive, which hampers appropriate treatment. Neuroinflammatory responses and neurodegenerative processes may occur in absence of overt neuroinvasion. METHODS Here we determined whether intranasal SARS-CoV-2 infection in male and female syrian golden hamsters results in persistent brain pathology. Brains 3 (symptomatic) or 14 days (viral clearance) post infection versus mock (n = 10 each) were immunohistochemically analyzed for viral protein, neuroinflammatory response and accumulation of tau, hyperphosphorylated tau and alpha-synuclein protein. FINDINGS Viral protein in the nasal cavity led to pronounced microglia activation in the olfactory bulb beyond viral clearance. Cortical but not hippocampal neurons accumulated hyperphosphorylated tau and alpha-synuclein, in the absence of overt inflammation and neurodegeneration. Importantly, not all brain regions were affected, which is in line with selective vulnerability. INTERPRETATION Thus, despite the absence of virus in brain, neurons develop signatures of proteinopathies that may contribute to progressive neuronal dysfunction. Further in depth analysis of this important mechanism is required. FUNDING Federal Ministry of Health (BMG; ZMV I 1-2520COR501), Federal Ministry of Education and Research (BMBF 01KI1723G), Ministry of Science and Culture of Lower Saxony in Germany (14 - 76103-184 CORONA-15/20), German Research Foundation (DFG; 398066876/GRK 2485/1), Luxemburgish National Research Fund (FNR, Project Reference: 15686728, EU SC1-PHE-CORONAVIRUS-2020 MANCO, no > 101003651).
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Affiliation(s)
- Christopher Käufer
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Cara S Schreiber
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; Center for Systems Neuroscience, Hannover, Germany
| | - Anna-Sophia Hartke
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; Center for Systems Neuroscience, Hannover, Germany
| | - Ivo Denden
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | | | - Sebastian Beck
- Leibniz Institute for Experimental Virology, Hamburg, Germany
| | | | - Georg Beythien
- Department of Pathology, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Kathrin Becker
- Department of Pathology, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Tom Schreiner
- Department of Pathology, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | | | - Andreas Beineke
- Department of Pathology, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; Center for Systems Neuroscience, Hannover, Germany
| | - Wolfgang Baumgärtner
- Department of Pathology, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; Center for Systems Neuroscience, Hannover, Germany
| | - Gülsah Gabriel
- Leibniz Institute for Experimental Virology, Hamburg, Germany; Institute for Virology, University for Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Franziska Richter
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; Center for Systems Neuroscience, Hannover, Germany.
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21
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Bauer L, Laksono BM, de Vrij FMS, Kushner SA, Harschnitz O, van Riel D. The neuroinvasiveness, neurotropism, and neurovirulence of SARS-CoV-2. Trends Neurosci 2022; 45:358-368. [PMID: 35279295 PMCID: PMC8890977 DOI: 10.1016/j.tins.2022.02.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/14/2022] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
Abstract
Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection is associated with a diverse spectrum of neurological complications during the acute and postacute stages. The pathogenesis of these complications is complex and dependent on many factors. For accurate and consistent interpretation of experimental data in this fast-growing field of research, it is essential to use terminology consistently. In this article, we outline the distinctions between neuroinvasiveness, neurotropism, and neurovirulence. Additionally, we discuss current knowledge of these distinct features underlying the pathogenesis of SARS-CoV-2-associated neurological complications. Lastly, we briefly discuss the advantages and limitations of different experimental models, and how these approaches can further be leveraged to advance the field.
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Affiliation(s)
- Lisa Bauer
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Steven A Kushner
- Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | | | - Debby van Riel
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands.
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22
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Intranasal delivery of SARS-CoV-2 spike protein is sufficient to cause olfactory damage, inflammation and olfactory dysfunction in zebrafish. Brain Behav Immun 2022; 102:341-359. [PMID: 35307504 PMCID: PMC8929544 DOI: 10.1016/j.bbi.2022.03.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/03/2022] [Accepted: 03/12/2022] [Indexed: 02/07/2023] Open
Abstract
Anosmia, loss of smell, is a prevalent symptom of SARS-CoV-2 infection. Anosmia may be explained by several mechanisms driven by infection of non-neuronal cells and damage in the nasal epithelium rather than direct infection of olfactory sensory neurons (OSNs). Previously, we showed that viral proteins are sufficient to cause neuroimmune responses in the teleost olfactory organ (OO). We hypothesize that SARS-CoV-2 spike (S) protein is sufficient to cause olfactory damage and olfactory dysfunction. Using an adult zebrafish model, we report that intranasally delivered SARS-CoV-2 S RBD mostly binds to the non-sensory epithelium of the olfactory organ and causes severe olfactory histopathology characterized by loss of cilia, hemorrhages and edema. Electrophysiological recordings reveal impaired olfactory function to both food and bile odorants in animals treated intranasally with SARS-CoV-2 S RBD. However, no loss of behavioral preference for food was detected in SARS-CoV-2 S RBD treated fish. Single cell RNA-Seq of the adult zebrafish olfactory organ indicated widespread loss of olfactory receptor expression and inflammatory responses in sustentacular, endothelial, and myeloid cell clusters along with reduced numbers of Tregs. Combined, our results demonstrate that intranasal SARS-CoV-2 S RBD is sufficient to cause structural and functional damage to the zebrafish olfactory system. These findings may have implications for intranasally delivered vaccines against SARS-CoV-2.
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23
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Matsunaga A, Tsuzuki S, Morioka S, Ohmagari N, Ishizaka Y. Long COVID: current status in Japan and knowledge about its molecular background. Glob Health Med 2022; 4:83-93. [PMID: 35586759 PMCID: PMC9066464 DOI: 10.35772/ghm.2022.01013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/23/2022] [Accepted: 04/04/2022] [Indexed: 06/15/2023]
Abstract
Even after recovering from coronavirus disease 2019 (COVID-19), patients can experience prolonged complaints, referred to as "long COVID". Similar to reports in Caucasians, a follow-up study in Japan revealed that fatigue, dyspnea, cough, anosmia/dysgeusia, and dyssomnia are common symptoms. Although the precise mode of long COVID remains elusive, multiple etiologies such as direct organ damage by infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), autoimmunity, prolonged inflammatory reactions, and psychiatric impairment seem to be involved. Notably, SARS-CoV-2 is neurotropic, and viral RNA and proteins are continuously detectable in multiple organs, including the brain. Viral proteins exert a number of different toxic effects on cells, suggesting that persistent infection is a key element for understanding long COVID. Here, we first reviewed the current status of long COVID in Japan, and then summarized literature that help us understand the molecular background of the symptoms. Finally, we discuss the feasibility of vaccination as a treatment for patients with long COVID.
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Affiliation(s)
- Akihiro Matsunaga
- Department of Intractable Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinya Tsuzuki
- AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Shinichiro Morioka
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukihito Ishizaka
- Department of Intractable Diseases, National Center for Global Health and Medicine, Tokyo, Japan
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24
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COVID-19 and the Brain: The Neuropathological Italian Experience on 33 Adult Autopsies. Biomolecules 2022; 12:biom12050629. [PMID: 35625558 PMCID: PMC9138268 DOI: 10.3390/biom12050629] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/16/2022] [Accepted: 04/22/2022] [Indexed: 02/04/2023] Open
Abstract
Neurological symptoms are increasingly recognized in SARS-CoV-2 infected individuals. However, the neuropathogenesis remains unclear and it is not possible to define a specific damage pattern due to brain virus infection. In the present study, 33 cases of brain autopsies performed during the first (February–April 2020) and the second/third (November 2020–April 2021) pandemic waves are described. In all the cases, SARS-CoV-2 RNA was searched. Pathological findings are described and compared with those presently published.
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25
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Morowitz JM, Pogson KB, Roque DA, Church FC. Role of SARS-CoV-2 in Modifying Neurodegenerative Processes in Parkinson's Disease: A Narrative Review. Brain Sci 2022; 12:536. [PMID: 35624923 PMCID: PMC9139310 DOI: 10.3390/brainsci12050536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic, caused by SARS-CoV-2, continues to impact global health regarding both morbidity and mortality. Although SARS-CoV-2 primarily causes acute respiratory distress syndrome (ARDS), the virus interacts with and influences other organs and tissues, including blood vessel endothelium, heart, gastrointestinal tract, and brain. We are learning much about the pathophysiology of SARS-CoV-2 infection; however, we are just beginning to study and understand the long-term and chronic health consequences. Since the pandemic's beginning in late 2019, older adults, those with pre-existing illnesses, or both, have an increased risk of contracting COVID-19 and developing severe COVID-19. Furthermore, older adults are also more likely to develop the neurodegenerative disorder Parkinson's disease (PD), with advanced age as the most significant risk factor. Thus, does SARS-CoV-2 potentially influence, promote, or accelerate the development of PD in older adults? Our initial focus was aimed at understanding SARS-CoV-2 pathophysiology and the connection to neurodegenerative disorders. We then completed a literature review to assess the relationship between PD and COVID-19. We described potential molecular and cellular pathways that indicate dopaminergic neurons are susceptible, both directly and indirectly, to SARS-CoV-2 infection. We concluded that under certain pathological circumstances, in vulnerable persons-with-Parkinson's disease (PwP), SARS-CoV-2 acts as a neurodegenerative enhancer to potentially support the development or progression of PD and its related motor and non-motor symptoms.
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Affiliation(s)
- Jeremy M. Morowitz
- Developmental and Stem Cell Biology Program, Duke University, Durham, NC 27708, USA;
| | - Kaylyn B. Pogson
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Daniel A. Roque
- Department of Neurology, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA;
| | - Frank C. Church
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA
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26
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Changes in the Intranetwork and Internetwork Connectivity of the Default Mode Network and Olfactory Network in Patients with COVID-19 and Olfactory Dysfunction. Brain Sci 2022; 12:brainsci12040511. [PMID: 35448042 PMCID: PMC9029634 DOI: 10.3390/brainsci12040511] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 12/21/2022] Open
Abstract
Olfactory dysfunction (OD) is a common symptom in coronavirus disease 2019 (COVID-19) patients. Moreover, many neurological manifestations have been reported in these patients, suggesting central nervous system involvement. The default mode network (DMN) is closely associated with olfactory processing. In this study, we investigated the internetwork and intranetwork connectivity of the DMN and the olfactory network (ON) in 13 healthy controls and 22 patients presenting with COVID-19-related OD using independent component analysis and region of interest functional magnetic resonance imaging (fMRI) analysis. There was a significant correlation between the butanol threshold test (BTT) and the intranetwork connectivity in ON. Meanwhile, the COVID-19 patients with OD showed significantly higher intranetwork connectivity in the DMN, as well as higher internetwork connectivity between ON and DMN. However, no significant difference was found between groups in the intranetwork connectivity within ON. We postulate that higher intranetwork functional connectivities compensate for the deficits in olfactory processing and general well-being in COVID-19 patients. Nevertheless, the compensation process in the ON may not be obvious at this stage. Our results suggest that resting-state fMRI is a potentially valuable tool to evaluate neurosensory dysfunction in COVID-19 patients.
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27
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Toebbe JT, Genter MB. An Update on Sphingosine-1-Phosphate and Lysophosphatidic Acid Receptor Transcripts in Rodent Olfactory Mucosa. Int J Mol Sci 2022; 23:ijms23084343. [PMID: 35457160 PMCID: PMC9032240 DOI: 10.3390/ijms23084343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 02/04/2023] Open
Abstract
Olfactory neurons connect the external environment and the brain, allowing the translocation of materials from the nasal cavity into the brain. The olfactory system is involved in SARS-CoV-2 infections; early in the pandemic declared in 2020, a loss of the sense of smell was found in many infected patients. Attention has also been focused on the role that the olfactory epithelium appears to play in the entry of the SARS-CoV-2 virus into the brain. Specifically, SARS-CoV-2 enters cells via the angiotensin-converting enzyme 2 protein (ACE2), which is found on supporting cells in the olfactory epithelium. The intranasal administration of sphingosine has been proposed to prevent the binding of SARS-CoV-2 to ACE2. Further, sphingosine-1-phosphate (S1P) receptors appear to facilitate the entry of SARS-CoV-2 into the brain. The goal of these studies was to characterize S1P receptor expression status in rodent olfactory mucosa. The expression of receptors for a related sphingolipid, lysophosphatidic acid (LPA), was also assessed. The results confirm previous reports of S1P1 and S1P3 receptor expression, as well as LPA receptor 1, in mouse olfactory mucosa; moreover, they extend the previous findings to identify additional S1P and LPA receptor transcripts in rat and mouse olfactory mucosa, as well as in cultured olfactory neurons. These findings may enhance the utility of rodent models in identifying agonists and/or antagonists of S1P and LPA receptors that may block the entry of SARS-CoV-2 and other viruses into nasal epithelial cells, and prevent transmission from the nasal cavity into the brain.
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28
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Vaira LA, De Riu G, Salzano G, Maglitto F, Boscolo-Rizzo P, Lechien JR. In Response to Clinical Features of Parosmia Associated with COVID-19 Infection. Laryngoscope 2022; 132:E28-E29. [PMID: 35385148 PMCID: PMC9088487 DOI: 10.1002/lary.30134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.,Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, Sassari, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giovanni Salzano
- ENT and Maxillofacial Surgery Unit, Istituto Tumori G. Pascale of Naples, Naples, Italy.,Maxillofacial Surgery Unit, University Hospital of Naples "Federico II", Naples, Italy
| | - Fabio Maglitto
- Maxillofacial Surgery Unit, University Hospital of Naples "Federico II", Naples, Italy
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Jerome R Lechien
- Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.,Department of Otolaryngology-Head Neck Surgery, Elsan Hospital, Paris, France
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29
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Morphological and Immunopathological Aspects of Lingual Tissues in COVID-19. Cells 2022; 11:cells11071248. [PMID: 35406811 PMCID: PMC8997468 DOI: 10.3390/cells11071248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 02/07/2023] Open
Abstract
COVID-19, a recently emerged disease caused by SARS-CoV-2 infection, can present with different degrees of severity and a large variety of signs and symptoms. The oral manifestations of COVID-19 often involve the tongue, with loss of taste being one of the most common symptoms of the disease. This study aimed to detect SARS-CoV-2 RNA and assess possible morphological and immunopathological alterations in the lingual tissue of patients who died with a history of SARS-CoV-2 infection. Sixteen cadavers from 8 SARS-CoV-2 positive (COVID-19+) and 8 negative (COVID-19−) subjects provided 16 tongues, that were biopsied. Samples underwent molecular analysis through Real-Time RT-PCR for the detection of SARS-CoV-2 RNA. Lingual papillae were harvested and processed for histological analysis and for immunohistochemical evaluation for ACE2, IFN-γ and factor VIII. Real-Time RT-PCR revealed the presence of SARS-CoV-2 RNA in filiform, foliate, and circumvallate papillae in 6 out of 8 COVID-19+ subjects while all COVID-19− samples resulted negative. Histology showed a severe inflammation of COVID-19+ papillae with destruction of the taste buds. ACE2 and IFN-γ resulted downregulated in COVID-19+ and no differences were evidenced for factor VIII between the two groups. The virus was detectable in most COVID-19+ tongues. An inflammatory damage to the lingual papillae, putatively mediated by ACE2 and IFN-γ in tongues from COVID-19+ cadavers, was observed. Further investigations are needed to confirm these findings and deepen the association between taste disorders and inflammation in SARS-CoV-2 infection.
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30
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Snitz K, Honigstein D, Weissgross R, Ravia A, Mishor E, Perl O, Karagach S, Medhanie A, Harel N, Shushan S, Roth Y, Iravani B, Arshamian A, Ernst G, Okamoto M, Poo C, Bonacchi N, Mainen Z, Monteleone E, Dinnella C, Spinelli S, Mariño-Sánchez F, Ferdenzi C, Smeets M, Touhara K, Bensafi M, Hummel T, Lundström JN, Sobel N. An olfactory self-test effectively screens for COVID-19. COMMUNICATIONS MEDICINE 2022; 2:34. [PMID: 35603293 PMCID: PMC9053292 DOI: 10.1038/s43856-022-00095-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/18/2022] [Indexed: 01/05/2023] Open
Abstract
Background Key to curtailing the COVID-19 pandemic are wide-scale screening strategies. An ideal screen is one that would not rely on transporting, distributing, and collecting physical specimens. Given the olfactory impairment associated with COVID-19, we developed a perceptual measure of olfaction that relies on smelling household odorants and rating them online. Methods Each participant was instructed to select 5 household items, and rate their perceived odor pleasantness and intensity using an online visual analogue scale. We used this data to assign an olfactory perceptual fingerprint, a value that reflects the perceived difference between odorants. We tested the performance of this real-time tool in a total of 13,484 participants (462 COVID-19 positive) from 134 countries who provided 178,820 perceptual ratings of 60 different household odorants. Results We observe that olfactory ratings are indicative of COVID-19 status in a country, significantly correlating with national infection rates over time. More importantly, we observe indicative power at the individual level (79% sensitivity and 87% specificity). Critically, this olfactory screen remains effective in participants with COVID-19 but without symptoms, and in participants with symptoms but without COVID-19. Conclusions The current odorant-based olfactory screen adds a component to online symptom-checkers, to potentially provide an added first line of defense that can help fight disease progression at the population level. The data derived from this tool may allow better understanding of the link between COVID-19 and olfaction.
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Affiliation(s)
- Kobi Snitz
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | | | - Reut Weissgross
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Aharon Ravia
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Eva Mishor
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Ofer Perl
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Shiri Karagach
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Abebe Medhanie
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Nir Harel
- Department of Fine Arts, Bezalel Academy of Fine Arts and Design, Jerusalem, Israel
| | - Sagit Shushan
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
- Department of Otolaryngology-Head & Neck Surgery, Edith Wolfson Medical Center, Holon, Israel
| | - Yehudah Roth
- Department of Otolaryngology-Head & Neck Surgery, Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Behzad Iravani
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Artin Arshamian
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gernot Ernst
- Psychological institute, Oslo University, Oslo, Norway
| | - Masako Okamoto
- Department of Applied Biological Chemistry, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Cindy Poo
- Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Niccolò Bonacchi
- Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Zachary Mainen
- Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Erminio Monteleone
- Department of Agriculture, Food, Environment and Forestry, University of Florence, Florence, Italy
| | - Caterina Dinnella
- Department of Agriculture, Food, Environment and Forestry, University of Florence, Florence, Italy
| | - Sara Spinelli
- Department of Agriculture, Food, Environment and Forestry, University of Florence, Florence, Italy
| | - Franklin Mariño-Sánchez
- Rhinology and Skull Base Surgery Unit, Otorhinolaryngology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Camille Ferdenzi
- Lyon Neuroscience Research Center, CNRS - INSERM - University Claude Bernard of Lyon, Lyon, France
| | - Monique Smeets
- Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, the Netherlands
| | - Kazushige Touhara
- Department of Applied Biological Chemistry, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Moustafa Bensafi
- Lyon Neuroscience Research Center, CNRS - INSERM - University Claude Bernard of Lyon, Lyon, France
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Johan N. Lundström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Monell Chemical Senses Center, Philadelphia, PA USA
| | - Noam Sobel
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
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31
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Patel ZM, Holbrook EH, Turner JH, Adappa ND, Albers MW, Altundag A, Appenzeller S, Costanzo RM, Croy I, Davis GE, Dehgani-Mobaraki P, Doty RL, Duffy VB, Goldstein BJ, Gudis DA, Haehner A, Higgins TS, Hopkins C, Huart C, Hummel T, Jitaroon K, Kern RC, Khanwalkar AR, Kobayashi M, Kondo K, Lane AP, Lechner M, Leopold DA, Levy JM, Marmura MJ, Mclelland L, Miwa T, Moberg PJ, Mueller CA, Nigwekar SU, O'Brien EK, Paunescu TG, Pellegrino R, Philpott C, Pinto JM, Reiter ER, Roalf DR, Rowan NR, Schlosser RJ, Schwob J, Seiden AM, Smith TL, Soler ZM, Sowerby L, Tan BK, Thamboo A, Wrobel B, Yan CH. International consensus statement on allergy and rhinology: Olfaction. Int Forum Allergy Rhinol 2022; 12:327-680. [PMID: 35373533 DOI: 10.1002/alr.22929] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/01/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The literature regarding clinical olfaction, olfactory loss, and olfactory dysfunction has expanded rapidly over the past two decades, with an exponential rise in the past year. There is substantial variability in the quality of this literature and a need to consolidate and critically review the evidence. It is with that aim that we have gathered experts from around the world to produce this International Consensus on Allergy and Rhinology: Olfaction (ICAR:O). METHODS Using previously described methodology, specific topics were developed relating to olfaction. Each topic was assigned a literature review, evidence-based review, or evidence-based review with recommendations format as dictated by available evidence and scope within the ICAR:O document. Following iterative reviews of each topic, the ICAR:O document was integrated and reviewed by all authors for final consensus. RESULTS The ICAR:O document reviews nearly 100 separate topics within the realm of olfaction, including diagnosis, epidemiology, disease burden, diagnosis, testing, etiology, treatment, and associated pathologies. CONCLUSION This critical review of the existing clinical olfaction literature provides much needed insight and clarity into the evaluation, diagnosis, and treatment of patients with olfactory dysfunction, while also clearly delineating gaps in our knowledge and evidence base that we should investigate further.
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Affiliation(s)
- Zara M Patel
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric H Holbrook
- Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Justin H Turner
- Otolaryngology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Nithin D Adappa
- Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark W Albers
- Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aytug Altundag
- Otolaryngology, Biruni University School of Medicine, İstanbul, Turkey
| | - Simone Appenzeller
- Rheumatology, School of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Richard M Costanzo
- Physiology and Biophysics and Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Ilona Croy
- Psychology and Psychosomatic Medicine, TU Dresden, Dresden, Germany
| | - Greg E Davis
- Otolaryngology, Proliance Surgeons, Seattle and Puyallup, Washington, USA
| | - Puya Dehgani-Mobaraki
- Associazione Naso Sano, Umbria Regional Registry of Volunteer Activities, Corciano, Italy
| | - Richard L Doty
- Smell and Taste Center, Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Valerie B Duffy
- Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | | | - David A Gudis
- Otolaryngology, Columbia University Irving Medical Center, New York, USA
| | - Antje Haehner
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | - Thomas S Higgins
- Otolaryngology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Claire Hopkins
- Otolaryngology, Guy's and St. Thomas' Hospitals, London Bridge Hospital, London, UK
| | - Caroline Huart
- Otorhinolaryngology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholgique de Louvain, Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | | | - Robert C Kern
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashoke R Khanwalkar
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Masayoshi Kobayashi
- Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kenji Kondo
- Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Andrew P Lane
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matt Lechner
- Otolaryngology, Barts Health and University College London, London, UK
| | - Donald A Leopold
- Otolaryngology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Joshua M Levy
- Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael J Marmura
- Neurology Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisha Mclelland
- Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Takaki Miwa
- Otolaryngology, Kanazawa Medical University, Ishikawa, Japan
| | - Paul J Moberg
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Sagar U Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin K O'Brien
- Otolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Teodor G Paunescu
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Carl Philpott
- Otolaryngology, University of East Anglia, Norwich, UK
| | - Jayant M Pinto
- Otolaryngology, University of Chicago, Chicago, Illinois, USA
| | - Evan R Reiter
- Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - David R Roalf
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas R Rowan
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Schlosser
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - James Schwob
- Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Allen M Seiden
- Otolaryngology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Timothy L Smith
- Otolaryngology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - Leigh Sowerby
- Otolaryngology, University of Western Ontario, London, Ontario, Canada
| | - Bruce K Tan
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew Thamboo
- Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bozena Wrobel
- Otolaryngology, Keck School of Medicine, USC, Los Angeles, California, USA
| | - Carol H Yan
- Otolaryngology, School of Medicine, UCSD, La Jolla, California, USA
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32
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Long-Term Subjective and Objective Assessment of Smell and Taste in COVID-19. Cells 2022; 11:cells11050788. [PMID: 35269410 PMCID: PMC8909596 DOI: 10.3390/cells11050788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/14/2022] [Accepted: 02/23/2022] [Indexed: 12/24/2022] Open
Abstract
Among the first clinical symptoms of the SARS-CoV-2 infection is olfactory−gustatory deficit; this continues for weeks and, in some cases, can be persistent. We prospectively evaluated 162 patients affected by COVID-19 using a visual analogue scale (VAS) for nasal and olfactory−gustatory symptoms. Patients were checked after 7, 14, 21, 28, 90, and 180 days. A total of 118 patients (72.8%) reported an olfactory VAS < 7 at baseline (group B), and 44 (27.2%) reported anosmia (VAS ≥ 7) (group A) and underwent the Brief Smell Identification Test (B-SIT) and Burghart Taste Strips (BTS) to quantify the deficit objectively and repeated the tests to confirm the sense recovery. Group A patients showed B-SIT anosmia and hyposmia in 44.2% and 55.8% of cases, respectively. A total of 88.6% of group A patients reported ageusia with VAS ≥ 7, and BTS confirmed 81.8% of ageusia and 18.2% of hypogeusia. VAS smell recovery was recorded starting from 14 days, with normalization at 28 days. The 28-day B-SIT score showed normosmia in 90.6% of group A patients. The mean time for full recovery (VAS = 0) was shorter in group B (22.9 days) than in group A (31.9 days). Chemosensory deficit is frequently the first symptom in patients with COVID-19, and, in most cases, recovery occurs after four weeks.
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Taga A, Lauria G. COVID-19 and the Peripheral Nervous System. A 2-year review from the pandemic to the vaccine era. J Peripher Nerv Syst 2022; 27:4-30. [PMID: 35137496 PMCID: PMC9115278 DOI: 10.1111/jns.12482] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 01/31/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
Abstract
Increasing literature has linked COVID‐19 to peripheral nervous system (PNS) diseases. In addition, as we move from the pandemic to the vaccination era, literature interest is shifting towards the potential association between COVID‐19 vaccines and PNS manifestations. We reviewed published literature on COVID‐19, COVID‐19 vaccines and PNS manifestations between 1 January 2020 and 1 December 2021. For Guillain‐Barré syndrome (GBS), isolated cranial neuropathy (ICN) and myositis associated with COVID‐19, the demographic, clinical, laboratory, electrophysiological and imaging features were included in a narrative synthesis. We identified 169 studies on COVID‐19‐associated complications, including 63 papers (92 patients) on GBS, 29 papers (37 patients) on ICN and 11 papers (18 patients) on myositis. Additional clinical phenotypes included chronic inflammatory demyelinating polyneuropathy, vasculitic neuropathies, neuralgic amyotrophy, critical care‐related complications, and myasthenia gravis. PNS complications secondary to COVID‐19 vaccines have been reported during randomized clinical trials, in real‐world case reports, and during large‐scale surveillance programs. These mainly include cases of GBS, Bell's palsy, and cases of neuralgic amyotrophy. Based on our extensive review of the literature, any conclusion about a pathophysiological correlation between COVID‐19 and PNS disorders remains premature, and solely supported by their temporal association, while epidemiological and pathological data are insufficient. The occurrence of PNS complications after COVID‐19 vaccines seems limited to a possible higher risk of facial nerve palsy and GBS, to a degree that widespread access to the ongoing vaccination campaign should not be discouraged, while awaiting for more definitive data from large‐scale surveillance studies.
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Affiliation(s)
- Arens Taga
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Giuseppe Lauria
- Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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Abstract
PURPOSE OF REVIEW This article reviews the literature on COVID-19 related anosmia, focusing on the epidemiology, pathophysiology recovery rates, current available treatment options, and research regarding novel treatments. RECENT FINDINGS Loss of sense of smell is one of the most prevalent symptoms reported by patients after COVID-19 infection. Even though there is a high self-reported recovery rate, recent studies have demonstrated that up to 7% of the patients remain anosmic more than 12 months after onset, leaving millions worldwide with severe olfactory dysfunction. Olfactory training remains the first line recommended treatment. Given the paucity of effective medical treatments options researchers are exploring novel therapeutic options. SUMMARY Olfactory dysfunction remains a significant and persistent legacy of the COVID-19 pandemic, but heightened awareness may stimulate research that leads to the development of much-needed treatment options.
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Affiliation(s)
- Katerina Karamali
- Department of Otorhinolaryngology, Guy's and St Thomas NHS Foundation Trust
| | - Michael Elliott
- Department of Otorhinolaryngology, Guy's and St Thomas NHS Foundation Trust
| | - Claire Hopkins
- Guy's and St Thomas’ NHS Foundation Trust, London, United Kingdom
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Klimek L, Hagemann J, Döge J, Koll L, Cuevas M, Klimek F, Hummel T. Störungen des Riech- und Schmeckvermögens bei COVID-19. ALLERGO JOURNAL 2022; 31:35-43. [PMCID: PMC9618349 DOI: 10.1007/s15007-022-5602-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Der Verlust des Riechvermögens ist eines der Symptome, die von Patienten mit COVID-19 mit am häufigsten angegeben werden. Obwohl die Spontanheilungsrate hoch ist, haben neuere Studien gezeigt, dass bis zu 7 % der Patienten mehr als zwölf Monate nach Beginn der Infektion anosmisch bleiben, sodass weltweit Millionen von Menschen unter schweren Riechstörungen leiden. Riechtraining ist nach wie vor die erste empfohlene Behandlungsform. Angesichts weiterhin fehlender zugelassener medikamentöser Behandlungsmöglichkeiten werden neue therapeutische Optionen erforscht. Dieser Artikel gibt einen Überblick über den aktuellen Stand der Wissenschaft zu COVID-19-bedingten Riechstörungen, wobei der Schwerpunkt auf der Epidemiologie, der Pathophysiologie, den Heilungsraten, den derzeit verfügbaren Behandlungsmöglichkeiten und der Forschung zu neuen Behandlungsmethoden liegt. Zitierweise: Klimek L, Hagemann J, Döge J, Freudelsperger L, Cuevas M, Klimek F, Hummel T. Olfactory and gustatory disorders in COVID-19. Allergo J Int 2022;31:243-50 https://doi.org/10.1007/s40629-022-00216-7
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Affiliation(s)
- Ludger Klimek
- FA für Dermatologie u. Allergologie, Zentrum f. Rhinologie und Allergologie, An den Quellen 10, 65183 Wiesbaden, Germany
| | - Jan Hagemann
- Klinik f. Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Julia Döge
- Klinik f. Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Laura Koll
- Hals-, Nasen-, Ohrenklinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany
| | - Mandy Cuevas
- Klinik u. Poliklinik für Hals- Nasen- und Ohrenheilkunde, Univ.-Klinikum Carl Gustav Carus, Fetscherstr. 74, 01307 Dresden, Germany
| | - Felix Klimek
- Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183 Wiesbaden, Germany
| | - Thomas Hummel
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
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To KKW, Sridhar S, Chiu KHY, Hung DLL, Li X, Hung IFN, Tam AR, Chung TWH, Chan JFW, Zhang AJX, Cheng VCC, Yuen KY. Lessons learned 1 year after SARS-CoV-2 emergence leading to COVID-19 pandemic. Emerg Microbes Infect 2021; 10:507-535. [PMID: 33666147 PMCID: PMC8006950 DOI: 10.1080/22221751.2021.1898291] [Citation(s) in RCA: 170] [Impact Index Per Article: 56.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 02/06/2023]
Abstract
Without modern medical management and vaccines, the severity of the Coronavirus Disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) might approach the magnitude of 1894-plague (12 million deaths) and 1918-A(H1N1) influenza (50 million deaths) pandemics. The COVID-19 pandemic was heralded by the 2003 SARS epidemic which led to the discovery of human and civet SARS-CoV-1, bat SARS-related-CoVs, Middle East respiratory syndrome (MERS)-related bat CoV HKU4 and HKU5, and other novel animal coronaviruses. The suspected animal-to-human jumping of 4 betacoronaviruses including the human coronaviruses OC43(1890), SARS-CoV-1(2003), MERS-CoV(2012), and SARS-CoV-2(2019) indicates their significant pandemic potential. The presence of a large reservoir of coronaviruses in bats and other wild mammals, culture of mixing and selling them in urban markets with suboptimal hygiene, habit of eating exotic mammals in highly populated areas, and the rapid and frequent air travels from these areas are perfect ingredients for brewing rapidly exploding epidemics. The possibility of emergence of a hypothetical SARS-CoV-3 or other novel viruses from animals or laboratories, and therefore needs for global preparedness should not be ignored. We reviewed representative publications on the epidemiology, virology, clinical manifestations, pathology, laboratory diagnostics, treatment, vaccination, and infection control of COVID-19 as of 20 January 2021, which is 1 year after person-to-person transmission of SARS-CoV-2 was announced. The difficulties of mass testing, labour-intensive contact tracing, importance of compliance to universal masking, low efficacy of antiviral treatment for severe disease, possibilities of vaccine or antiviral-resistant virus variants and SARS-CoV-2 becoming another common cold coronavirus are discussed.
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Affiliation(s)
- Kelvin Kai-Wang To
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Siddharth Sridhar
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Kelvin Hei-Yeung Chiu
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Derek Ling-Lung Hung
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Xin Li
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Ivan Fan-Ngai Hung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Anthony Raymond Tam
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Tom Wai-Hin Chung
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Jasper Fuk-Woo Chan
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Anna Jian-Xia Zhang
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Vincent Chi-Chung Cheng
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Kwok-Yung Yuen
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
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37
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Vallée A. Dysautonomia and Implications for Anosmia in Long COVID-19 Disease. J Clin Med 2021; 10:jcm10235514. [PMID: 34884216 PMCID: PMC8658706 DOI: 10.3390/jcm10235514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 12/25/2022] Open
Abstract
Long COVID-19 patients often reported anosmia as one of the predominant persisting symptoms. Recent findings have shown that anosmia is associated with neurological dysregulations. However, the involvement of the autonomic nervous system (ANS), which can aggregate all the long COVID-19 neurological symptoms, including anosmia, has not received much attention in the literature. Dysautonomia is characterized by the failure of the activities of components in the ANS. Long COVID-19 anosmia fatigue could result from damage to olfactory sensory neurons, leading to an augmentation in the resistance to cerebrospinal fluid outflow by the cribriform plate, and further causing congestion of the glymphatic system with subsequent toxic build-up in the brain. Studies have shown that anosmia was an important neurologic symptom described in long COVID-19 in association with potential COVID-19 neurotropism. SARS-CoV-2 can either travel via peripheral blood vessels causing endothelial dysfunction, triggering coagulation cascade and multiple organ dysfunction, or reach the systemic circulation and take a different route to the blood–brain barrier, damaging the blood–brain barrier and leading to neuroinflammation and neuronal excitotoxicity. SARS-CoV-2 entry via the olfactory epithelium and the increase in the expression of TMPRSS2 with ACE2 facilitates SARS-CoV-2 neurotropism and then dysautonomia in long COVID-19 patients. Due to this effect, patients with anosmia persisting 3 months after COVID-19 diagnosis showed extensive destruction of the olfactory epithelium. Persistent anosmia observed among long COVID-19 patients may be involved by a cascade of effects generated by dysautonomia leading to ACE2 antibodies enhancing a persistent immune activation.
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Affiliation(s)
- Alexandre Vallée
- Department of Clinical Research and Innovation, Foch Hospital, 92150 Suresnes, France
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Khan M, Yoo SJ, Clijsters M, Backaert W, Vanstapel A, Speleman K, Lietaer C, Choi S, Hether TD, Marcelis L, Nam A, Pan L, Reeves JW, Van Bulck P, Zhou H, Bourgeois M, Debaveye Y, De Munter P, Gunst J, Jorissen M, Lagrou K, Lorent N, Neyrinck A, Peetermans M, Thal DR, Vandenbriele C, Wauters J, Mombaerts P, Van Gerven L. Visualizing in deceased COVID-19 patients how SARS-CoV-2 attacks the respiratory and olfactory mucosae but spares the olfactory bulb. Cell 2021; 184:5932-5949.e15. [PMID: 34798069 PMCID: PMC8564600 DOI: 10.1016/j.cell.2021.10.027] [Citation(s) in RCA: 224] [Impact Index Per Article: 74.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/01/2021] [Accepted: 10/25/2021] [Indexed: 12/28/2022]
Abstract
Anosmia, the loss of smell, is a common and often the sole symptom of COVID-19. The onset of the sequence of pathobiological events leading to olfactory dysfunction remains obscure. Here, we have developed a postmortem bedside surgical procedure to harvest endoscopically samples of respiratory and olfactory mucosae and whole olfactory bulbs. Our cohort of 85 cases included COVID-19 patients who died a few days after infection with SARS-CoV-2, enabling us to catch the virus while it was still replicating. We found that sustentacular cells are the major target cell type in the olfactory mucosa. We failed to find evidence for infection of olfactory sensory neurons, and the parenchyma of the olfactory bulb is spared as well. Thus, SARS-CoV-2 does not appear to be a neurotropic virus. We postulate that transient insufficient support from sustentacular cells triggers transient olfactory dysfunction in COVID-19. Olfactory sensory neurons would become affected without getting infected.
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Affiliation(s)
- Mona Khan
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | - Seung-Jun Yoo
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | - Marnick Clijsters
- Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium
| | - Wout Backaert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, KU Leuven, Leuven, Belgium
| | - Arno Vanstapel
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Kato Speleman
- Department of Otorhinolaryngology, Head and Neck Surgery, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Charlotte Lietaer
- Department of Otorhinolaryngology, Head and Neck Surgery, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Sumin Choi
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | | | - Lukas Marcelis
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Andrew Nam
- NanoString Technologies Inc., Seattle, WA, USA
| | - Liuliu Pan
- NanoString Technologies Inc., Seattle, WA, USA
| | | | - Pauline Van Bulck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Hai Zhou
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | - Marc Bourgeois
- Department of Anesthesiology and Intensive Care Medicine, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Yves Debaveye
- Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, KU Leuven, Leuven, Belgium
| | - Paul De Munter
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Jan Gunst
- Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, KU Leuven, Leuven, Belgium
| | - Mark Jorissen
- Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Department of Laboratory Medicine and National Reference Centre for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Bacteriology and Mycology, KU Leuven, Leuven, Belgium
| | - Natalie Lorent
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Arne Neyrinck
- Department of Anesthesia, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Marijke Peetermans
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Dietmar Rudolf Thal
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, Laboratory of Neuropathology and Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Christophe Vandenbriele
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Joost Wauters
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Peter Mombaerts
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany.
| | - Laura Van Gerven
- Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, KU Leuven, Leuven, Belgium.
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COVID-19 Anosmia: High Prevalence, Plural Neuropathogenic Mechanisms, and Scarce Neurotropism of SARS-CoV-2? Viruses 2021; 13:v13112225. [PMID: 34835030 PMCID: PMC8625547 DOI: 10.3390/v13112225] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 12/14/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative pathogen of coronavirus disease 2019 (COVID-19). It is known as a respiratory virus, but SARS-CoV-2 appears equally, or even more, infectious for the olfactory epithelium (OE) than for the respiratory epithelium in the nasal cavity. In light of the small area of the OE relative to the respiratory epithelium, the high prevalence of olfactory dysfunctions (ODs) in COVID-19 has been bewildering and has attracted much attention. This review aims to first examine the cytological and molecular biological characteristics of the OE, especially the microvillous apical surfaces of sustentacular cells and the abundant SARS-CoV-2 receptor molecules thereof, that may underlie the high susceptibility of this neuroepithelium to SARS-CoV-2 infection and damages. The possibility of SARS-CoV-2 neurotropism, or the lack of it, is then analyzed with regard to the expression of the receptor (angiotensin-converting enzyme 2) or priming protease (transmembrane serine protease 2), and cellular targets of infection. Neuropathology of COVID-19 in the OE, olfactory bulb, and other related neural structures are also reviewed. Toward the end, we present our perspectives regarding possible mechanisms of SARS-CoV-2 neuropathogenesis and ODs, in the absence of substantial viral infection of neurons. Plausible causes for persistent ODs in some COVID-19 convalescents are also examined.
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Hernandez M, González-Zamora J, Recalde S, Moreno-Orduña M, Bilbao-Malavé V, Saenz de Viteri M, Landecho MF, Fernandez-Robredo P, García-Layana A. Evaluation of Macular Retinal Vessels and Histological Changes in Two Cases of COVID-19. Biomedicines 2021; 9:1546. [PMID: 34829775 PMCID: PMC8615149 DOI: 10.3390/biomedicines9111546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to assess vascular and histological alterations in two COVID-19 and three control post-mortem retinas. The macular areas of flat-mounted samples were processed for immunofluorescence. Lectin and collagen IV positive vessels were captured under confocal microscopy, and endothelium loss and tortuosity were analyzed. Expression of ACE2 (angiotensin-converting enzyme 2) (the receptor for SARS-CoV-2), Iba1 (ionized calcium-binding adaptor molecule 1) and GFAP (glial fibrillary acidic protein) were quantified in retinal sections. The number of lectin vessels in COVID-19 retinas decreased by 27% compared to the control (p < 0.01) and the tortuosity increased in COVID-19 retinas (7.3 ± 0.2) vs. control retinas (6.8 ± 0.07) (p < 0.05). Immunofluorescence analysis revealed an increase in ACE2 (2.3 ± 1.3 vs. 1.0 ± 0.1; p < 0.0001) and Iba1 expression (3.06 ± 0.6 vs. 1.0 ± 0.1; p < 0.01) in COVID-19 sections whereas no changes in GFAP were observed. Analysis of the COVID-19 macular retinal tissue suggested that endothelial cells are a preferential target of SARS-CoV-2 with subsequent changes through their ACE2 receptor expression and morphology. Thus, microglial activation was hyperactive when facing an ensuing immunological challenge after SARS-CoV-2 infection.
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Affiliation(s)
- Maria Hernandez
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (J.G.-Z.); (M.M.-O.); (V.B.-M.); (M.S.d.V.); (P.F.-R.); (A.G.-L.)
- Navarra Institute for Health Research—IdiSNA, 31008 Pamplona, Spain
- Red Temática de Investigación Cooperativa Sanitaria en Enfermedades Oculares (Oftared), 31008 Pamplona, Spain
| | - Jorge González-Zamora
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (J.G.-Z.); (M.M.-O.); (V.B.-M.); (M.S.d.V.); (P.F.-R.); (A.G.-L.)
| | - Sergio Recalde
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (J.G.-Z.); (M.M.-O.); (V.B.-M.); (M.S.d.V.); (P.F.-R.); (A.G.-L.)
- Navarra Institute for Health Research—IdiSNA, 31008 Pamplona, Spain
- Red Temática de Investigación Cooperativa Sanitaria en Enfermedades Oculares (Oftared), 31008 Pamplona, Spain
| | - Maite Moreno-Orduña
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (J.G.-Z.); (M.M.-O.); (V.B.-M.); (M.S.d.V.); (P.F.-R.); (A.G.-L.)
- Navarra Institute for Health Research—IdiSNA, 31008 Pamplona, Spain
| | - Valentina Bilbao-Malavé
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (J.G.-Z.); (M.M.-O.); (V.B.-M.); (M.S.d.V.); (P.F.-R.); (A.G.-L.)
| | - Manuel Saenz de Viteri
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (J.G.-Z.); (M.M.-O.); (V.B.-M.); (M.S.d.V.); (P.F.-R.); (A.G.-L.)
- Navarra Institute for Health Research—IdiSNA, 31008 Pamplona, Spain
- Red Temática de Investigación Cooperativa Sanitaria en Enfermedades Oculares (Oftared), 31008 Pamplona, Spain
| | - Manuel F. Landecho
- COVID-19 Unit, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- Department of Internal Medicine, Clinica Universidad de Navarra, 31008 Pamplona, Spain
| | - Patricia Fernandez-Robredo
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (J.G.-Z.); (M.M.-O.); (V.B.-M.); (M.S.d.V.); (P.F.-R.); (A.G.-L.)
- Navarra Institute for Health Research—IdiSNA, 31008 Pamplona, Spain
- Red Temática de Investigación Cooperativa Sanitaria en Enfermedades Oculares (Oftared), 31008 Pamplona, Spain
| | - Alfredo García-Layana
- Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (J.G.-Z.); (M.M.-O.); (V.B.-M.); (M.S.d.V.); (P.F.-R.); (A.G.-L.)
- Navarra Institute for Health Research—IdiSNA, 31008 Pamplona, Spain
- Red Temática de Investigación Cooperativa Sanitaria en Enfermedades Oculares (Oftared), 31008 Pamplona, Spain
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41
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Manifestations and mechanisms of central nervous system damage caused by SARS-CoV-2. Brain Res Bull 2021; 177:155-163. [PMID: 34571039 PMCID: PMC8462004 DOI: 10.1016/j.brainresbull.2021.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 01/08/2023]
Abstract
The global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its threat to humans have drawn worldwide attention. The acute and long-term effects of SARS-CoV-2 on the nervous system pose major public health challenges. Patients with SARS-CoV-2 present diverse symptoms of the central nervous system. Exploring the mechanism of coronavirus damage to the nervous system is essential for reducing the long-term neurological complications of COVID-19. Despite rapid progress in characterizing SARS-CoV-2, the long-term effects of COVID-19 on the brain remain unclear. The possible mechanisms of SARS-CoV-2 injury to the central nervous system include: 1) direct injury of nerve cells, 2) activation of the immune system and inflammatory cytokines caused by systemic infection, 3) a high affinity of the SARS-CoV-2 spike glycoprotein for the angiotensin-converting enzyme ACE2, 4) cerebrovascular disease caused by hypoxia and coagulation dysfunction, and 5) a systemic inflammatory response that promotes cognitive impairment and neurodegenerative diseases. Although we do not fully understand the mechanism by which SARS-CoV-2 causes nerve injury, we hope to provide a framework by reviewing the clinical manifestations, complications, and possible mechanisms of neurological damage caused by SARS-CoV-2. With hope, this will facilitate the early identification, diagnosis, and treatment of possible neurological sequelae, which could contribute toward improving patient prognosis and preventing transmission.
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Majolo F, da Silva GL, Vieira L, Anli C, Timmers LFSM, Laufer S, Goettert MI. Neuropsychiatric Disorders and COVID-19: What We Know So Far. Pharmaceuticals (Basel) 2021; 14:ph14090933. [PMID: 34577633 PMCID: PMC8465079 DOI: 10.3390/ph14090933] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 01/09/2023] Open
Abstract
SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) affects the central nervous system (CNS), which is shown in a significant number of patients with neurological events. In this study, an updated literature review was carried out regarding neurological disorders in COVID-19. Neurological symptoms are more common in patients with severe infection according to their respiratory status and divided into three categories: (1) CNS manifestations; (2) cranial and peripheral nervous system manifestations; and (3) skeletal muscle injury manifestations. Patients with pre-existing cerebrovascular disease are at a higher risk of admission to the intensive care unit (ICU) and mortality. The neurological manifestations associated with COVID-19 are of great importance, but when life-threatening abnormal vital signs occur in severely ill COVID-19 patients, neurological problems are usually not considered. It is crucial to search for new treatments for brain damage, as well as for alternative therapies that recover the damaged brain and reduce the inflammatory response and its consequences for other organs. In addition, there is a need to diagnose these manifestations as early as possible to limit long-term consequences. Therefore, much research is needed to explain the involvement of SARS-CoV-2 causing these neurological symptoms because scientists know zero about it.
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Affiliation(s)
- Fernanda Majolo
- Post-Graduate Program in Biotechnology, Universidade do Vale do Taquari-Univates, Lajeado 95914-014, Rio Grande do Sul, Brazil; (F.M.); (C.A.); (L.F.S.M.T.)
- Postgraduate Program in Medical Sciences Center, Universidade do Vale do Taquari-Univates, Lajeado 95914-014, Rio Grande do Sul, Brazil; (G.L.d.S.); (L.V.)
| | - Guilherme Liberato da Silva
- Postgraduate Program in Medical Sciences Center, Universidade do Vale do Taquari-Univates, Lajeado 95914-014, Rio Grande do Sul, Brazil; (G.L.d.S.); (L.V.)
| | - Lucas Vieira
- Postgraduate Program in Medical Sciences Center, Universidade do Vale do Taquari-Univates, Lajeado 95914-014, Rio Grande do Sul, Brazil; (G.L.d.S.); (L.V.)
| | - Cetin Anli
- Post-Graduate Program in Biotechnology, Universidade do Vale do Taquari-Univates, Lajeado 95914-014, Rio Grande do Sul, Brazil; (F.M.); (C.A.); (L.F.S.M.T.)
| | - Luís Fernando Saraiva Macedo Timmers
- Post-Graduate Program in Biotechnology, Universidade do Vale do Taquari-Univates, Lajeado 95914-014, Rio Grande do Sul, Brazil; (F.M.); (C.A.); (L.F.S.M.T.)
- Postgraduate Program in Medical Sciences Center, Universidade do Vale do Taquari-Univates, Lajeado 95914-014, Rio Grande do Sul, Brazil; (G.L.d.S.); (L.V.)
| | - Stefan Laufer
- Department of Pharmaceutical and Medicinal Chemistry, Institute of Pharmacy, Eberhard Karls Universität Tübingen, 72076 Tübingen, Germany;
- Tübingen Center for Academic Drug Discovery (TüCAD2), 72076 Tübingen, Germany
| | - Márcia Inês Goettert
- Post-Graduate Program in Biotechnology, Universidade do Vale do Taquari-Univates, Lajeado 95914-014, Rio Grande do Sul, Brazil; (F.M.); (C.A.); (L.F.S.M.T.)
- Postgraduate Program in Medical Sciences Center, Universidade do Vale do Taquari-Univates, Lajeado 95914-014, Rio Grande do Sul, Brazil; (G.L.d.S.); (L.V.)
- Correspondence: ; Tel.: +55-5137147000
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High Prevalence of Pre-Existing Liver Abnormalities Identified Via Autopsies in COVID-19: Identification of a New Silent Risk Factor? Diagnostics (Basel) 2021; 11:diagnostics11091703. [PMID: 34574044 PMCID: PMC8467907 DOI: 10.3390/diagnostics11091703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 12/23/2022] Open
Abstract
A high prevalence of hepatic pathology (in 17 of 19 cases) was reported in post-mortem (PM) examinations of COVID-19 patients, undertaken between March 2020 and February 2021 by a single autopsy pathologist in two English Coronial jurisdictions. The patients in our cohort demonstrated high levels of recognised COVID-19 risk factors, including hypertension (8/16, 50%), type 2 diabetes mellitus (8/16, 50%) and evidence of arteriopathy 6/16 (38%). Hepatic abnormalities included steatosis (12/19; 63%), moderate to severe venous congestion (5/19; 26%) and cirrhosis (4/19; 21%). A subsequent literature review indicated a significantly increased prevalence of steatosis (49%), venous congestion (34%) and cirrhosis (9.3%) in COVID-19 PM cases, compared with a pre-pandemic PM cohort (33%, 16%, and 2.6%, respectively), likely reflecting an increased mortality risk in SARS-CoV-2 infection for patients with pre-existing liver disease. To corroborate this observation, we retrospectively analysed the admission liver function test (LFT) results of 276 consecutive, anonymised COVID-19 hospital patients in our centre, for whom outcome data were available. Of these patients, 236 (85.5%) had significantly reduced albumin levels at the time of admission to hospital, which was likely indicative of pre-existing chronic liver or renal disease. There was a strong correlation between patient outcome (length of hospital admission or death) and abnormal albumin at the time of hospital admission (p = 0.000012). We discuss potential mechanisms by which our observations of hepatic dysfunction are linked to a risk of COVID-19 mortality, speculating on the importance of recently identified anti-interferon antibodies.
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AKTAS B, ASLIM B. Neuropathy in COVID-19 associated with dysbiosis-related inflammation. Turk J Biol 2021; 45:390-403. [PMID: 34803442 PMCID: PMC8573843 DOI: 10.3906/biy-2105-53] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/30/2021] [Indexed: 01/08/2023] Open
Abstract
Although COVID-19 affects mainly lungs with a hyperactive and imbalanced immune response, gastrointestinal and neurological symptoms such as diarrhea and neuropathic pains have been described as well in patients with COVID-19. Studies indicate that gut-lung axis maintains host homeostasis and disease development with the association of immune system, and gut microbiota is involved in the COVID-19 severity in patients with extrapulmonary conditions. Gut microbiota dysbiosis impairs the gut permeability resulting in translocation of gut microbes and their metabolites into the circulatory system and induce systemic inflammation which, in turn, can affect distal organs such as the brain. Moreover, gut microbiota maintains the availability of tryptophan for kynurenine pathway, which is important for both central nervous and gastrointestinal system in regulating inflammation. SARS-CoV-2 infection disturbs the gut microbiota and leads to immune dysfunction with generalized inflammation. It has been known that cytokines and microbial products crossing the blood-brain barrier induce the neuroinflammation, which contributes to the pathophysiology of neurodegenerative diseases including neuropathies. Therefore, we believe that both gut-lung and gut-brain axes are involved in COVID-19 severity and extrapulmonary complications. Furthermore, gut microbial dysbiosis could be the reason of the neurologic complications seen in severe COVID-19 patients with the association of dysbiosis-related neuroinflammation. This review will provide valuable insights into the role of gut microbiota dysbiosis and dysbiosis-related inflammation on the neuropathy in COVID-19 patients and the disease severity.
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Affiliation(s)
- Busra AKTAS
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Burdur Mehmet Akif Ersoy University, BurdurTurkey
| | - Belma ASLIM
- Department of Biology, Faculty of Sciences, Gazi University, AnkaraTurkey
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45
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Maiese A, Manetti AC, Bosetti C, Del Duca F, La Russa R, Frati P, Di Paolo M, Turillazzi E, Fineschi V. SARS-CoV-2 and the brain: A review of the current knowledge on neuropathology in COVID-19. Brain Pathol 2021; 31:e13013. [PMID: 34390282 PMCID: PMC8420197 DOI: 10.1111/bpa.13013] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/18/2021] [Accepted: 07/27/2021] [Indexed: 12/12/2022] Open
Abstract
SARS‐CoV‐2 (severe acute respiratory syndrome coronavirus 2), the new coronavirus responsible for the pandemic disease in the last year, is able to affect the central nervous system (CNS). Compared with its well‐known pulmonary tropism and respiratory complications, little has been studied about SARS‐CoV‐2 neurotropism and pathogenesis of its neurological manifestations, but also about postmortem histopathological findings in the CNS of patients who died from COVID‐19 (coronavirus disease 2019). We present a systematic review, carried out according to the Preferred Reporting Items for Systematic Review standards, of the neuropathological features of COVID‐19. We found 21 scientific papers, the majority of which refer to postmortem examinations; the total amount of cases is 197. Hypoxic changes are the most frequently reported alteration of brain tissue, followed by ischemic and hemorrhagic lesions and reactive astrogliosis and microgliosis. These findings do not seem to be specific to SARS‐CoV‐2 infection, they are more likely because of systemic inflammation and coagulopathy caused by COVID‐19. More studies are needed to confirm this hypothesis and to detect other possible alterations of neural tissue. Brain examination of patients dead from COVID‐19 should be included in a protocol of standardized criteria to perform autopsies on these subjects.
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Affiliation(s)
- Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa, Italy
| | - Alice Chiara Manetti
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa, Italy
| | - Chiara Bosetti
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa, Italy
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Di Paolo
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa, Italy
| | - Emanuela Turillazzi
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
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46
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Boscutti A, Delvecchio G, Pigoni A, Cereda G, Ciappolino V, Bellani M, Fusar-Poli P, Brambilla P. Olfactory and gustatory dysfunctions in SARS-CoV-2 infection: A systematic review. Brain Behav Immun Health 2021; 15:100268. [PMID: 34027497 PMCID: PMC8129998 DOI: 10.1016/j.bbih.2021.100268] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Among Coronavirus Disease 2019 (COVID-19) manifestations, Olfactory (OD) and Gustatory (GD) Dysfunctions (OGD) have drawn considerable attention, becoming a sort of hallmark of the disease. Many have speculated on the pathogenesis and clinical characteristics of these disturbances; however, no definite answers have been produced on the topic. With this systematic review, we aimed to collect all the available evidence regarding the prevalence of OGD, the timing of their onset and their resolution, their rate of recovery and their role as diagnostic and prognostic tools for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. METHODS A systematic review comprising all the observational studies that reported the prevalence and/or the longitudinal trajectories of OGD in COVID-19 patients, as self-reported by patients or measured through objective psychophysical tests. RESULTS After the selection process, 155 studies were included, with a total of 70,920 patients and 105,291 not-infected individuals. Prevalence reports were extremely variable across studies, with wide ranges for OD (0%-98%) and GD (0-89%) prevalence. OGD occurred early during the disease course and only rarely preceded other symptoms; out of 30 studies with a follow-up time of at least 20 days, only in 5 studies OGD fully resolved in more than 90% of patients. OGD had low sensitivity and high specificity for SARS-CoV-2 infection; accuracy of OD and GD for infection identification was higher than 80% in 10 out of 33 studies and in 8 out of 22 studies considered, respectively. 28 out of 30 studies that studied the association between OGD and disease severity found how OGD were associated with lower rates of severe pneumonia, hospitalization and mortality. CONCLUSIONS OGD seem to be highly prevalent in SARS-CoV-2 infection. They occur early, concomitantly with other symptoms and often persist after recovery, in some cases for months; whether a full recovery eventually occurs in all cases is not clear yet. OGD are good predictors of SARS-CoV-2 infection and are associated with a milder disease course.
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Affiliation(s)
- A. Boscutti
- Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
| | - G. Delvecchio
- Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
| | - A. Pigoni
- Social and Affective Neuroscience Group, MoMiLab, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - G. Cereda
- Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
| | - V. Ciappolino
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Department of Neurosciences and Mental Health, 20122, Milan, Italy
| | - M. Bellani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata, Verona (AOUI), Italy
| | - P. Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - P. Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Department of Neurosciences and Mental Health, 20122, Milan, Italy
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47
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Xydakis MS, Albers MW, Holbrook EH, Lyon DM, Shih RY, Frasnelli JA, Pagenstecher A, Kupke A, Enquist LW, Perlman S. Post-viral effects of COVID-19 in the olfactory system and their implications. Lancet Neurol 2021; 20:753-761. [PMID: 34339626 PMCID: PMC8324113 DOI: 10.1016/s1474-4422(21)00182-4] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/17/2021] [Accepted: 06/02/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The mechanisms by which any upper respiratory virus, including SARS-CoV-2, impairs chemosensory function are not known. COVID-19 is frequently associated with olfactory dysfunction after viral infection, which provides a research opportunity to evaluate the natural course of this neurological finding. Clinical trials and prospective and histological studies of new-onset post-viral olfactory dysfunction have been limited by small sample sizes and a paucity of advanced neuroimaging data and neuropathological samples. Although data from neuropathological specimens are now available, neuroimaging of the olfactory system during the acute phase of infection is still rare due to infection control concerns and critical illness and represents a substantial gap in knowledge. RECENT DEVELOPMENTS The active replication of SARS-CoV-2 within the brain parenchyma (ie, in neurons and glia) has not been proven. Nevertheless, post-viral olfactory dysfunction can be viewed as a focal neurological deficit in patients with COVID-19. Evidence is also sparse for a direct causal relation between SARS-CoV-2 infection and abnormal brain findings at autopsy, and for trans-synaptic spread of the virus from the olfactory epithelium to the olfactory bulb. Taken together, clinical, radiological, histological, ultrastructural, and molecular data implicate inflammation, with or without infection, in either the olfactory epithelium, the olfactory bulb, or both. This inflammation leads to persistent olfactory deficits in a subset of people who have recovered from COVID-19. Neuroimaging has revealed localised inflammation in intracranial olfactory structures. To date, histopathological, ultrastructural, and molecular evidence does not suggest that SARS-CoV-2 is an obligate neuropathogen. WHERE NEXT?: The prevalence of CNS and olfactory bulb pathosis in patients with COVID-19 is not known. We postulate that, in people who have recovered from COVID-19, a chronic, recrudescent, or permanent olfactory deficit could be prognostic for an increased likelihood of neurological sequelae or neurodegenerative disorders in the long term. An inflammatory stimulus from the nasal olfactory epithelium to the olfactory bulbs and connected brain regions might accelerate pathological processes and symptomatic progression of neurodegenerative disease. Persistent olfactory impairment with or without perceptual distortions (ie, parosmias or phantosmias) after SARS-CoV-2 infection could, therefore, serve as a marker to identify people with an increased long-term risk of neurological disease.
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Affiliation(s)
- Michael S Xydakis
- Human Performance Wing, Air Force Research Lab, US Department of Defense, Wright-Patterson Air Force Base, Dayton, OH, USA.
| | - Mark W Albers
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric H Holbrook
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Dina M Lyon
- Human Performance Wing, Air Force Research Lab, US Department of Defense, Wright-Patterson Air Force Base, Dayton, OH, USA
| | - Robert Y Shih
- Division of Neuroradiology, Walter Reed National Military Medical Center, US Department of Defense, Bethesda, MD, USA
| | - Johannes A Frasnelli
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Axel Pagenstecher
- Department of Neuropathology, Philipps University of Marburg, Marburg, Germany
| | - Alexandra Kupke
- Marburg Virology Institute, Philipps University of Marburg, Marburg, Germany
| | - Lynn W Enquist
- Princeton Neuroscience Institute, Princeton University, Princeton, NJ, USA
| | - Stanley Perlman
- Department of Microbiology and Immunology, University of Iowa, Iowa City, IA, USA
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Vaira LA, Deiana G, Lechien JR, De Vito A, Cossu A, Dettori M, Del Rio A, Saussez S, Madeddu G, Babudieri S, Fois AG, Cocuzza C, Hopkins C, De Riu G, Piana AF. Correlations Between Olfactory Psychophysical Scores and SARS-CoV-2 Viral Load in COVID-19 Patients. Laryngoscope 2021; 131:2312-2318. [PMID: 34287905 PMCID: PMC8441733 DOI: 10.1002/lary.29777] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/15/2021] [Accepted: 07/12/2021] [Indexed: 12/24/2022]
Abstract
Objectives/Hypothesis The aim of this study was to evaluate the correlations between the severity and duration of olfactory dysfunctions (OD), assessed with psychophysical tests, and the viral load on the rhino‐pharyngeal swab determined with a direct method, in patients affected by coronavirus disease 2019 (COVID‐19). Study design Prospective cohort study. Methods Patients underwent psychophysical olfactory assessment with Connecticut Chemosensory Clinical Research Center test and determination of the normalized viral load on nasopharyngeal swab within 10 days of the clinical onset of COVID‐19. Results Sixty COVID‐19 patients were included in this study. On psychophysical testing, 12 patients (20% of the cohort) presented with anosmia, 11 (18.3%) severe hyposmia, 13 (18.3%) moderate hyposmia, and 10 (16.7%) mild hyposmia with an overall prevalence of OD of 76.7%. The overall median olfactory score was 50 (interquartile range [IQR] 30–72.5) with no significant differences between clinical severity subgroups. The median normalized viral load detected in the series was 2.56E+06 viral copies/106 copies of human beta‐2microglobulin mRNA present in the sample (IQR 3.17E+04–1.58E+07) without any significant correlations with COVID‐19 severity. The correlation between viral load and olfactory scores at baseline (R2 = 0.0007; P = .844) and 60‐day follow‐up (R2 = 0.0077; P = .519) was weak and not significant. Conclusions The presence of OD does not seem to be useful in identifying subjects at risk for being super‐spreaders or who is at risk of developing long‐term OD. Similarly, the pathogenesis of OD is probably related to individual factors rather than to viral load and activity. Level of Evidence 4 Laryngoscope, 131:2312–2318, 2021
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Affiliation(s)
- Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.,Biomedical Science PhD School, Biomedical Science Department, University of Sassari, Sassari, Italy
| | - Giovanna Deiana
- Biomedical Science PhD School, Biomedical Science Department, University of Sassari, Sassari, Italy.,Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Jerome R Lechien
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Human and Experimental Oncology, Faculty of Medicine UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Andrea De Vito
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Andrea Cossu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Marco Dettori
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Arcadia Del Rio
- Biomedical Science PhD School, Biomedical Science Department, University of Sassari, Sassari, Italy.,Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Sven Saussez
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Human and Experimental Oncology, Faculty of Medicine UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Giordano Madeddu
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Sergio Babudieri
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Alessandro G Fois
- Respiratory Diseases Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Clementina Cocuzza
- Medicine and Surgery Department, Bicocca University of Milan, Milan, Italy
| | | | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Andrea Fausto Piana
- Biomedical Science PhD School, Biomedical Science Department, University of Sassari, Sassari, Italy.,Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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49
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Chemosensory dysfunction in COVID-19: Is there really a correlation with viral load? Am J Otolaryngol 2021; 42:103037. [PMID: 33875304 PMCID: PMC8046703 DOI: 10.1016/j.amjoto.2021.103037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/13/2021] [Indexed: 12/29/2022]
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50
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Systemic inflammatory markers and psychophysical olfactory scores in coronavirus disease 2019 patients: is there any correlation? The Journal of Laryngology & Otology 2021; 135:723-728. [PMID: 34184623 PMCID: PMC8267245 DOI: 10.1017/s0022215121001651] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective To analyse the correlations between olfactory psychophysical scores and the serum levels of D-dimer, C-reactive protein, ferritin, lactate dehydrogenase, procalcitonin and neutrophil-to-lymphocyte ratio in coronavirus disease 2019 patients. Methods Patients underwent psychophysical olfactory assessment with the Connecticut Chemosensory Clinical Research Center test, and determination of blood serum levels of the inflammatory markers D-dimer, C-reactive protein, ferritin, lactate dehydrogenase, procalcitonin and neutrophil-to-lymphocyte ratio within 10 days of the clinical onset of coronavirus disease 2019 and 60 days after. Results Seventy-seven patients were included in this study. D-dimer, procalcitonin, ferritin and neutrophil-to-lymphocyte ratio correlated significantly with severe coronavirus disease 2019. No significant correlations were found between baseline and 60-day Connecticut Chemosensory Clinical Research Center test scores and the inflammatory markers assessed. Conclusion Olfactory disturbances appear to have little prognostic value in predicting the severity of coronavirus disease 2019 compared to D-dimer, ferritin, procalcitonin and neutrophil-to-lymphocyte ratio. The lack of correlation between the severity and duration of olfactory disturbances and serum levels of inflammatory markers seems to further suggest that the pathogenetic mechanisms underlying the loss of smell in coronavirus disease 2019 patients are related to local rather than systemic inflammatory factors.
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