Hypogeusia as the initial presenting symptom of COVID-19

COVID-19 is the disease caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which first arose in Wuhan, China, in December 2019 and has since been declared a pandemic. The clinical sequelae vary from mild, self-limiting upper respiratory infection symptoms to severe respiratory distress, acute cardiopulmonary arrest and death. Otolaryngologists around the globe have reported a significant number of mild or otherwise asymptomatic patients with COVID-19 presenting with olfactory dysfunction. We present a case of COVID-19 resulting in intensive care unit (ICU) admission, presenting with the initial symptom of disrupted taste and flavour perception prior to respiratory involvement. After 4 days in the ICU and 6 days on the general medicine floor, our patient regained a majority of her sense of smell and was discharged with only lingering dysgeusia. In this paper, we review existing literature and the clinical course of SARS-CoV-2 in relation to the reported symptoms of hyposmia, hypogeusia and dysgeusia

Neurological manifestations of patients with mild-to-moderate COVID-19 attending a public hospital in Lima, Peru

OBJECTIVE: To determine the prevalence and characteristics of the most common neurological manifestations in Peruvian patients with mild-to-moderate COVID-19. METHODS: We conducted a single-center prospective, cross-sectional study at an isolation center functioning as a public acute-care hospital during the COVID-19 pandemic in Lima, the capital city of Peru. This was a convenience sample of patients with acute COVID-19 infection and mild-to-moderate respiratory symptoms who presented for hospital admission between September 25 and November 25, 2020. We interviewed participants and collected demographic, medical history and clinical presentation data; all participants underwent a complete physical and neurological examination. Descriptive statistics and prevalence ratios (PR) with corresponding 95% confidence intervals and p-values were calculated to explore between-groups differences. RESULTS: Of 199 patients with mild-to-moderate COVID-19 enrolled in this study, 83% presented with at least one neurological symptom (mean symptom duration 8 +/- 6 days). The most common neurological symptoms were headache (72%), hypogeusia or ageusia (41%), hyposmia or anosmia (40%) and dizziness (34%). Only 2.5% of the cohort had an abnormal neurological examination. The majority (42%) had no prior comorbidities. Presence of at least 1 neurological symptom was independently associated with fever, dyspnea, cough, poor appetite, sore throat, chest tightness or diarrhea, but not with comorbid conditions. CONCLUSIONS: This cross-sectional study found that headaches, and smell and taste dysfunction are common among patients presenting with mild-to-moderate acute COVID-19 in Lima, Peru. International longitudinal studies are needed to determine the long-term neurological sequelae of COVID-19 during the acute and post-infectious period

Olfactory and gustatory manifestations in hospitalized patients with COVID-19

Background: Pulmonary involvement is the main clinical and imaging feature of the novel corona virus disease (COVID-19). However, some patients present with upper airway symptoms. Aim: In this study, we report upper respiratory manifestations, specifically focusing on smell and taste disorders in COVID-19. Methods: We performed this cross-sectional prospective study in patients admitted to Masih Daneshvari Hospital, a tertiary referral center in Tehran, Iran, with severe COVID-19 as documented by the polymerase chain reaction assay. Results: We included 268 hospitalized patients, 183 (68.3%) men and 85 (31.7%) women. The average age was 52.8±16.4. The sinonasal symptoms included nasal obstruction (44 [16.4%]), rhinorrhea (31 [11.5%]), sneeze (33 [12.3%]), headache (77 [28.6%]), facial pain (12 [4.5%]), associated with hypogeusia (65 [24.2%]) and olfactory dysfunction (90 [33.5%]). In 35 (38.9%) patients with olfactory symptoms, change in the smell was the sole initial manifestation of COVID-19. On logistic regression, the relationship between the olfactory symptoms and headache (p=0.002), nasal obstruction (p=0.0001) and sneeze (p=0.018) were statistically significant. Conclusion: We report a considerable prevalence of olfactory and gustatory symptoms in hospitalized patients with COVID-19. Not infrequently, these symptoms were the sole initial presenting symptoms in the course COVID-19. During the current pandemic, we suggest that presence of these symptoms should mandate expedited screening for COVID-19, isolation and close monitoring of the patients for evolution of the clinical course

Evaluating Patients with Olfactory Dysfunction after COVID-19 Infection by Questionnaire of Olfactory Disorders-Negative Statements

Background: The number of patients with COVID-19-induced olfactory dysfunction has consistently increased since the onset of the pandemic. Since a considerable proportion of these patients have olfactory dysfunction for a relatively long period of time, their quality of life (QOL) may considerably be impacted as a result. Aim: The aim of the present study was to investigate the adverse effects of olfactory dysfunction on QOL in patients with COVID-19-induced hyposmia or anosmia. Methods: The data were obtained via self-reported online questionnaire in individuals who met the inclusion criteria. The questionnaire included demographics, olfactory status and Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS). Results: Among1531 participants, 1072 individuals met the inclusion criteria, with 588 (54.85%) having hyposmia and 484 (45.15%) anosmia. Average age was 35.7 in the hyposmic group and 34.5 in the anosmic group. Concurrent hypogeusia/ageusia was reported in 398 (67.7%) of cases with hyposmia and in 346 (71.5%) of participants with anosmia. Lack of enjoyment of eating food was the most negative effect in both hyposmic and anosmic groups, followed by annoyance when eating food and a continuous awareness of the olfactory problem. The mean QOD-NS score was 20.5±10.2 in the hyposmic group and 23.3±10.4 in the anosmic group, demonstrating significant adverse impact on QOL. Conclusion: Persistent olfactory dysfunction in patients with COVID-19 has adverse effects on QOL. Early diagnosis and treatment of olfactory dysfunction may be crucial in limiting the adverse impact on QOL by psychological and nutritional support and olfactory rehabilitation

Olfactory and Gustatory Recovery Time Evaluation of COVID-19: A Systematic Review and Meta-Analysis

Background: Olfactory dysfunction is a common symptom of Coronavirus disease 2019 (COVID-19). In this study, we aimed to evaluate the recovery rate and duration of these symptoms in COVID-19patients. Methods: This systematic review was conducted by searching PubMed and Google Scholar from April 1st, 2020, until October 1st, 2022, using the terms ‘‘COVID-19’’ OR ‘‘COV-2,’’ OR ‘‘Coronavirus 2’’ OR coronavirus AND ‘‘loss of smell’’ OR Anosmia OR Hyposmia OR olfaction OR ‘‘olfactory loss’’ AND ageusia OR Hypogeusia OR dysgeusia OR ‘‘gustatory loss’’ OR gustation OR ‘‘loss of taste’’. The references of included studies were also manually screened. Random-effects meta-analysis was performed. Results: One hundred and twenty-five studies with test-confirmed COVID-19 infection from 31 countries were included. 62 publications which reported data on loss of taste were used to estimate patients' recovery rate in 13700 COVID-19 patients. Accordingly, the time to recovery of loss of taste among COVID-19 patients ranged from 2±0.352 to 43.6 ± 28.5 days. The estimated overall pooled recovery rate of loss of taste among COVID-19 patients was 74%. The estimated overall pooled time to recover loss of taste among COVID-19 patients was 11.44 days [95% CI 8.11, 14.77(]. 90 publications which reported data on loss of smell were used to estimate patients' recovery rate in 20027 COVID-19 patients. Accordingly, the time to recover the loss of smell among COVID-19 patients ranged from 2.44±0.352 to 31.9 ± 30.7 days The estimated overall pooled recovery rate of loss of smell among COVID-19 patients was 72%. The estimated overall pooled time to recover loss of smell among COVID-19 patients was 12.87 days [95% CI)1011, 15.64(]. Conclusion: The recovery rate of loss of smell and taste among COVID-19 patients was high globally, and time to recovery of loss of smell and taste among COVID-19 patients usually was less than 2 weeks; regional differences supported the relevance of these symptoms as important markers. Health workers must consider smell and taste symptoms as suspicion indices for the empirical diagnosis of COVID-19 infection and reassure patients with their high recovery rate in a short period of time

A likely association between low mannan-binding lectin level and brain fog onset in long COVID patients

: Brain fog can be described as a constellation of new-onset neuropsychiatric sequelae in the post-acute phase of COVID-19 (long COVID). The symptoms include inattention, short-term memory loss, and reduced mental acuity, which may undermine cognition, concentration, and sleep. This cognitive impairment, persisting for weeks or months after the acute phase of SARS-CoV-2 infection, can significantly impact on daily activities and the quality of life. An important role for the complement system (C) in the pathogenesis of COVID-19 has emerged since the beginning of pandemic outbreak. A number of pathophysiological characteristics including microangiopathy and myocarditis have been attributed to dysregulated C activation due to SARS-CoV-2 infection. Mannan-binding lectin (MBL), the first recognition subcomponent of the C lectin pathway, has been shown to bind to glycosylated SARS-CoV-2 spike protein, genetic variants of MBL2 are suggested to have an association with severe COVID-19 manifestations requiring hospitalization. In the present study, we evaluated MBL activity (lectin pathway activation) and levels in the sera of a cohort of COVID-19 patients, presenting brain fog or only hyposmia/hypogeusia as persistent symptoms, and compared them with healthy volunteers. We found significantly lower levels of MBL and lectin pathway activity in the sera of patients experiencing brain fog as compared to recovered COVID-19 patients without brain fog. Our data indicate that long COVID-associated brain fog can be listed among the variegate manifestations of increased susceptibility to infections and diseases contributed by MBL deficiency

Six-month smell and taste recovery rates in coronavirus disease 2019 patients: a prospective psychophysical study

Background The long-term recovery rate for coronavirus disease 2019 related chemosensory disturbances has not yet been clarified. Methods Olfactory and gustatory functions were assessed with psychophysical tests in patients in the first seven days from coronavirus disease 2019 onset and one, two, three and six months after the first evaluation. Results A total of 300 patients completed the study. The improvement in olfactory function was significant at the two-month follow up. At the end of the observation period, 27 per cent of the patients still experienced a persistent olfactory disturbance, including anosmia in 5 per cent of cases. As for taste, the improvement in the psychophysical scores was significant only between the baseline and the 30-day control. At the 6-month evaluation, 10 per cent of the patients presented with a persistent gustatory disturbance with an incidence of complete ageusia of 1 per cent. Conclusion Six months after the onset of coronavirus disease 2019, about 6 per cent of patients still had a severe persistent olfactory or gustatory disturbance