Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Objective

To investigate the occurrence of olfactory and gustatory dysfunctions in patients with laboratory-confirmed COVID-19 infection.

Methods

Patients with laboratory-confirmed COVID-19 infection were recruited from 12 European hospitals. The following epidemiological and clinical outcomes have been studied: age, sex, ethnicity, comorbidities, and general and otolaryngological symptoms. Patients completed olfactory and gustatory questionnaires based on the smell and taste component of the National Health and Nutrition Examination Survey, and the short version of the Questionnaire of Olfactory Disorders-Negative Statements (sQOD-NS).

Results

A total of 417 mild-to-moderate COVID-19 patients completed the study (263 females). The most prevalent general symptoms consisted of cough, myalgia, and loss of appetite. Face pain and nasal obstruction were the most disease-related otolaryngological symptoms. 85.6% and 88.0% of patients reported olfactory and gustatory dysfunctions, respectively. There was a significant association between both disorders ( p < 0.001). Olfactory dysfunction (OD) appeared before the other symptoms in 11.8% of cases. The sQO-NS scores were significantly lower in patients with anosmia compared with normosmic or hyposmic individuals ( p = 0.001). Among the 18.2% of patients without nasal obstruction or rhinorrhea, 79.7% were hyposmic or anosmic. The early olfactory recovery rate was 44.0%. Females were significantly more affected by olfactory and gustatory dysfunctions than males ( p = 0.001).

Conclusion

Olfactory and gustatory disorders are prevalent symptoms in European COVID-19 patients, who may not have nasal symptoms. The sudden anosmia or ageusia need to be recognized by the international scientific community as important symptoms of the COVID-19 infection.

Electronic supplementary material

The online version of this article (10.1007/s00405-020-05965-1) contains supplementary material, which is available to authorized users.

Related collections

Most cited references 17

Record: found
Abstract: found
Article: not found

Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

Nanshan Chen, Min Zhou, Xuan Dong … (2022)

Summary Background In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. We aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia. Methods In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data. Outcomes were followed up until Jan 25, 2020. Findings Of the 99 patients with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 55·5 years (SD 13·1), including 67 men and 32 women. 2019-nCoV was detected in all patients by real-time RT-PCR. 50 (51%) patients had chronic diseases. Patients had clinical manifestations of fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). According to imaging examination, 74 (75%) patients showed bilateral pneumonia, 14 (14%) patients showed multiple mottling and ground-glass opacity, and one (1%) patient had pneumothorax. 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure. Interpretation The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection. Funding National Key R&D Program of China.

0 comments Cited 9733 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster

Jasper Chan, Shuofeng Yuan, Kin-Hang Kok … (2020)

Summary Background An ongoing outbreak of pneumonia associated with a novel coronavirus was reported in Wuhan city, Hubei province, China. Affected patients were geographically linked with a local wet market as a potential source. No data on person-to-person or nosocomial transmission have been published to date. Methods In this study, we report the epidemiological, clinical, laboratory, radiological, and microbiological findings of five patients in a family cluster who presented with unexplained pneumonia after returning to Shenzhen, Guangdong province, China, after a visit to Wuhan, and an additional family member who did not travel to Wuhan. Phylogenetic analysis of genetic sequences from these patients were done. Findings From Jan 10, 2020, we enrolled a family of six patients who travelled to Wuhan from Shenzhen between Dec 29, 2019 and Jan 4, 2020. Of six family members who travelled to Wuhan, five were identified as infected with the novel coronavirus. Additionally, one family member, who did not travel to Wuhan, became infected with the virus after several days of contact with four of the family members. None of the family members had contacts with Wuhan markets or animals, although two had visited a Wuhan hospital. Five family members (aged 36–66 years) presented with fever, upper or lower respiratory tract symptoms, or diarrhoea, or a combination of these 3–6 days after exposure. They presented to our hospital (The University of Hong Kong-Shenzhen Hospital, Shenzhen) 6–10 days after symptom onset. They and one asymptomatic child (aged 10 years) had radiological ground-glass lung opacities. Older patients (aged >60 years) had more systemic symptoms, extensive radiological ground-glass lung changes, lymphopenia, thrombocytopenia, and increased C-reactive protein and lactate dehydrogenase levels. The nasopharyngeal or throat swabs of these six patients were negative for known respiratory microbes by point-of-care multiplex RT-PCR, but five patients (four adults and the child) were RT-PCR positive for genes encoding the internal RNA-dependent RNA polymerase and surface Spike protein of this novel coronavirus, which were confirmed by Sanger sequencing. Phylogenetic analysis of these five patients' RT-PCR amplicons and two full genomes by next-generation sequencing showed that this is a novel coronavirus, which is closest to the bat severe acute respiatory syndrome (SARS)-related coronaviruses found in Chinese horseshoe bats. Interpretation Our findings are consistent with person-to-person transmission of this novel coronavirus in hospital and family settings, and the reports of infected travellers in other geographical regions. Funding The Shaw Foundation Hong Kong, Michael Seak-Kan Tong, Respiratory Viral Research Foundation Limited, Hui Ming, Hui Hoy and Chow Sin Lan Charity Fund Limited, Marina Man-Wai Lee, the Hong Kong Hainan Commercial Association South China Microbiology Research Fund, Sanming Project of Medicine (Shenzhen), and High Level-Hospital Program (Guangdong Health Commission).

0 comments Cited 4199 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients

Lirong Zou, Feng Ruan, Mingxing Huang … (2020)

To the Editor: The 2019 novel coronavirus (SARS-CoV-2) epidemic, which was first reported in December 2019 in Wuhan, China, and has been declared a public health emergency of international concern by the World Health Organization, may progress to a pandemic associated with substantial morbidity and mortality. SARS-CoV-2 is genetically related to SARS-CoV, which caused a global epidemic with 8096 confirmed cases in more than 25 countries in 2002–2003. 1 The epidemic of SARS-CoV was successfully contained through public health interventions, including case detection and isolation. Transmission of SARS-CoV occurred mainly after days of illness 2 and was associated with modest viral loads in the respiratory tract early in the illness, with viral loads peaking approximately 10 days after symptom onset. 3 We monitored SARS-CoV-2 viral loads in upper respiratory specimens obtained from 18 patients (9 men and 9 women; median age, 59 years; range, 26 to 76) in Zhuhai, Guangdong, China, including 4 patients with secondary infections (1 of whom never had symptoms) within two family clusters (Table S1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org). The patient who never had symptoms was a close contact of a patient with a known case and was therefore monitored. A total of 72 nasal swabs (sampled from the mid-turbinate and nasopharynx) (Figure 1A) and 72 throat swabs (Figure 1B) were analyzed, with 1 to 9 sequential samples obtained from each patient. Polyester flock swabs were used for all the patients. From January 7 through January 26, 2020, a total of 14 patients who had recently returned from Wuhan and had fever (≥37.3°C) received a diagnosis of Covid-19 (the illness caused by SARS-CoV-2) by means of reverse-transcriptase–polymerase-chain-reaction assay with primers and probes targeting the N and Orf1b genes of SARS-CoV-2; the assay was developed by the Chinese Center for Disease Control and Prevention. Samples were tested at the Guangdong Provincial Center for Disease Control and Prevention. Thirteen of 14 patients with imported cases had evidence of pneumonia on computed tomography (CT). None of them had visited the Huanan Seafood Wholesale Market in Wuhan within 14 days before symptom onset. Patients E, I, and P required admission to intensive care units, whereas the others had mild-to-moderate illness. Secondary infections were detected in close contacts of Patients E, I, and P. Patient E worked in Wuhan and visited his wife (Patient L), mother (Patient D), and a friend (Patient Z) in Zhuhai on January 17. Symptoms developed in Patients L and D on January 20 and January 22, respectively, with viral RNA detected in their nasal and throat swabs soon after symptom onset. Patient Z reported no clinical symptoms, but his nasal swabs (cycle threshold [Ct] values, 22 to 28) and throat swabs (Ct values, 30 to 32) tested positive on days 7, 10, and 11 after contact. A CT scan of Patient Z that was obtained on February 6 was unremarkable. Patients I and P lived in Wuhan and visited their daughter (Patient H) in Zhuhai on January 11 when their symptoms first developed. Fever developed in Patient H on January 17, with viral RNA detected in nasal and throat swabs on day 1 after symptom onset. We analyzed the viral load in nasal and throat swabs obtained from the 17 symptomatic patients in relation to day of onset of any symptoms (Figure 1C). Higher viral loads (inversely related to Ct value) were detected soon after symptom onset, with higher viral loads detected in the nose than in the throat. Our analysis suggests that the viral nucleic acid shedding pattern of patients infected with SARS-CoV-2 resembles that of patients with influenza 4 and appears different from that seen in patients infected with SARS-CoV. 3 The viral load that was detected in the asymptomatic patient was similar to that in the symptomatic patients, which suggests the transmission potential of asymptomatic or minimally symptomatic patients. These findings are in concordance with reports that transmission may occur early in the course of infection 5 and suggest that case detection and isolation may require strategies different from those required for the control of SARS-CoV. How SARS-CoV-2 viral load correlates with culturable virus needs to be determined. Identification of patients with few or no symptoms and with modest levels of detectable viral RNA in the oropharynx for at least 5 days suggests that we need better data to determine transmission dynamics and inform our screening practices.

0 comments Cited 2533 times – based on 0 reviews      Review now

All references

Author and article information

Contributors

Jerome R. Lechien: Jerome.Lechien@umons.ac.be

Journal

Journal ID (nlm-ta): Eur Arch Otorhinolaryngol

Journal ID (iso-abbrev): Eur Arch Otorhinolaryngol

Title: European Archives of Oto-Rhino-Laryngology

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0937-4477

ISSN (Electronic): 1434-4726

Publication date (Electronic): 6 April 2020

Pages: 1-11

Affiliations

[1 ]COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France

[2 ]GRID grid.8364.9, ISNI 0000 0001 2184 581X, Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, , UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), ; Mons, Belgium

[3 ]GRID grid.12832.3a, ISNI 0000 0001 2323 0229, Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, , UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), ; Paris, France

[4 ]GRID grid.4989.c, ISNI 0000 0001 2348 0746, Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, , Université Libre de Bruxelles, ; Brussels, Belgium

[5 ]GRID grid.414651.3, Department of Otorhinolaryngology-Head and Neck Surgery, , Hospital Universitario Donostia, ; San Sebastian, Spain

[6 ]GRID grid.7942.8, ISNI 0000 0001 2294 713X, Department of Otorhinolaryngology and Head and Neck Surgery, , CHU Saint-Luc, Université Catholique de Louvain, ; Brussels, Belgium

[7 ]Department of Neurology, EpiCURA Hospital, Ath, Belgium

[8 ]Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Quironsalud Valencia, Valencia, Spain

[9 ]Department of Otolaryngology-Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain

[10 ]GRID grid.410559.c, ISNI 0000 0001 0743 2111, Division of Otolaryngology-Head and Neck Surgery, , Centre Hospitalier de l’Université de Montréal, ; Montreal, QC Canada

[11 ]Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of L. Vanvitelli, Naples, Italy

[12 ]GRID grid.415079.e, ISNI 0000 0004 1759 989X, Department of Otolaryngology-Head and Neck Surgery, , Morgagni Pierantoni Hospital, ; Forli, Italy

[13 ]Department of Otolaryngology-Head and Neck Surgery, EpiCURA Hospital, Baudour, Belgium

[14 ]GRID grid.492608.1, Department of Otolaryngology-Head and Neck Surgery, , CHU Ambroise Paré, ; Mons, Belgium

[15 ]GRID grid.492608.1, Division of Infectious Disease, , CHU Ambroise-Paré, ; Mons, Belgium

[16 ]GRID grid.150338.c, ISNI 0000 0001 0721 9812, Rhinology-Olfactology Unit, Department of Otorhinolaryngology, Head and Neck Surgery, , Geneva University Hospitals (HUG), ; Geneva, Switzerland

[17 ]GRID grid.414435.3, ISNI 0000 0001 2200 9055, Department of Neuroradiology, , Université Paris-Descartes-Sorbonne-Paris-Cité, IMABRAIN-INSERM-UMR1266, DHU-Neurovasc, Centre Hospitalier Sainte-Anne, ; Paris, France

[18 ]GRID grid.460789.4, ISNI 0000 0004 4910 6535, Department of Radiology, APHP, Hôpitaux R. Poincaré-Ambroise Paré, DMU Smart Imaging, , GH Université Paris-Saclay, U 1179 UVSQ/Paris-Saclay, ; Paris, France

[19 ]GRID grid.8364.9, ISNI 0000 0001 2184 581X, Department of Neurosciences, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, , University of Mons (UMons), ; Mons, Belgium

[20 ]GRID grid.5608.b, ISNI 0000 0004 1757 3470, Department of Neuroscience, Audiology Unit, , Padova University, ; Treviso, Italy

[21 ]GRID grid.8364.9, ISNI 0000 0001 2184 581X, Department of Metabolic and Molecular Biochemistry, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, , University of Mons (UMons), ; Mons, Belgium

[22 ]Department of Otorhinolaryngology-Head and Neck Surgery, APHM, Aix Marseille University, La Conception University Hospital, Marseille, France

Article

Publisher ID: 5965

DOI: 10.1007/s00405-020-05965-1

PMC ID: 7134551

PubMed ID: 31664514

SO-VID: 59b93931-2daf-4f59-a8e4-1bd2617e4985

License:

This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study

Read this article at

Abstract

Objective

Methods

Results

Conclusion

Electronic supplementary material

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 17

Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster

SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients

Author and article information

Contributors

Journal

Affiliations

Article

History

Categories

Comments

Comment on this article

Similar content 388

Cited by 635

Most referenced authors 2,221