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      Objective evaluation of anosmia and ageusia in COVID‐19 patients: Single‐center experience on 72 cases

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          Abstract

          Background

          The first European case series are detecting a very high frequency of chemosensitive disorders in COVID‐19 patients, ranging between 19.4% and 88%.

          Methods

          Olfactory and gustatory function was objectively tested in 72 COVID‐19 patients treated at University Hospital of Sassari.

          Results

          Overall, 73.6% of the patients reported having or having had chemosensitive disorders. Olfactory assessment showed variable degree hyposmia in 60 cases and anosmia in two patients. Gustatory assessment revealed hypogeusia in 33 cases and complete ageusia in one patient. Statistically significant differences in chemosensitive recovery were detected based on age and distance from the onset of clinical manifestations.

          Conclusion

          Olfactory and gustatory dysfunctions represent common clinical findings in COVID‐19 patients. Otolaryngologists and head‐neck surgeons must by now keep this diagnostic option in mind when evaluating cases of ageusia and nonspecific anosmia that arose suddenly and are not associated with rhinitis symptoms.

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          Most cited references 13

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          A new coronavirus associated with human respiratory disease in China

           Fan Wu,  Su Zhao,  Bin Yu (2020)
          Emerging infectious diseases, such as severe acute respiratory syndrome (SARS) and Zika virus disease, present a major threat to public health 1–3 . Despite intense research efforts, how, when and where new diseases appear are still a source of considerable uncertainty. A severe respiratory disease was recently reported in Wuhan, Hubei province, China. As of 25 January 2020, at least 1,975 cases had been reported since the first patient was hospitalized on 12 December 2019. Epidemiological investigations have suggested that the outbreak was associated with a seafood market in Wuhan. Here we study a single patient who was a worker at the market and who was admitted to the Central Hospital of Wuhan on 26 December 2019 while experiencing a severe respiratory syndrome that included fever, dizziness and a cough. Metagenomic RNA sequencing 4 of a sample of bronchoalveolar lavage fluid from the patient identified a new RNA virus strain from the family Coronaviridae, which is designated here ‘WH-Human 1’ coronavirus (and has also been referred to as ‘2019-nCoV’). Phylogenetic analysis of the complete viral genome (29,903 nucleotides) revealed that the virus was most closely related (89.1% nucleotide similarity) to a group of SARS-like coronaviruses (genus Betacoronavirus, subgenus Sarbecovirus) that had previously been found in bats in China 5 . This outbreak highlights the ongoing ability of viral spill-over from animals to cause severe disease in humans.
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            Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury

            The outbreak of the 2019-nCoV infection began in December 2019 in Wuhan, Hubei province, and rapidly spread to many provinces in China as well as other countries. Here we report the epidemiological, clinical, laboratory, and radiological characteristics, as well as potential biomarkers for predicting disease severity in 2019-nCoV-infected patients in Shenzhen, China. All 12 cases of the 2019-nCoV-infected patients developed pneumonia and half of them developed acute respiratory distress syndrome (ARDS). The most common laboratory abnormalities were hypoalbuminemia, lymphopenia, decreased percentage of lymphocytes (LYM) and neutrophils (NEU), elevated C-reactive protein (CRP) and lactate dehydrogenase (LDH), and decreased CD8 count. The viral load of 2019-nCoV detected from patient respiratory tracts was positively linked to lung disease severity. ALB, LYM, LYM (%), LDH, NEU (%), and CRP were highly correlated to the acute lung injury. Age, viral load, lung injury score, and blood biochemistry indexes, albumin (ALB), CRP, LDH, LYM (%), LYM, and NEU (%), may be predictors of disease severity. Moreover, the Angiotensin II level in the plasma sample from 2019-nCoV infected patients was markedly elevated and linearly associated to viral load and lung injury. Our results suggest a number of potential diagnosis biomarkers and angiotensin receptor blocker (ARB) drugs for potential repurposing treatment of 2019-nCoV infection. Electronic Supplementary Material Supplementary material is available for this article at 10.1007/s11427-020-1643-8 and is accessible for authorized users.
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              Self-reported Olfactory and Taste Disorders in Patients With Severe Acute Respiratory Coronavirus 2 Infection: A Cross-sectional Study

              To the Editor—We read with interest the article by Wang et al [1] describing the clinical features of 69 patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Wuhan, China. The authors provide a detailed description of major signs and symptoms of overt disease [2, 3], but fail to give an account of minor symptoms that may be present at earlier stages of the infection. After some patients admitted for coronavirus disease 2019 (COVID-19) at the Infectious Disease Department of L. Sacco Hospital in Milan, Italy, complained of olfactory and taste disorders (OTDs), we performed a cross-sectional survey of the prevalence of these alterations in the context of SARS-CoV-2 infection. On 19 March 2020, a simple questionnaire including questions about the presence or absence of OTDs, their type and time of onset respective to hospitalization were submitted through verbal interview to all SARS-CoV-2–positive hospitalized patients who were able to give informed consent. Of 88 hospitalized patients, 59 were able to be interviewed (29 were nonrespondents, of whom 4 had dementia, 2 had a linguistic barrier, and 23 were on noninvasive ventilation) (Table 1). Of these, 20 (33.9%) reported at least 1 taste or olfactory disorder and 11 (18.6%) both. Twelve patients (20.3%) presented the symptoms before the hospital admission, whereas 8 (13.5%) experienced the symptoms during the hospital stay. Taste alterations were more frequently (91%) before hospitalization, whereas after hospitalization taste and olfactory alteration appeared with equal frequency. Females reported OTDs more frequently than males (10/19 [52.6%] vs 10/40 [25%]; P = .036). Moreover, patients with at least 1 OTD were younger than those without (median, 56 years [interquartile range {IQR}, 47–60] vs 66 [IQR, 52–77]; P = .035). All patients reported the persistence of OTDs at the time of the interview. Table 1. Characteristics of Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection Assessed for Taste and Olfactory Disorders (N = 59) Patients No. (%) Age, y, median (IQR) 60 (50–74) Male sex 40 (67.8) Days from illness onset to hospital admission, median (IQR) 6 (4–10) Days from illness onset to the interview, median (IQR) 15 (10–21) Pneumonia at hospital admission 43 (72.8) Symptoms at hospital admission  Fever 43 (72.8)  Cough 22 (37.3)  Dyspnea 15 (25.4)  Sore throat 1 (1.7)  Arthralgia 3 (5.1)  Coryza 1 (1.7)  Headache 2 (3.4)  Asthenia 1 (1.7)  Abdominal symptoms 5 (8.5) No taste or olfactory disorders 39 (66.1) With olfactory and/or taste disorders 20 (33.9) Taste disorders only  Dysgeusia 5 (8.5)  Ageusia 1 (1.7) Olfactory disorders only  Hyposmia 3 (5.1)  Anosmia 0 (0) Mixed taste and olfactory disorders  Dysgeusia and hyposmia 2 (3.4)  Dysgeusia and anosmia 2 (3.4)  Ageusia and hyposmia 2 (3.4)  Ageusia and anosmia 5 (8.5) Data are presented as no. (%) unless otherwise indicated. Abbreviations: IQR, interquartile range; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2. Olfactory and taste disorders are well known to be related with a wide range of viral infections [4, 5]. SARS-CoV has demonstrated in a mice model a transneural penetration through the olfactory bulb [6]. Moreover, angiotensin-converting enzyme 2 receptor, which is used by SARS-CoV-2 to bind and penetrate into the cell, is widely expressed on the epithelial cells of the mucosa of the oral cavity [7]. These findings could explain the underlying pathogenetic mechanism of taste and olfactory disorders in SARS-CoV-2 infection. Due to limitations related to the diffusivity of the disease and emergency contingencies, it was impossible to perform a more structured questionnaire associated with validated tests (ie, Pennsylvania smell identification test) [8]. However, our survey shows that OTDs are fairly frequent in patients with SARS-CoV-2 infection and may precede the onset of full-blown clinical disease. In a pandemic context, further investigations on nonhospitalized infected patients are required to ascertain if these symptoms, albeit unspecific, may represent a clinical screening tool to orientate testing of pauci-symptomatic individuals.
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                Author and article information

                Contributors
                luigi.vaira@gmail.com
                Journal
                Head Neck
                Head Neck
                10.1002/(ISSN)1097-0347
                HED
                Head & Neck
                John Wiley & Sons, Inc. (Hoboken, USA )
                1043-3074
                1097-0347
                29 April 2020
                June 2020
                : 42
                : 6 ( doiID: 10.1002/hed.v42.6 )
                : 1252-1258
                Affiliations
                [ 1 ] Maxillofacial Surgery Operative Unit University Hospital of Sassari Sassari Italy
                [ 2 ] Department of Medical, Surgical and Experimental Sciences University of Sassari Sassari Italy
                [ 3 ] Respiratory Diseases Operative Unit University Hospital of Sassari Sassari Italy
                [ 4 ] Infectious Diseases Operative Unit University Hospital of Sassari Sassari Italy
                [ 5 ] Maxillofacial Surgery Operative Unit Bellaria and Maggiore Hospital Bologna Italy
                [ 6 ] Department of Surveillance and Prevention University Hospital of Sassari Sassari Italy
                [ 7 ] Otolaryngology Operative Unit University Hospital of Sassari Sassari Italy
                [ 8 ] Maxillofacial Surgery Unit University Hospital of Naples “Federico II” Naples Italy
                Author notes
                [* ] Correspondence

                Luigi Angelo Vaira, Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Viale San Pietro 43/B, 07100 Sassari, Italy.

                Email: luigi.vaira@ 123456gmail.com

                Article
                HED26204
                10.1002/hed.26204
                7267244
                32342566
                fe94644c-fdac-4a60-9438-d29fecb4afe3
                © 2020 Wiley Periodicals, Inc.

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                Page count
                Figures: 1, Tables: 6, Pages: 7, Words: 4141
                Product
                Categories
                Special Issue
                Otolaryngology‐head and Neck Surgery
                Custom metadata
                2.0
                June 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.3 mode:remove_FC converted:03.06.2020

                Otolaryngology

                ageusia, anosmia, covid‐19, gustatory function, olfactory function

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