Anosmia (loss of smell) confirmed as a clinical feature of COVID-19

Anosmia (loss of smell) confirmed as a clinical feature of COVID-19

Loss of smell hints at coronavirus infection If an infected person with such a mucoid discharge were to touch their noses, for instance, to wipe the nose and then don’t wash the hands before touching another surface, the latter could be contaminated. This can serve as a source of infection. How is the diagnosis made at present? The diagnosis of COVID-19 is typically made when individuals who may have been exposed to the virus develop fever, cough, and a feeling of breathlessness. If they also then develop severe breathing distress, feel constant pressure or pain in the chest, become confused (not fully aware of the surroundings), or are difficult to rouse to full consciousness, severe or critical illness is diagnosed. Medical assistance should be sought at once. In up to 80% of cases, the disease is thought to be asymptomatic or mild and resolves by itself without medical support. Anosmia and COVID-19 The olfactory epithelium is a 150 square cm area of smell-sensitive neurons located above the respiratory mucosa of the nasal cavity. It is, therefore, readily infected by the virus, resulting in the loss of smell. The current review covered 19 papers reporting various disorders of the nose and sinuses observed concerning the current pandemic of COVID-19. One of them is a Paris study of 55 patients who presented with anosmia but had no nasal block and were tested for the virus by nasal swabs. The polymerase chain reaction (PCR) was used to test for the presence of the virus. The study showed that 94% of them had COVID-19. The authors of the unpublished Parisian paper, Dominique Salmon and Alain Corré, described their findings: “Patients with allergic rhinitis seem more affected. It occurs suddenly 2 to 3 days after the beginning of usually rather mild symptoms related to COVID 19 disease such as headaches, low-grade fever, and diarrhea. In most cases, the signs of cold (such as cough, fever) are absent or have disappeared.” The sense of smell usually begins to return within 5-10 days but may take longer to recover in some patients completely. What does this mean for clinicians and patients? The critical indicator that the anosmia is related to the virus is the absence of other symptoms of a viral cold or the seasonal flu, like nasal obstruction, or the production of excessive mucus. The anosmia may occur at any time, but if it is the first symptom, it is still more important as it could help to recognize the illness early and prompt self-isolation to limit its spread. This motivated the current call to recognize sudden-onset anosmia without other symptoms of nasal involvement as a sign of COVID-19, and restrict one’s social activity, isolate from others at home and work, and ask healthcare providers about testing. This comes against a background of uncertainty as to when a patient should be tested for the illness since the testing capability is limited, and the increase in the number of suspected cases is huge. When coupled with high levels of viral replication within the nasal mucosa, the early occurrence of this sign and the fact that the patient has no or very mild symptoms of infection, the presence of anosmia should prompt an early call for testing and self-quarantine. Says Sedaghat, “The occurrence of sudden onset anosmia without nasal obstruction is highly predictive of COVID-19 and should trigger the individual to immediately self-quarantine with presumptive COVID-19.” Journal reference: Gengler, I., Wang, J. C., Speth, M. M., and Sedaghat, A. R. (2020). Sinonasal pathophysiology of SARS‐CoV‐2 and COVID‐19: a systematic review of the current evidence. Laryngoscope Investigative Otolaryngology. https://doi.org/10.1002/lio2.384 . https://onlinelibrary.wiley.com/doi/10.1002/lio2.384



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