Cargando…

Olfactory Dysfunction in Coronavirus Disease 2019 Patients: Observational Cohort Study and Systematic Review

BACKGROUND: Olfactory dysfunction (OD) has been reported in coronavirus disease 2019 (COVID-19). However, there are knowledge gaps about the severity, prevalence, etiology, and duration of OD in COVID-19 patients. METHODS: Olfactory function was assessed in all participants using questionnaires and...

Descripción completa

Detalles Bibliográficos
Autores principales: Chung, Tom Wai-Hin, Sridhar, Siddharth, Zhang, Anna Jinxia, Chan, Kwok-Hung, Li, Hang-Long, Wong, Fergus Kai-Chuen, Ng, Ming-Yen, Tsang, Raymond King-Yin, Lee, Andrew Chak-Yiu, Fan, Zhimeng, Ho, Ronnie Siu-Lun, Luk, Shiobhon Yiu, Kan, Wai-Kuen, Lam, Sonia Hiu-Yin, Wu, Alan Ka-Lun, Leung, Sau-Man, Chan, Wai-Ming, Ng, Pauline Yeung, To, Kelvin Kai-Wang, Cheng, Vincent Chi-Chung, Lung, Kwok-Cheung, Hung, Ivan Fan-Ngai, Yuen, Kwok-Yung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7284010/
https://www.ncbi.nlm.nih.gov/pubmed/32548209
http://dx.doi.org/10.1093/ofid/ofaa199
_version_ 1783544379032469504
author Chung, Tom Wai-Hin
Sridhar, Siddharth
Zhang, Anna Jinxia
Chan, Kwok-Hung
Li, Hang-Long
Wong, Fergus Kai-Chuen
Ng, Ming-Yen
Tsang, Raymond King-Yin
Lee, Andrew Chak-Yiu
Fan, Zhimeng
Ho, Ronnie Siu-Lun
Luk, Shiobhon Yiu
Kan, Wai-Kuen
Lam, Sonia Hiu-Yin
Wu, Alan Ka-Lun
Leung, Sau-Man
Chan, Wai-Ming
Ng, Pauline Yeung
To, Kelvin Kai-Wang
Cheng, Vincent Chi-Chung
Lung, Kwok-Cheung
Hung, Ivan Fan-Ngai
Yuen, Kwok-Yung
author_facet Chung, Tom Wai-Hin
Sridhar, Siddharth
Zhang, Anna Jinxia
Chan, Kwok-Hung
Li, Hang-Long
Wong, Fergus Kai-Chuen
Ng, Ming-Yen
Tsang, Raymond King-Yin
Lee, Andrew Chak-Yiu
Fan, Zhimeng
Ho, Ronnie Siu-Lun
Luk, Shiobhon Yiu
Kan, Wai-Kuen
Lam, Sonia Hiu-Yin
Wu, Alan Ka-Lun
Leung, Sau-Man
Chan, Wai-Ming
Ng, Pauline Yeung
To, Kelvin Kai-Wang
Cheng, Vincent Chi-Chung
Lung, Kwok-Cheung
Hung, Ivan Fan-Ngai
Yuen, Kwok-Yung
author_sort Chung, Tom Wai-Hin
collection PubMed
description BACKGROUND: Olfactory dysfunction (OD) has been reported in coronavirus disease 2019 (COVID-19). However, there are knowledge gaps about the severity, prevalence, etiology, and duration of OD in COVID-19 patients. METHODS: Olfactory function was assessed in all participants using questionnaires and the butanol threshold test (BTT). Patients with COVID-19 and abnormal olfaction were further evaluated using the smell identification test (SIT), sinus imaging, and nasoendoscopy. Selected patients received nasal biopsies. Systematic review was performed according to PRISMA guidelines. PubMed items from January 1, 2020 to April 23, 2020 were searched. Studies that reported clinical data on olfactory disturbances in COVID-19 patients were analyzed. RESULTS: We included 18 COVID-19 patients and 18 controls. Among COVID-19 patients, 12 of 18 (67%) reported olfactory symptoms and OD was confirmed in 6 patients by BTT and SIT. Olfactory dysfunction was the only symptom in 2 patients. Mean BTT score of patients was worse than controls (P = .004, difference in means = 1.8; 95% confidence interval, 0.6–2.9). Sinusitis and olfactory cleft obstruction were absent in most patients. Immunohistochemical analysis of nasal biopsy revealed the presence of infiltrative CD68(+) macrophages harboring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen in the stroma. Olfactory dysfunction persisted in 2 patients despite clinical recovery. Systematic review showed that the prevalence of olfactory disturbances in COVID-19 ranged from 5% to 98%. Most studies did not assess olfaction quantitatively. CONCLUSIONS: Olfactory dysfunction is common in COVID-19 and may be the only symptom. Coronavirus disease 2019-related OD can be severe and prolonged. Mucosal infiltration by CD68(+) macrophages expressing SARS-CoV-2 viral antigen may contribute to COVID-19-related OD.
format Online
Article
Text
id pubmed-7284010
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-72840102020-06-15 Olfactory Dysfunction in Coronavirus Disease 2019 Patients: Observational Cohort Study and Systematic Review Chung, Tom Wai-Hin Sridhar, Siddharth Zhang, Anna Jinxia Chan, Kwok-Hung Li, Hang-Long Wong, Fergus Kai-Chuen Ng, Ming-Yen Tsang, Raymond King-Yin Lee, Andrew Chak-Yiu Fan, Zhimeng Ho, Ronnie Siu-Lun Luk, Shiobhon Yiu Kan, Wai-Kuen Lam, Sonia Hiu-Yin Wu, Alan Ka-Lun Leung, Sau-Man Chan, Wai-Ming Ng, Pauline Yeung To, Kelvin Kai-Wang Cheng, Vincent Chi-Chung Lung, Kwok-Cheung Hung, Ivan Fan-Ngai Yuen, Kwok-Yung Open Forum Infect Dis Major Article BACKGROUND: Olfactory dysfunction (OD) has been reported in coronavirus disease 2019 (COVID-19). However, there are knowledge gaps about the severity, prevalence, etiology, and duration of OD in COVID-19 patients. METHODS: Olfactory function was assessed in all participants using questionnaires and the butanol threshold test (BTT). Patients with COVID-19 and abnormal olfaction were further evaluated using the smell identification test (SIT), sinus imaging, and nasoendoscopy. Selected patients received nasal biopsies. Systematic review was performed according to PRISMA guidelines. PubMed items from January 1, 2020 to April 23, 2020 were searched. Studies that reported clinical data on olfactory disturbances in COVID-19 patients were analyzed. RESULTS: We included 18 COVID-19 patients and 18 controls. Among COVID-19 patients, 12 of 18 (67%) reported olfactory symptoms and OD was confirmed in 6 patients by BTT and SIT. Olfactory dysfunction was the only symptom in 2 patients. Mean BTT score of patients was worse than controls (P = .004, difference in means = 1.8; 95% confidence interval, 0.6–2.9). Sinusitis and olfactory cleft obstruction were absent in most patients. Immunohistochemical analysis of nasal biopsy revealed the presence of infiltrative CD68(+) macrophages harboring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen in the stroma. Olfactory dysfunction persisted in 2 patients despite clinical recovery. Systematic review showed that the prevalence of olfactory disturbances in COVID-19 ranged from 5% to 98%. Most studies did not assess olfaction quantitatively. CONCLUSIONS: Olfactory dysfunction is common in COVID-19 and may be the only symptom. Coronavirus disease 2019-related OD can be severe and prolonged. Mucosal infiltration by CD68(+) macrophages expressing SARS-CoV-2 viral antigen may contribute to COVID-19-related OD. Oxford University Press 2020-06-05 /pmc/articles/PMC7284010/ /pubmed/32548209 http://dx.doi.org/10.1093/ofid/ofaa199 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Major Article
Chung, Tom Wai-Hin
Sridhar, Siddharth
Zhang, Anna Jinxia
Chan, Kwok-Hung
Li, Hang-Long
Wong, Fergus Kai-Chuen
Ng, Ming-Yen
Tsang, Raymond King-Yin
Lee, Andrew Chak-Yiu
Fan, Zhimeng
Ho, Ronnie Siu-Lun
Luk, Shiobhon Yiu
Kan, Wai-Kuen
Lam, Sonia Hiu-Yin
Wu, Alan Ka-Lun
Leung, Sau-Man
Chan, Wai-Ming
Ng, Pauline Yeung
To, Kelvin Kai-Wang
Cheng, Vincent Chi-Chung
Lung, Kwok-Cheung
Hung, Ivan Fan-Ngai
Yuen, Kwok-Yung
Olfactory Dysfunction in Coronavirus Disease 2019 Patients: Observational Cohort Study and Systematic Review
title Olfactory Dysfunction in Coronavirus Disease 2019 Patients: Observational Cohort Study and Systematic Review
title_full Olfactory Dysfunction in Coronavirus Disease 2019 Patients: Observational Cohort Study and Systematic Review
title_fullStr Olfactory Dysfunction in Coronavirus Disease 2019 Patients: Observational Cohort Study and Systematic Review
title_full_unstemmed Olfactory Dysfunction in Coronavirus Disease 2019 Patients: Observational Cohort Study and Systematic Review
title_short Olfactory Dysfunction in Coronavirus Disease 2019 Patients: Observational Cohort Study and Systematic Review
title_sort olfactory dysfunction in coronavirus disease 2019 patients: observational cohort study and systematic review
topic Major Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7284010/
https://www.ncbi.nlm.nih.gov/pubmed/32548209
http://dx.doi.org/10.1093/ofid/ofaa199
work_keys_str_mv AT chungtomwaihin olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT sridharsiddharth olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT zhangannajinxia olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT chankwokhung olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT lihanglong olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT wongferguskaichuen olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT ngmingyen olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT tsangraymondkingyin olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT leeandrewchakyiu olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT fanzhimeng olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT horonniesiulun olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT lukshiobhonyiu olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT kanwaikuen olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT lamsoniahiuyin olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT wualankalun olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT leungsauman olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT chanwaiming olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT ngpaulineyeung olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT tokelvinkaiwang olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT chengvincentchichung olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT lungkwokcheung olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT hungivanfanngai olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview
AT yuenkwokyung olfactorydysfunctionincoronavirusdisease2019patientsobservationalcohortstudyandsystematicreview