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

TitleOlfactory Dysfunction in Coronavirus Disease 2019 Patients: Observational Cohort Study and Systematic Review
Authors
Keywordsanosmia
COVID-19
olfactory dysfunction
SARS-CoV-2
smell impairment
Issue Date2020
PublisherOxford University Press (OUP): Policy C. The Journal's web site is located at http://ofid.oxfordjournals.org/
Citation
Open Forum Infectious Diseases, 2020, v. 7 n. 6, p. article no. ofaa199 How to Cite?
AbstractBackground: 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.
Persistent Identifierhttp://hdl.handle.net/10722/284247
ISSN
2019 Impact Factor: 3.656
PubMed Central ID

 

DC FieldValueLanguage
dc.contributor.authorChung, TWH-
dc.contributor.authorSridhar, S-
dc.contributor.authorZhang, AJ-
dc.contributor.authorChan, KH-
dc.contributor.authorLi, HL-
dc.contributor.authorWong, FKC-
dc.contributor.authorNg, MY-
dc.contributor.authorTsang, RKY-
dc.contributor.authorLee, ACY-
dc.contributor.authorFan, Z-
dc.contributor.authorHo, RSL-
dc.contributor.authorLuk, SY-
dc.contributor.authorKan, WK-
dc.contributor.authorLam, SHY-
dc.contributor.authorWu, AKL-
dc.contributor.authorLeung, SM-
dc.contributor.authorChan, WM-
dc.contributor.authorYeung Ng, P-
dc.contributor.authorTo, KKW-
dc.contributor.authorCheng, VCC-
dc.contributor.authorLung, KC-
dc.contributor.authorHung, IFN-
dc.contributor.authorYuen, KY-
dc.date.accessioned2020-07-20T05:57:13Z-
dc.date.available2020-07-20T05:57:13Z-
dc.date.issued2020-
dc.identifier.citationOpen Forum Infectious Diseases, 2020, v. 7 n. 6, p. article no. ofaa199-
dc.identifier.issn2328-8957-
dc.identifier.urihttp://hdl.handle.net/10722/284247-
dc.description.abstractBackground: 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.-
dc.languageeng-
dc.publisherOxford University Press (OUP): Policy C. The Journal's web site is located at http://ofid.oxfordjournals.org/-
dc.relation.ispartofOpen Forum Infectious Diseases-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectanosmia-
dc.subjectCOVID-19-
dc.subjectolfactory dysfunction-
dc.subjectSARS-CoV-2-
dc.subjectsmell impairment-
dc.titleOlfactory Dysfunction in Coronavirus Disease 2019 Patients: Observational Cohort Study and Systematic Review-
dc.typeArticle-
dc.identifier.emailSridhar, S: sid8998@hku.hk-
dc.identifier.emailZhang, AJ: zhangajx@hkucc.hku.hk-
dc.identifier.emailChan, KH: chankh2@hkucc.hku.hk-
dc.identifier.emailLi, HL: ronlihl@hku.hk-
dc.identifier.emailNg, MY: myng2@hku.hk-
dc.identifier.emailTsang, RKY: rkytsang@hku.hk-
dc.identifier.emailLee, ACY: cyalee@hku.hk-
dc.identifier.emailFan, Z: fanzm@hku.hk-
dc.identifier.emailHo, RSL: hsl388@hku.hk-
dc.identifier.emailWu, AKL: alanklwu@hkucc.hku.hk-
dc.identifier.emailLeung, SM: smsleung@hku.hk-
dc.identifier.emailChan, WM: drchanwm@hkucc.hku.hk-
dc.identifier.emailYeung Ng, P: pyeungng@hku.hk-
dc.identifier.emailTo, KKW: kelvinto@hku.hk-
dc.identifier.emailCheng, VCC: vcccheng@hkucc.hku.hk-
dc.identifier.emailLung, KC: lungkc@hku.hk-
dc.identifier.emailHung, IFN: ivanhung@hkucc.hku.hk-
dc.identifier.emailYuen, KY: kyyuen@hkucc.hku.hk-
dc.identifier.authoritySridhar, S=rp02249-
dc.identifier.authorityZhang, AJ=rp00413-
dc.identifier.authorityChan, KH=rp01921-
dc.identifier.authorityNg, MY=rp01976-
dc.identifier.authorityTsang, RKY=rp01386-
dc.identifier.authorityYeung Ng, P=rp02517-
dc.identifier.authorityTo, KKW=rp01384-
dc.identifier.authorityHung, IFN=rp00508-
dc.identifier.authorityYuen, KY=rp00366-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1093/ofid/ofaa199-
dc.identifier.pmid32548209-
dc.identifier.pmcidPMC7284010-
dc.identifier.scopuseid_2-s2.0-85086922537-
dc.identifier.hkuros310970-
dc.identifier.volume7-
dc.identifier.issue6-
dc.identifier.spagearticle no. ofaa199-
dc.identifier.epagearticle no. ofaa199-
dc.publisher.placeUnited Kingdom-

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