Comment
Up to April the 18th 2020, a total of 2.160.207 patients had tested positive for the new SARS-CoV-2 coronavirus worldwide and 146.088 (6.7%) died. From those, 88,283 positive patients and 4.108 dies correspond to Latin-American countries (4,6%) [1].
According to the clinical studies from Asia, the most prevalent symptoms consist of fever, cough, dyspnea, sputum production, myalgia, arthralgia, headache, diarrhea, rhinorrhea and sore throat [2]. However, an increasing number of reports from Europe [3], United Kingdom [4] and the Middle East [5] has highlighted a new atypical presentation of the disease including olfactory and taste dysfunctions.
The occurrence of smell dysfunction in viral infections is well known in otolaryngology [6]. However, dysosmia linked to SARS-CoV-2 infection seems particular as not associated with rhinorrhea or other nasal symptoms. This can be relevant in a region particularly vulnerable to the outbreak as Burki highlight, due to the high number of patients suffer from high risk comorbidities, other concurrent outbreaks like dengue, zika, chikungunya, yellow fever and tuberculosis, slums, and the lack of facilities and ventilators where and early and accurate diagnosis can be key to the management COVID-19 pandemic [7].
In order to support our colleagues, clinical data of patients with confirmed COVID-19 infection prospectively collected in the ear, nose, and throat (ENT) consultation from 1 Spanish, 1 Uruguayan, 1 Venezuelan and 1 Argentinian Hospitals is presented. The following inclusion criteria have been considered: adult (>18yo); with a nasopharyngeal RT-PCR laboratory-confirmed COVID-19 infection. Information was collected using an online questionnaire created with Professional Survey Monkey (San Mateo, California, USA).
The selection of the relevant epidemiological and clinical features composing the questionnaire carried out by the COVID-19 Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (YO-IFOS), which consisted of 4 general subset (Demographic data, medical background, ENT symptoms and Olfactory and Gustatory disfunction). All patients were invited to fulfill the Short version of Questionnaire of Olfactory Disorders-Negative Statements (sQOD-NS) [8]. The rest of the olfactory and taste questions were based on the smell and taste component of the National Health and Nutrition Examination Survey [9].
Five-Hundred and forty-two patients completed the study. Mean age of patients was 34 ± 11 (range: 18–88). There were 324 females and 218 males. Countries of origin are described in Table 1 . Four-Hundred and forty-four patients (81.9%) had olfactory dysfunction (OD) related to the infection. Among these patients, 67,5% had a partial loss of smell, 14,4% had a total loss of smell. Phantosmia and parosmia concerned (42; 7.7%) and (68; 12.5%) of patients during the disease course, respectively. The OD appeared before other symptoms in 122 (22,5%) of cases. 19.4% of patients reported that OD appeared during the clinical course of the disease, whereas 52.4% of patients revealed that their OD developed after general or ENT symptoms. Among the 444 patients with OD, 261 (58.78%) reported a recovery of the olfactory function throughout the 14 first days following the resolution of the disease. Patients suffer from OD at the time of the evaluation had a significant lower score of sQOD-NS compared with patients with normosmia (p = 0.0001; Kruskal-Wallis). In the present study, 443 patients had no nasal obstruction and no rhinorrhea during the clinical course of the disease. Among them, 307 (69.3%) suffered from a partial loss of smell and 37 (8.3%) a total loss of smell. Three-Hundred and thirty tree patients (61.4%) reported taste disorder, which was characterized by impairment of the following four taste modalities: salty, sweet, bitter and sour.
Table 1.
Demographic and clinical data. Olfactory outcomes have been assessed through cross-tab generation between two variables (binary or categorical variables) and Chi-square test. A level of p < 0.05 was used to determine statistical significance. Abbreviations: SEL = systemic lupus erythematosus; RA: rheumatoid arthritis.
| Characteristics | All patients = 542 | % | p |
|---|---|---|---|
| Median age (years) | 34 ± 11 (range: 18–88) | ||
| Sex Male Female |
218 324 |
40.2 59.8 |
0.001 |
| Ethnicity | 0.682 | ||
| Argentina | 116 | 21.4 | |
| Peru | 93 | 17.1 | |
| Colombia | 84 | 15.5 | |
| Uruguay | 71 | 13.1 | |
| Ecuador | 52 | 9.6 | |
| Venezuela | 47 | 8.7 | |
| Bolivia | 34 | 6.3 | |
| Chile | 27 | 5 | |
| Nicaragua | 11 | 2 | |
| Panama | 7 | 1.3 | |
| Current SMOKER | 63 | 11.6 | 0.576 |
| History of seasonal allergy | 125 | 23.1 | 0.464 |
| Comorbidities | |||
| Diabetes | 29 | 5.3 | 0.936 |
| Heart problems | 15 | 2.8 | 0.189 |
| COPD | 9 | 1.7 | 0.929 |
| Hypertension | 39 | 7.2 | 0.445 |
| Asthma | 29 | 5.4 | 0.572 |
| Hypothyroidism Autoimmune disease (LES, RA) |
20 6 |
3.7 1.1 |
0.711 0.719 |
| General symptoms | |||
| Headache | 393 | 72.5 | 0.060 |
| Myalgia | 340 | 62.7 | 0.056 |
| Cough | 229 | 43.6 | 0.379 |
| Loss of appetite | 253 | 46.7 | 0.074 |
| Dyspnea | 44 | 5.8 | 0.344 |
| Diarrhea, abdominal pain | 172 | 31.7 | 0.058 |
| Fever (>38C) | 192 | 35.4 | 0.079 |
| Arthralgia | 255 | 47 | 0.065 |
| Nausea, vomiting | 108 | 19.9 | 0.061 |
| Sticky mucus/phlegm | 101 | 18.6 | 0.923 |
| Ear, nose and throat symptoms | |||
| Nasal obstruction | 99 | 18.2 | 0.291 |
| Sore throat | 83 | 15.3 | 0.344 |
| Rhinorrhea | 40 | 7.4 | 0.535 |
| Postnasal drip | 77 | 14.2 | 0.420 |
| Face pain/heaviness | 106 | 19.5 | 0.116 |
| Ear pain | 26 | 4.8 | 0.275 |
| Dysphagia | 30 | 5.5 | 0.384 |
There was no significant association between comorbidities and the development of olfactory or gustatory dysfunctions (Table 1). Olfactory dysfunction was not significantly associated with rhinorrhea or nasal obstruction (Table 1). There was a significant positive association between olfactory and taste dysfunctions (p = 0.003).
To the best of our knowledge, this is the first report of Latin-American ethnic patients. As in previous report, olfactory and gustatory disfunction are present in Latin-American population. We consider these results can have a paramount of importance due to difficult in the diagnosis of the COVID-19 infection due to the lack of resources, which may be associated with misdiagnosis and related lack of precaution for isolating these patients and their families. According to the data of the present study, the prevalence of olfactory and taste dysfunction would be similar to those reported from European COVID-19 patients. In addition, OD may appear before the rest of the other complaints in 22.5% of cases, yielding the symptoms important for an early detection of the disease. Despite our study limitations, the focus on mild-to-moderate patients, the inclusion of Latin-American patients living in Spain, and the absence of objective nasal testing, any effort is important to alert physicians across Latin-American countries to be aware about these symptoms in suspected patients.
Ethics
Four ethics committees approved the current study protocol (HAP2020-011; CHUSP20032020; EpiCURA-2020-2303; CHU-Charleroi: B32522020).
Declaration of competing interest
The authors declare don't have any conflicts of interest.
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