Study of the sensitivity and specificity of smell and taste disorders as a predictive factor of SARS-CoV-2 infection among primary care healthcare professionals

Backgroundamong the manifestations of COVID-19 are Taste and Smell Disorders (TSDs).AimThe aim of the study is to evaluate the sensitivity and specificity of TSDs and other associated symptoms to estimate predictive values for determining SARS-CoV-2 infection.Design and settingRetrospective observational study.Methodsa study of the sensitivity and specificity of TSDs has been carried out using the Polymerase Chain Reaction (PCR) test for the diagnosis of SARS-CoV-2 as the Gold Standard value. Logistic regressions adjusted for age and sex were performed to identify additional symptoms that might be associated with COVID-19.Resultsthe results are based on 226 healthcare workers with clinical symptoms suggestive of COVID-19, 116 with positive PCR and 111 with negative PCR. TSDs had an OR of 12.43 (CI 0.95 6.33–26.19), sensitivity 60.34% and specificity 89.09%. In the logistic regression model, the association of TSD, fever or low-grade fever, shivering, dyspnoea, arthralgia and myalgia obtained an area under the curve of 85.7% (CI 0.95: 80.7 % - 90.7 %), sensitivity 82.8 %, specificity 80% and positive predictive values 81.4% and negative 81.5%.ConclusionsTSDs are a strong predictor of COVID-19. The association of TSD, fever, low-grade fever or shivering, dyspnoea, arthralgia and myalgia correctly predicts 85.7% of the results of the COVID-19 test.

A Challenge of COVID—19: Associated Infective Endocarditis with Streptococcus gordonii in a Young Immunocompetent Patient

The COVID-19 pandemic is a new challenge for the diagnosis and treatment of infective endocarditis (IE). Fever and other unspecific symptoms of coronaviral infection could be misleading or masking its manifestations. We present the case of a young patient admitted for persistent fever, profuse sweating, headache, articular pain, myalgias, and weight loss. She reported regression taste and smell disorders compared to a month earlier when diagnosed with moderate COVID-19 pneumonia. While the RT-PCR SARS-COV-2 test was positive, she was admitted to a COVID-19 ward. Investigations of febrile syndrome revealed two positive blood cultures with Streptococcus gordonii and the presence of vegetations on the aortic valve, supporting a certain diagnosis of IE. After six weeks of antibiotic treatment, the patient had clinical and biologic favorable outcomes. Streptococcus gordonii is a common commensal related to the dental biofilm, although there were no caries in our patient. The influence of COVID-19 infection on the human microbiome by modifying the virulence of some commensal germs may be a risk factor for IE pathogenesis on native valves and requires the vigilance of clinicians for suspicion of this disease.

How COVID-19 brought smell disorders in the spotlight

The rapid spread of the COVID-19 infection required prompt recognition and immediate isolation of patients. In the evolution of the disease various symptoms were indicated as suggestive of a SARS-CoV-2 infection, among them being also described anosmia and ageusia. In order to review how olfactory disorders are related to COVID-19 disease, we carried out an analysis by searching PubMed, Science Direct, Springer, and LILACS. The research was made using MeSH descriptors and the Boolean operator, “AND”, for the terms “olfactory disorders” or “olfactory dysfunction” or “anosmia” or “neurologic manifestations” or “ENT symptoms” AND “COVID-19” or “SARS-CoV-2” or “coronavirus infections”, with a filter on the publication date set for 01.01.2020 – 18.06.2021. A total of 956 articles were found in the databases, out of which 14 were included in the study. The statistics suggest that alterations of the chemosensory function are strongly correlated with COVID-19, although the exact pathophysiologic mechanism is not well established. Symptomatology suggestive of chemosensory dys-function (smell primarily and then taste alterations) elevate the degree of suspicion of a SARS-CoV-2 infection and they commend prompt isolation and surveillance measurements.

Database searches for smell/taste disorders and coronavirus and their relation to COVID-19 cases in Finland 2020: A time series analysis of citizens’ and healthcare professionals’ Internet information seeking using log and register data in assessing model improvement (Preprint)

BACKGROUND Background: The COVID-19 pandemic has prevailed over a year, and log and register data on coronavirus have been tried to model from Internet sources to detect the pandemic. However, many sources comprise unreliable health information on COVID-19 and its symptoms, and platforms cannot characterize the users performing searches. Prior studies have assessed symptom searches from general search engines (Google/Google Trends). Little is known how modelling log data on smell/taste disorders and coronavirus from the dedicated Internet databases used by citizens and healthcare professionals could enhance disease surveillance. Our material and method provide a novel approach to analyze Internet information seeking to detect infectious disease outbreaks. OBJECTIVE Objective: The aim of this study was 1) to assess whether citizens’ and professionals’ searches for smell/taste disorders and coronavirus relate to epidemiological data on COVID-19 cases, and 2) to test negative binomial models whether the inclusion of the case count could improve the model. METHODS Methods: We collected weekly log data on searches related to COVID-19 (smell/taste disorders, coronavirus) during 30/12/2019–30/11/2020 (49 weeks). Two major medical Internet databases in Finland were used: Health Library (HL), a free portal aimed at citizens, and Physician’s Database (PD), widely used among healthcare professionals. Log data from databases were combined with register data on the numbers of COVID-19 cases reported in the Finnish National Infectious Diseases Register. We used negative binomial regression modelling to assess if the case numbers could explain some of the dynamics of searches when plotting Internet searches. RESULTS Results: We found that coronavirus searches drastically increased in HL (0 to 744,113) and in PD (4 to 5,375) prior to the first wave of COVID-19 cases during December 2019 and March 2020. Searches for smell disorders in HL doubled from end of December 2019 to end of March 2020 (2,148 to 4,195), and searches for taste disorders in HL increased from mid-May to end of November (0 to 1,980). Case numbers were significantly associated with smell disorders in HL (P < .001), and with coronavirus searches (P < .001) in PD. We could not identify any other associations between case numbers and searches in either database. CONCLUSIONS Conclusions: Modelling log data from Internet databases was seen to improve the model only occasionally. However, search behaviors among citizens and professionals could be used as a supplementary source of information for infectious disease surveillance. Further research is needed to apply statistical models to log data of the dedicated medical databases. CLINICALTRIAL None

Prevalence and Correlates of Parosmia and Phantosmia among Smell Disorders

Among those many individuals who suffer from a reduced odor sensitivity (hyposmia/anosmia) some individuals also experience disorders that lead to odor distortion, such as parosmia (i.e., distorted odor with a known source), or odor phantoms (i.e., odor sensation without an odor source). We surveyed a large population with at least one olfactory disorder (N = 2031) and found that odor distortions were common (46%), with respondents reporting either parosmia (19%), phantosmia (11%), or both (16%). In comparison to respondents with hyposmia or anosmia, respondents with parosmia were more likely to be female, young, and suffered from post-viral olfactory loss (p < 0.001), while phantosmia occurred most frequently in middle-aged respondents (p < 0.01) and was more likely to be caused by head trauma than parosmia (p < 0.01). A higher prevalence of odor distortion was observed 3 months to a year after their olfactory symptom onset (p < 0.001), which coincides with the timeline of physiological recovery. Additionally, we observed that the frequency and duration of distortions negatively affects quality of life, with parosmia showing a higher range of severity than phantosmia (p < 0.001). Previous research often grouped these distortions together, but our results show that they have distinct patterns of demographics, medical history, and loss in quality of life.

Molecular and Neural Mechanism of Dysphagia Due to Cancer

Cancer is one of the most common causes of death worldwide. Along with the advances in diagnostic technology achieved through industry–academia partnerships, the survival rate of cancer patients has improved dramatically through treatments that include surgery, radiation therapy, and pharmacotherapy. This has increased the population of cancer “survivors” and made cancer survivorship an important part of life for patients. The senses of taste and smell during swallowing and cachexia play important roles in dysphagia associated with nutritional disorders in cancer patients. Cancerous lesions in the brain can cause dysphagia. Taste and smell disorders that contribute to swallowing can worsen or develop because of pharmacotherapy or radiation therapy; metabolic or central nervous system damage due to cachexia, sarcopenia, or inflammation can also cause dysphagia. As the causes of eating disorders in cancer patients are complex and involve multiple factors, cancer patients require a multifaceted and long-term approach by the medical care team.

Sense of smell disorders in family physician practice

A properly functioning sense of smell recognizes both food and danger and provides sensory input. Sense of smell is lost and/or impaired in diseases accompanied by impaired nasal patency such as chronic rhinosinusitis with or without nasal polyps, allergic rhinitis, respiratory infections including acute rhinosinusitis. In the case of rhinosinusitis in adults, olfactory impairment is one of the four main symptoms of the disease. They can also be caused by damage to the olfactory neuron, e.g. in the course of a viral infection. Loss of smell and/or taste reported by patients with COVID-19 may be a diagnostic hint. Modern intranasal glucocorticosteroids are used to treat olfactory disturbances and loss of smell caused by nasal patency impairment (or accompanying diseases with nasal patency impairment).

Acupuncture is associated with a positive effect on odour discrimination in patients with postinfectious smell loss—a controlled prospective study

Introduction Smell disorders are common in the general population and occur e.g., after infections, trauma or idiopathically Treatment strategies for smell loss range from surgery, medication to olfactory training, depending on the pathology, but they are limited This study examined the effect of acupuncture on olfactory function. Methods Sixty patients with smell loss following infections of the upper respiratory tract were included in this investigation Half of the study group were randomly assigned to verum acupuncture and the other half to sham acupuncture Olfaction was measured by means of the “Sniffin’ Sticks” test battery (odour threshold, discrimination and identification). Results Compared to sham acupuncture, verum was associated with an improvement of smell function as measured by the TDI score (p = 0.039) The improvement was largely determined by improvement in odour discrimination, and was significantly better in patients with a shorter duration of the disorder. Conclusion The present results suggest that acupuncture is an effective supplementary treatment option for patients with olfactory loss.

Smell disorders associated with COVID-19 infection

Background We performed a search in the PubMed databases, Web of Science, LILACS, MEDLINE, SciELO, and Cochrane Library using the keywords COVID-19, Novel coronavirus, corona, 2019-nCoV, SARS-CoV-2, ENT, nose, anosmia, hyposmia, smell, olfactory, ORL, different ENT related symptoms. We reviewed published and peer-reviewed studies that reported the ENT manifestations in COVID-19 laboratory-confirmed positive patients. Main text Within the included 2549 COVID-19 laboratory-confirmed positive patients, smell affection was reported in 1453 patients (57%). The other reported ENT manifestations were taste disorder (49.2%), headache (42.8%), nasal blockage (26.3%), sore throat (25.7%), runny nose or rhinorrhea (21.3%), upper respiratory tract infection (URTI) (7.9%), and frequent sneezing (3.6%). Conclusion Smell affection in COVID-19 is common and could be one of the red flag signs in COVID-19 infection. With a sensitivity of utilized questionnaire in smell identification, a homogenous universal well-defined COVID-19 questionnaire is needed to make the COVID-19 data collection more sensible.