Anosmia as a presenting symptom of SARS-CoV-2 infection in healthcare workers – A systematic review of the literature, case series, and recommendations for clinical assessment and management

Abstract

Background: Healthcare workers are at the forefront of the ongoing COVID-19 pandemic and are at high risk for both the contraction and subsequent spread of virus. Understanding the role of anosmia as an early symptom of infection may improve monitoring and management of SARS-CoV2 infection. Methodology:We conducted a systematic review of the literature of SARS-CoV2 infection/COVID-19 and anosmia to help inform management of anosmia in healthcare works. We report a case series of healthcare workers, who presented with a loss of sense of smell secondary to COVID-19 infection to demonstrate management principles. RT-PCR was used to confirm COVID-19 positivity and psychophysical testing of olfaction was performed using the British version of the University of Pennsylvania Smell Identification Test, UPSIT. Results:The systematic literature search returned 31 articles eligible for inclusion in the study and informed our recommendations for clinical assessment and management. All three healthcare professionals who presented with loss of sense of smell subsequently tested positive for SARS-CoV-2. Psychophysical testing of olfaction using the UPSIT confirmed mild and moderate microsmia in two, respectively, and normosmia at day 17 in one. Conclusions:Olfactory (± gustatory) dysfunction is indicative of COVID-19 infection and thus has important implications in the context of healthcare workers, or key workers in general, who work in close contact with others if not recognised as suffering from COVID. This leads to a potentially higher likelihood of spreading the virus. In conjunction with our literature review these findings have helped with creating recommendations on the assessment and management of olfactory dysfunction during the ongoing COVID-19 pandemic, both for healthcare workers and patients.

Symptomatology of COVID-19 from the otorhinolaryngology perspective: a survey of 223 SARS-CoV-2 RNA-positive patients

“…Aftermath of the first phase of COVID-19 might be especially challenging for Otorhinolaryngology clinics around the globe. There are many studies addressing smell and taste loss in the literature, each reporting different prevalence [19,[30][31][32][33]. A recent meta-analysis reported the prevalence of olfactory dysfunction as 52.73% and gustatory dysfunction as 43.93% [15].…”

COVID-19 pandemic and mental health consequences: Systematic review of the current evidence

“…Interestingly two case studies reports SARS-CoV-2 meningitis/encephalitis (Moriguchi et al, 2020;Ye et al, 2020); however, only one of them had a confirmed positive SARS-CoV-2 RT-PCR test on CSF (Moriguchi et al, 2020). ACE2 is a functional receptor for SARS-CoV-2 (Li et al, 2005) and it is known that ACE2 is expressed in neurons (Troyer et al, 2020), which is interesting in the light of the many reports of anosmia as an early symptom of COVID-19 (Lechner et al, 2020), since SARS-CoV-1 has been suggested to enter the brain trough the olfactory bulb (Netland et al, 2008). Taken together this indicates that SARS-CoV-2 could be neurotrophic entering the brain through the olfactory bulb, leading to an increase in neuropsychiatric symptoms among the patients surviving COVID-19.…”

A compendium answering 150 questions on COVID‐19 and SARS‐CoV‐2

“…108 This has resulted in anosmia to be included in the list of symptoms used in early screening tools for possible COVID-19 in many international bodies. 108…”