Can symptoms of anosmia and dysgeusia be diagnostic for COVID‐19?

Zahra, Syeda Anum; Iddawela, Sashini; Pillai, Kiran; Choudhury, Rafaat; Harky, Amer

doi:10.1002/brb3.1839

Cited by 50 publications

(51 citation statements)

References 84 publications

(281 reference statements)

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“…Thus, anosmia or dysgeusia may even be regarded as a highly reliable diagnostic marker in very mild cases, as also proposed by other colleagues. 23,24 Of note, we could not find a correlation between the number of symptoms (implying severity) and the level of the neutralisation titre as supported by other recently published data. 25,26 Our data further indicate that in individuals with anosmia/dysgeusia as a sole symptom, the quality and quantity of neutralising/protective antibodies does not differ compared to those with several reported and typical COVID-19 symptoms (fever, cough, dyspnoea).…”

Section: Discussionsupporting

confidence: 85%

A longitudinal seroprevalence study in a large cohort of working adults reveals that neutralising SARS-CoV-2 RBD-specific antibodies persist for at least six months independent of the severity of symptoms

Wagner

Guzek

Ruff

et al. 2020

Preprint

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BackgroundIn spring 2020, at the beginning of the first pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wave in Europe, we set up an assay system for large-scale testing of virus-specific and protective antibodies including their longevity.MethodsWe analysed the sera of 1655 adult employees for SARS-CoV-2-specific antibodies using the S1 subunit of the spike protein of SARS-CoV-2. Sera containing S1-reactive antibodies were further evaluated for receptor-binding domain (RBD)- and nucleocapsid protein (NCP)-specific antibodies in relation to the neutralisation test (NT) results at 0, three and six months.FindingsWe found immunoglobulin G (IgG) and/or IgA antibodies reactive to the S1 protein in 10.15% (n=168) of the participants. In total, 0.97% (n=16) were positive for S1-IgG, 0.91% (n=15) were S1-IgG-borderline and 8.28% (n=137) exhibited only S1-IgA antibodies. Next, we evaluated the 168 S1-reactive sera for RBD- and NCP specificity: 8.33% (n=14) had detectable RBD-specific and 6.55% (n=11) NCP-specific antibodies. The latter correlated with NTs (kappa coefficient = 0.8660) but started to decline already after 3 months. RBD-specific antibodies correlated best with the NT (kappa = 0.9448) and only these antibodies were stable for up to six months. All participants with virus-neutralising antibodies reported symptoms, of which, anosmia and/or dysgeusia correlated best with the detection of virus-neutralising antibodies.InterpretationRBD-specific antibodies were most reliably detected post infection, independent of the number/severity of symptoms, and correlated best with protective neutralising antibodies at least for six months. They thus qualify best for large-scale seroepidemiological evaluation of both seroprevalence and seroprotection.FundingThis study received funding from the Austrian Ministry of Education, Science and Research within the research framework in relation to the coronavirus disease 2019 pandemic (GZ 2020 0225 104).Key pointsPersistence of SARS-CoV-2 antibodies depends on their specificity. Total RBD-specific antibodies are those that are stable for up to at least six months and correlate best with neutralisation independent of the presence and severity of COVID-19 symptoms.Research in contextEvidence before the studyAt the beginning of the study (early pandemic in April 2020), the SARS-Cov-2 specific seroprevalence was totally unknown. Additionally, S1-specific antibody assays being the first on the market were tested with limited sample size showing a lower sensitivity and specificity at that time. Furthermore, at that time, there were no unambiguous interpretations of antibody test results with regard to immunity/protection against reinfection. It was also not clear whether the detection of different antibody specificities could yield an essential input into the interpretation of the antibody’s qualities. Another open question was how long antibodies of the various specificities as well as antibodies with protective capacities would persist.Added value of this studyWe provide data to confirm the most reliable correlation of RBD-specific antibodies with neutralising antibodies that are stable for at least six months. S1- and NCP-specific antibodies wane more quickly than RBD-specific antibodies, rendering them not as ideal candidates for longitudinal seroprevalence studies. Concerning symptoms, anosmia/dysgeusia was strongly associated with NT-seropositivity and seroprotection in the overall study population.Implications of all the available evidenceOur data suggest that RBD-specific total antibody measurements with assays of high specificity can be used for cross-sectional as well as longitudinal seroepidemiological studies, even in low-prevalence settings. Detection of these antibodies also indicates robust seroprotection for at least six months. Due to the substantial loss of S1- and NCP-specific antibodies within the first months, assays targeting these antigen specificities – in contrast to RBD-specific antibody measurements – are not optimal to assess the duration of seroprotection. Overall, respiratory symptoms alone were not useful in predicting a past infection with SARS-CoV-2. However, anosmia/dysgeusia appeared to be a significant diagnostic marker, in particular for mild COVID-19.

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Section: Discussionsupporting

confidence: 85%

A longitudinal seroprevalence study in a large cohort of working adults reveals that neutralising SARS-CoV-2 RBD-specific antibodies persist for at least six months independent of the severity of symptoms

Wagner

Guzek

Ruff

et al. 2020

Preprint

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“…Finally, 45 systematic reviews met the inclusion criteria and were included in this overview. 11 – 55 …”

Section: Resultsmentioning

confidence: 99%

The neurological symptoms of COVID-19: a systematic overview of systematic reviews, comparison with other neurological conditions and implications for healthcare services

Wildwing

Holt

2021

Therapeutic Advances in Chronic Disease

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Aims: In response to the rapid spread of COVID-19, this paper provides health professionals with better accessibility to available evidence, summarising findings from a systematic overview of systematic reviews of the neurological symptoms seen in patients with COVID-19. Implications of so-called ‘Long Covid’ on neurological services and primary care and similarities with other neurological disorders are discussed. Methods: Firstly, a systematic overview of current reviews of neurological symptoms of COVID-19 was conducted. Secondly, the implications of these findings are discussed in relation to the potential effect on neurological services and the similarities in the experience of patients with COVID-19 and those with other neurological disorders. A total of 45 systematic reviews were identified within seven databases, published between 11 April 2020 and 15 October 2020, following a search in June 2020, updated on 20 October 2020. Results: The results indicated that COVID-19 exhibits two types of neurological symptoms; life-threatening symptoms such as Guillain–Barre Syndrome (GBS) and encephalitis, and less devastating symptoms such as fatigue and myalgia. Many of these so-called lesser symptoms appear to be emerging as longer-term for some sufferers and have been recently labelled Long Covid. When compared, these less devastating symptoms are very similar to other neurological conditions such as chronic fatigue syndrome (CFS) and functional neurological disorder (FND). Conclusion: Implications for neurological healthcare services in the United Kingdom (UK) may include longer waiting times and a need for more resources (including more qualified health professionals). There is also a possible change-effect on health professionals’ perceptions of other neurological conditions such as CFS and FND. Future research is recommended to explore changes in health professionals’ perceptions of neurological symptoms because of COVID-19.

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“…Over the past year, we have come to know that COVID-19 may also present with neurologic complications such as anosmia, dysgeusia, encephalopathy, Guillain-Barre syndrome, Miller-Fisher syndrome, and polyneuritis cranialis [ 14 - 17 ]. Like this 36-year-old patient, Bell’s palsy and CoV is predominantly seen in adults and is often unilateral.…”

Section: Discussionmentioning

confidence: 99%

Bell's Palsy as a Late Neurologic Manifestation of COVID-19 Infection

Oke¹,

Oladunjoye²,

Oladunjoye³

et al. 2021

Cureus

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Bell's palsy is acute peripheral facial nerve palsy; its cause is often unknown but it can be triggered by acute viral infection. Coronavirus disease 2019 (COVID-19) infection commonly presents with respiratory symptoms, but neurologic complications have been reported. A few studies have reported the occurrence of facial nerve palsy during the COVID-19 pandemic. We present a case of Bell's palsy in a 36-year-old man with COVID-19 infection and a past medical history of nephrolithiasis. He presented to the emergency room with a day history of sudden right facial weakness and difficulty closing his right eye four weeks following a diagnosis of COVID-19 infection. Physical examination revealed right lower motor neuron facial nerve palsy (House-Brackmann grade IV). Serologic screen for Lyme disease, human immunodeficiency virus (HIV), and herpes simplex virus (HSV) 1 and 2 were negative for acute infection; however, neuroimaging with MRI confirmed Bell's palsy. He made remarkable improvement following treatment with a course of valacyclovir and methylprednisolone. This case adds to the growing body of literature on neurological complications that should be considered when managing patients with COVID-19 infection.

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Can symptoms of anosmia and dysgeusia be diagnostic for COVID‐19?

Cited by 50 publications

References 84 publications

A longitudinal seroprevalence study in a large cohort of working adults reveals that neutralising SARS-CoV-2 RBD-specific antibodies persist for at least six months independent of the severity of symptoms

A longitudinal seroprevalence study in a large cohort of working adults reveals that neutralising SARS-CoV-2 RBD-specific antibodies persist for at least six months independent of the severity of symptoms

The neurological symptoms of COVID-19: a systematic overview of systematic reviews, comparison with other neurological conditions and implications for healthcare services

Bell's Palsy as a Late Neurologic Manifestation of COVID-19 Infection

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