COVID-19 Reinfection and Second Episodes of Olfactory and Gustatory Dysfunctions: Report of First Cases

Abstract

The pandemic of coronavirus disease 2019 (COVID-19) is associated with a significant number of deaths worldwide. Currently, there is an increase of new cases of COVID-19 in Europe, leading to many hospitalizations of patients. 1 According to the high rate of virus mutation, 2 and the prevalence of patients without postinfection antibodies, 3 many questions rise about the risk of reinfection, especially in anosmic patients who may have less antibodies than nonanosmic individuals. 4 In this letter, we report 2 cases of patients who developed a second COVID-19, which was associated with a second episode of both loss of smell and taste.A 42-year-old Parisian male developed moderate form of COVID-19 in March with dyspnea, fever, headache, diarrhea, and abdominal pain as main symptoms. The patient was homemanaged and developed ageusia and total loss of smell at the end of the disease. Total loss of smell was characterized by a Sniffin' Sticks test of 0/16 (Medisense). He had no nasal symptoms. Nasal swab was not performed because a shortage of tests (reverse transcription polymerase chain reaction [RT-PCR]) in France at this time. Serology testing was realized 2 months after the infection and reported mild level of anti-SARS-CoV-2 immunoglobulin G (IgG; 7.31). Patient benefited from 2-month olfactory training and reported that he progressively recovered smell (June). Gustatory function, defined as impairment of salty, sweet, bitter, and sour, recovered 1-month postinfection. In the end of July, patient had a normal olfactory function. In August, the patient traveled in a region characterized by a high rate of new cases of COVID-19 (isolated cluster region) and developed fever, nasal burning, and a new total loss of smell and taste. He had no additional symptoms. Patient was addressed in our Department in October 5, 2020. The clinical examination did not report edema in the olfactory clefts, and Sniffin' Sticks tests (Medisense) revealed anosmia (7/16). A second serology using similar method that the first reported an increase of the level of anti-SARS-CoV-2 IgG (70.34), confirming the reinfection.

Reinfection of SARS-CoV-2 – analysis of 23 cases from the literature

“…We identified 23 cases from 13 different countries (Belgium, Brazil, Ecuador, France, Hong Kong, Israel, Italy, Qatar, South Korea, Spain, Turkey, UK and USA) [4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. Mean age (±standard deviation) of cases was 44.5 (±7.3) years, and 10 (43.5%) were women.…”

“…Mean interval between the two episodes was 15.0 ± 5.6 weeks. For all cases, except three, each episode was confirmed by a positive PCR test on nasopharyngeal swab: for the three cases in which a swab was not performed or resulted negative the diagnosis was based on clinical manifestations and serology [14,17,22]. For 19 cases (82.6%), serology was reported [4,[7][8][9][10][11][12][13][15][16][17][18][19][20][21][22]24]: more than half of these (10/19 cases) were recorded as IgG positive following the first infection [4,8,11,12,[14][15][16][17]24].…”

“…For all cases, except three, each episode was confirmed by a positive PCR test on nasopharyngeal swab: for the three cases in which a swab was not performed or resulted negative the diagnosis was based on clinical manifestations and serology [14,17,22]. For 19 cases (82.6%), serology was reported [4,[7][8][9][10][11][12][13][15][16][17][18][19][20][21][22]24]: more than half of these (10/19 cases) were recorded as IgG positive following the first infection [4,8,11,12,[14][15][16][17]24]. In 10 cases [9][10][11]13,16,[18][19][20]25], viral genomic material was isolated at each of the two episodes and was sequenced: significant differences in the nucleotide sequences emerged, and in six cases phylogenetic analysis showed that the viruses responsible for the two episodes belonged to different clades [9][10][11]13,16,19].…”

What might COVID-19 Patients Experience after Recovery? A Systematic Review

“…The time between the first and second infection ranged from 26 to 145 days (Table 2). The included studies had different designs: prospective cohort studies (30), retrospective cohort studies (11), cross-sectional (17), retrospective and prospective (1), longitudinal study (3), observational (2), case-control (1), qualitative (semi-structured interviews) (2), and case series (2).…”

COVID-19, Neuropathology, and Aging: SARS-CoV-2 Neurological Infection, Mechanism, and Associated Complications

“…Emerging evidence suggests that SARS-CoV-2 can enter the neuronal cells through the olfactory nerve and spreads to the olfactory bulb ( Figure 2 ). Lechien and colleagues in a multi-centric European study and a case report showed that 86% and 88% of COVID-19 patients respectively, reported the loss of smell and taste (Lechien et al, 2020a , b ). Cranial neuropathy is an erratic event in the setting of COVID-19; however, one case study involving a 40-year-old female COVID-19 patient showed isolated oculomotor nerve palsy in severely ill patients, which could be due to inflammatory reaction against SARS-CoV-2 (Wei et al, 2020 ).…”