CARTA AL EDITOR
REVISTA DE LA FACULTAD DE MEDICINA HUMANA 2020 - Universidad Ricardo PalmaDOI 10.25176/RFMH.v20i3.2949
ANOSMIA AS AN EARLY SYMPTOM IN PATIENTS WITH COVID-19
LA ANOSMIA COMO SÍNTOMA TEMPRANO EN PACIENTES CON COVID-19
Alex Huamán-Navarro1,aJuliana Aparcana-Machado2,b
1
Asociación de estudiantes de Investigación y Ciencia de la Medicina (ASICEM). Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista. Ica, Peru.
2Departamento de Neurología, Hospital Regional de Ica. Ica, Perú.
aMedical student.
bMedical Specialist in Neurology.
Dear Editor
From the time of knowledge of the outbreak appearance in mid-December 2019 due to the new coronavirus (SARS-CoV-2) in the city of Wuhan, China, epidemiologic and clinical studies have been developing to best
define the symptomatology of the disease from coronavirus 2019 (COVID-19). However, within some significant reports, we have been informed that one of the initial symptoms of this disease can also be alterations in smell and taste (30 and
60% in the Korean and German series, respectively)(1).
COVID-19 commonly produces fever, dry cough and respiratory distress, but some publications also report cases regarding alterations in the senses of taste and smell, likewise, in a statement presented by the Sociedad de Rinología
Británica, it is detailed that good evidence exits in countries such as South Korea, China and Italy, where a significant number of patients with a positive infection for COVID-19 have developed loss of smell (anosmia) and a partial reduction
of such (hyposmia), as in Germany, where 2 out of 3 confirmed cases for COVID-19 have anosmia (1).
In a hospital in Milan, Italy, in a study regarding olfactory and taste disorders developed among hospitalized patients with COVID-19, it was informed that out of 59 patients interviewed, 33.9% informed having at least one taste or
smell disorder and 18.6% had both alterations (2). For this reason, we should not underestimate the measures in addition to the temperature monitoring that some countries have adopted such as South Korea, a country
that is surviving the pandemic in an exemplary way, where early detection of patients with probable COVID-19 infection is also performed through the acetic acid (vinegar) test, which consists of the patient detecting the substance’s smell,
if it is not recognized or there exists any difficulty then they are asked to enter an isolation zone and follow-up to rule-out COVID-19 (3).
In a report of cases, it was found that some people manifested anosmia suddenly, isolated and without nasal congestion, and days later resulted positive for COVID-19, it was even evidenced in Google trends that towards end of February
2020 the search tendency of “anosmia” started to increase in countries such as Italy, United Kingdom and United States, which gives evidence to its association to COVID-19 increase of cases in these countries (4).
Recently in a multicentric study in 12 European hospitals of different countries such as France, Italy, Spain and Belgium, which recruited 417 people with COVID-19 diagnosis, we found that 85.6% and 88.0% of patients reported having
olfactory and taste dysfunctions, respectively. Out of all the patients with olfactory dysfunctions (357), 79.6% were anosmic and 20.4% had hyposmia. That is why we concluded that olfactory and taste disorders are prevalent symptoms in European
patients with COVID-19 (5) Recently in a multicentric study in 12 European hospitals of different countries such as France, Italy, Spain and Belgium, which recruited 417 people with COVID-19 diagnosis, we found
that 85.6% and 88.0% of patients reported having olfactory and taste dysfunctions, respectively. Out of all the patients with olfactory dysfunctions (357), 79.6% were anosmic and 20.4% had hyposmia. That is why we concluded that olfactory
and taste disorders are prevalent symptoms in European patients with COVID-19
The physiopathologic mechanism by which COVID-19 is associated to taste and smell are still unclear, but evidence exists in which it has been informed that the brain expresses angiotensin converting enzyme type 2 receptors, SARS-CoV-2
target receptors, that are found on glial and neuronal cells, which converts them in a potential target for COVID-19, causing neuronal damage and death, covering from peripheral neurons through the cribriform plate to the olfactory bulb (6).
Hence the importance, that for the SARS-CoV-2 infection confirmation through molecular tests, nasal and pharyngeal swabs are required, which strongly sums up that there is a high viral load in these zones.
Therefore, it is recommended to take into account and consider these symptoms (anosmia and hyposmia) within the epidemiologic clinical investigation sheet from the Ministry of Health of Peru (Ministerio de Salud del Peru), as part
of the diagnosis for early detection of the disease, since recognizing it promptly, including in the first level of attention, would be very beneficial, in turn, it is also clear that it is necessary to amplify studies and obtain more data
about the olfactory and taste tests in COVID-19 confirmed patients in the country, to provide and amplify a greater scientific information, with the objective of early detection of asymptomatic patients with probable SARS-CoV-2 infection and
in this way avoid its spread. atención,
Author contributions:AHN y JAM participated in the conception of this article, data collection, data analysis and interpretation, drafting and final approval of the article.
Financing: Self-financed.
Conflict of interests: The authors declare they do not have any conflict of interests in the publication of this article.
Received:April 15, 2020
Approved:May 20, 2020
Correspondence: Alex Stiven Huamán Navarro.
Address: Av. Montevideo 249, La Tinguiña, Ica, Perú.
Telephone number: +51 944 916 960
E-mail: alex_hn22@outlook.com
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