Characteristic Temporary Loss of Taste and Olfactory Senses in SARS-CoV-2-positive-Individuals with Mild Symptoms

Read in PDF format
Published May 16, 2020

Authors

Ricarda M. Schmithausen1, #, Manuel Döhla1, #, Heidrun Schößler2, Christin Diegmann1, Bianca Schulte3, Enrico Richter 3, Anna-Maria Eis-Hübinger3, Hendrik Streeck3,*

Affiliated Institutions

1 Institute for Hygiene and Public Health; One Health Department; Medical Faculty; University of Bonn; Venusberg Campus 1; 53127 Bonn, Germany
2 Local Health Authority; Heinsberg; Valkenburger Str. 45; 52525 Heinsberg, Germany
3 Institute of Virology; Medical Faculty; University of Bonn; Venusberg Campus 1; 53127 Bonn, Germany
# contributed equally

Corresponding Author

Hendrik Streeck
Institute of Virology, Faculty of Medicine
University Bonn
Bonn, Germany
Telephone: +49 (0) 228 287-15522
Fax: +49 (0) 228 287-19144
[email protected]

DOI

10.20411/pai.v5i1.374

Suggested Citation

Schmithausen RM, Döhla M, Schößler H, Diegmann C, Schulte B, Richter E, Eis-Hübinger AM, Streeck H. Characteristic Temporary Loss of Taste and Olfactory Senses in SARS-CoV-2-positive-Individuals with Mild Symptoms. Pathogens and Immunity. 2020;5(1):117-20. PubMed PMID. doi: 10.20411/pai.v5i1.374

Keywords: Coronavirus, SARS-CoV-2, COVID-19, Symptoms

SARS-CoV-2 infection has been characterized as an upper and lower respiratory tract infection with symptoms ranging from sore throat, cough, headache, and fatigue to a severe respiratory syndrome that requires intensive care [1-7]. Although a lower death rate has been recorded for SARS-CoV-2 in comparison to other recent coronavirus outbreaks, such as MERS or SARS, a compromised respiratory status on admission has been associated with fatal outcomes. Among the >1200 SARS-CoV-2-infected individuals in Germany to date, many of the diagnosed persons show mild symptoms to no clinical signs of infection. Here we describe the onset and characteristics of symptoms in a cluster outbreak after a carnival celebration in a small town in the state of North Rhine-Westphalia currently contributing 43% of the total number of infected individuals in Germany to date [8]. Among the nearly 500 individuals in domestic quarantine as ordered by the Local Health Authority at that time, we interviewed 41 randomly selected individuals with qPCR confirmed SARS-CoV-2 infection. Inclusion criteria for the survey participation were: residents, positive for SARS-CoV-2 in pharyngeal swabs, ≥18 years of age, and confirmed informed consent. Median age was 40 years (IQR: 31-53, range: 18-82) and 51% were female. All persons examined had attended a carnival festivity also attended by the SARS-CoV-2positive index patient. All persons who attended this carnival festivity were tested for SARS-CoV-2 by the local health authorities 10 days later. Among survey participants, onset of symptoms began 12 days (IQR: 11-13) after probable infection and a median of 6 distinct symptoms (IQR: 4-8) were described.

The most frequent symptom was a dry and persistent, non-productive cough, which was present in 30 individuals (73%). Interestingly, 12 (IQR: 12-14.5) days after probable infection, individuals described a disturbing loss of taste and/or olfactory sense (28 patients, 68%). Onset of dysosmia and dysgeusia was described as gradual, persisting for 3-5 days, and followed by a slow recovery. There was no association with any other symptoms, such as sore throat, runny nose, or headache. Dysosmia is also described for different viral infections (sinusitis, common cold), but also as a symptom of other diseases (stroke, drug abuse, tumors, craniocerebral trauma, toxin poisoning) [a href="#_ENREF_9">9]. Accordingly to our data, other recent studies also show that dysosmia could be an independent predictive symptom of COVID-19 [a href="#_ENREF_10">10-a href="#_ENREF_13">13]. Another common symptom was general fatigue (28 patients, 68%), followed by runny nose (21 patients, 51%), and headache and muscle/limb pain (18 patients each, 44%). Seventeen patients had fever (42%), 17 patients had a sore throat (42%), and one third described persistent diarrhea (13 patients, 32%), which was more frequent than in other reports.

Although previous reports have mainly focused on moderate to severe symptoms, we describe here distinct and characteristic symptoms in individuals presenting with only mild symptoms. Thus, our data suggest that individuals presenting with a combination of a dry cough and loss of smell and/or taste should trigger diagnostic evaluation for SARS-CoV-2.

References

1. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020; 30;382(18):1708–1720. PMID: 32109013. doi: 10.1056/NEJMoa2002032

2. Ghebreyesus TA, Swaminathan S. Scientists are sprinting to outpace the novel coronavirus. Lancet 2020;395:762-4. Lancet. 2020;395(10226):762–764. PMID: 32105610. doi: 10.1016/S0140-6736(20)30420-7

3. Xu X, Yu C, Qu J, Zhang L, Jiang S, Huang D, Chen B, Zhang Z, Guan W, Ling Z, Jiang R, Hu T, Ding Y, Lin L, Gan Q, Luo L, Tang X, Liu J. Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2. Eur J Nucl Med Mol Imaging. 2020;47(5):1275–1280. PMID: 32107577. doi: 10.1007/s00259-020-04735-9

4. Hoehl S, Rabenau H, Berger A, Kortenbusch M, Cinatl J, Bojkova D, Behrens P, Böddinghaus B, Götsch U, Naujoks F, Neumann P, Schork J, Tiarks-Jungk P, Walczok A, Eickmann M, Vehreschild MJGT, Kann G, Wolf T, Gottschalk R, Ciesek S. Evidence of SARS-CoV-2 Infection in Returning Travelers from Wuhan, China. N Engl J Med. 2020;382(13):1278–1280. PMID: 32069388. doi: 10.1056/NEJMc2001899

5. Peng YD, Meng K, Guan HQ, Leng L, Zhu RR, Wang BY, He MA, Cheng LX, Huang K, Zeng QT. [Clinical characteristics and outcomes of 112 cardiovascular disease patients infected by 2019-nCoV]. Zhonghua Xin Xue Guan Bing Za Zhi. 2020;48:E004. doi: 10.3760/cma.j.cn112148-20200220-00105

6. Lippi G, Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chim Acta. 2020;505:190–191. doi: 10.1016/j.cca.2020.03.004. PMID: 32145275

7. Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, Fang C, Huang D, Huang LQ, Huang Q, Han Y, Hu B, Hu F, Li BH, Li YR, Liang K, Lin LK, Luo LS, Ma J, Ma LL, Peng ZY, Pan YB, Pan ZY, Ren XQ, Sun HM, Wang Y, Wang YY, Weng H, Wei CJ, Wu DF, Xia J, Xiong Y, Xu HB, Yao XM, Yuan YF, Ye TS, Zhang XC, Zhang YW, Zhang YG, Zhang HM, Zhao Y, Zhao MJ, Zi H, Zeng XT, Wang YY, Wang XH. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res 2020;7(1):4. doi: 10.1186/s40779-020-0233-6

8. COVID-19: Fallzahlen in Deutschland, China und weltweit. 2020. at https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Fallzahlen.html .)

9. Boesveldt S, Postma EM, Boak D, Welge-Luessen A, Schöpf V, Mainland JD, Martens J, Ngai J, Duffy VB.. Anosmia—A Clinical Review. Chem Senses. 2017;42(7): 513–523. doi: 10.1093/chemse/bjx025

10. Moein ST, Hashemian SMR, Mansourafshar B, Khorram-Tousi A, Tabarsi P, Doty RL. Smell dysfunction: a biomarker for COVID‐19. Int Forum Allergy Rhinol. 2020. doi: 10.1002/alr.22587

11. Marinosci A, Landis BN, Calmv A. Possible link between anosmia and COVID-19: sniffing out the truth. Eur Arch Otorhinolaryngol. 2020. doi: 10.1007/s00405-020-05966-0

12. Hopkins C, Surda P, Kumar N. Presentation of new onset anosmia during the COVID-19 pandemic. Rhinology. 2020. doi: 10.4193/Rhin20.11613.

13. Menni C, Valdes A, Freydin MB, Ganesh S, El-Sayed Moustafa J, Visconti A, Hysi P, Bowyer RCE, Mangino M, Falchi M, Wolf J, Steves C, Spector T. Loss of smell and taste in combination with other symptoms is a strong predictor of COVID-19 infection. medRxiv 2020.04.05.20048421. doi: 10.1101/2020.04.05.20048421

Footnotes

Submitted March 27, 2020 | Accepted April 14, 2020 | Published May 16, 2020