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• W3111989506 abstract "Chemosensory dysfunction has increasingly been reported in patients with coronavirus disease 2019 (COVID-19). Here, we document a case of a patient with taste and smell alterations as the only clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In March 2020, a 36-year-old woman presented with self-reported hypogeusia/ageusia and hyposmia/anosmia in the absence of any respiratory symptom. The patient, who had no clinical and radiographic signs of sinusitis and was otherwise healthy, eventually had a positive test result for SARS-CoV-2. She did not develop any COVID-19–related symptoms throughout her 6-month follow up. Her self-reported chemosensory dysfunction lasted for 12 weeks. To the best of our knowledge, this is the first report that has accurately documented taste and smell alteration as the sole manifestation of COVID-19 in an otherwise healthy individual. Overall, analysis of current evidence supports the inclusion of gustatory and olfactory alterations as cardinal symptoms of COVID-19. Dentists’ awareness of the diagnostic criteria for case definition of COVID-19 can facilitate early detection of the disease. Chemosensory dysfunction has increasingly been reported in patients with coronavirus disease 2019 (COVID-19). Here, we document a case of a patient with taste and smell alterations as the only clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In March 2020, a 36-year-old woman presented with self-reported hypogeusia/ageusia and hyposmia/anosmia in the absence of any respiratory symptom. The patient, who had no clinical and radiographic signs of sinusitis and was otherwise healthy, eventually had a positive test result for SARS-CoV-2. She did not develop any COVID-19–related symptoms throughout her 6-month follow up. Her self-reported chemosensory dysfunction lasted for 12 weeks. To the best of our knowledge, this is the first report that has accurately documented taste and smell alteration as the sole manifestation of COVID-19 in an otherwise healthy individual. Overall, analysis of current evidence supports the inclusion of gustatory and olfactory alterations as cardinal symptoms of COVID-19. Dentists’ awareness of the diagnostic criteria for case definition of COVID-19 can facilitate early detection of the disease. Early detection of individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is key to reducing the spread of coronavirus disease 2019 (COVID-19) and is particularly challenging in asymptomatic or paucisymptomatic patients. Commonly reported clinical manifestations of COVID-19 include fever, cough, myalgia or fatigue, pneumonia, and complicated dyspnea.1Guan WJ Ni ZY Hu Y et al.Clinical characteristics of coronavirus disease 2019 in China.N Engl J Med. 2020; 382: 1708-1720Crossref PubMed Scopus (19218) Google Scholar Although the most prevalent signs/symptoms in patients with COVID-19 (i.e., cough, fever, and fatigue, according to a recent meta-analysis2Hasani H Mardi S Shakerian S Taherzadeh-Ghahfarokhi N Mardi P. The novel coronavirus disease (COVID-19): a PRISMA systematic review and meta-analysis of clinical and paraclinical characteristics.Biomed Res Int. 2020; 20203149020Crossref PubMed Scopus (14) Google Scholar) have been used as cardinal clinical diagnostic criteria since the beginning of the outbreak, new olfactory and taste disorder(s) were not initially linked to SARS-CoV-2 infection and were not used for case identification and testing prioritization by the Centers for Disease Control and Prevention (CDC) or the World Health Organization (WHO) until August 2020.3Cirillo N. Taste alteration in COVID-19: a rapid review with data synthesis reveals significant geographical differences.medRxiv. 2020; https://doi.org/10.1101/2020.09.11.20192831Crossref Scopus (0) Google Scholar The first systematic assessments of the evidence available up to March 2020 failed to identify associations between anosmia/ageusia and COVID-19.4Lovato A de Filippis C. Clinical presentation of COVID-19: a systematic review focusing on upper airway symptoms.Ear Nose Throat J. 2020; 99: 569-576Crossref PubMed Scopus (224) Google Scholar,5O'Donovan J, Greenhalgh T, Ma S, Hopkins C, Jones N, Wise S. Sniffing out the evidence for olfactory symptoms as a clinical feature of COVID-19: a systematic scoping review. Centre for Evidence-Based Medicine. Available at: https://www.cebm.net/wp-content/uploads/2020/03/Rapid-Review-Anosmia-COVID19-.pdfGoogle Scholar For example, none of the studies included in an early systematic review reported olfactory or gustative dysfunction.4Lovato A de Filippis C. Clinical presentation of COVID-19: a systematic review focusing on upper airway symptoms.Ear Nose Throat J. 2020; 99: 569-576Crossref PubMed Scopus (224) Google Scholar When looking specifically at the evidence for anosmia in COVID-19 up to March 23, 2020, researchers found it to be “limited and inconclusive”.5O'Donovan J, Greenhalgh T, Ma S, Hopkins C, Jones N, Wise S. Sniffing out the evidence for olfactory symptoms as a clinical feature of COVID-19: a systematic scoping review. Centre for Evidence-Based Medicine. Available at: https://www.cebm.net/wp-content/uploads/2020/03/Rapid-Review-Anosmia-COVID19-.pdfGoogle Scholar In sharp contrast, a most recent meta-analysis of smell and taste alterations reported not only that approximately half of patients with COVID-19 had these symptoms but also, that 15% of patients had olfactory and gustatory abnormalities as their initial clinical manifestations.6Chi H Chiu NC Peng CC et al.One-seventh of patients with COVID-19 had olfactory and gustatory abnormalities as their initial symptoms: a systematic review and meta-analysis.Life (Basel). 2020; 10: 158Google Scholar In agreement with the growing body of evidence, sudden onset of anosmia, ageusia, or dysgeusia has now been recognized as a major clinical characteristic of the disease and has been included in the list of key clinical criteria for case definition of COVID-19 by the European Centre for Disease Prevention and Control as well as other public health surveillance organizations across the world, such as the CDC, the WHO,3Cirillo N. Taste alteration in COVID-19: a rapid review with data synthesis reveals significant geographical differences.medRxiv. 2020; https://doi.org/10.1101/2020.09.11.20192831Crossref Scopus (0) Google Scholar and Public Health England.7Public Health England. COVID-19: investigation and initial clinical management of possible cases. Updated October 2, 2020. Available at: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-initial-investigation-of-possible-cases/investigation-and-initial-clinical-management-of-possible-cases-of-wuhan-novel-coronavirus-wn-cov-infection#criteria. Accessed October 11, 2020.Google Scholar However, it is not known whether concurrent olfactory and gustatory alterations may indeed represent the only clinical signs of SARS-CoV-2 infection in otherwise healthy patients. Here, we aimed to document a case of a patient with taste and smell alterations as the only clinical manifestations of SARS-CoV-2 infection. Furthermore, we surveyed current high-level evidence on this topic. A 36-year-old Caucasian woman presented for observation to the Oral and Maxillofacial Surgery Unit, Azienda Ospedaliero-Universitaria University of Campania Luigi Vanvitelli, Italy, on March 7, 2020, complaining of a reduction of her ability to taste food in the last 7 days. She reported a score of 4 on a 10-cm visual analog scale (VAS), where 0 indicated lack of sensation and 10 was optimal. When questioned further, she also admitted a diminishing ability to smell odors (VAS score 7/10). Intraoral examination did not reveal the presence of any mucosal alteration such as atrophy, ulceration, or tongue coating. Extraorally, no preauricular, submandibular, or cervical lymphadenopathy was detected. The patient's medical history revealed no concomitant disease, systemic signs and symptoms, or use of medications. Despite not showing signs of nasal congestion, she was initially prescribed posteroanterior occipitomental radiographic investigation to rule out sinus pathology, which eventually showed no abnormalities. At follow-up on March 11, the patient reported complete loss of taste and smell (ageusia and anosmia) and was referred to the neurology unit to rule out space-occupying lesions or other neurologic disturbances. Because anosmia and ageusia had occasionally been linked to SARS-CoV-2 infection at that time, the presence of other signs and symptoms suggestive of COVID-19 were investigated. The patient's body temperature taken orally with an electronic digital thermometer was 36.7°C, and her history was negative for headache, fatigue, and muscle pain. She eventually underwent SARS-CoV-2 testing (oropharyngeal swab and polymerase chain reaction), which returned a positive result on March 21. The patient underwent self-isolation at home and hence did not undergo any further diagnostic tests. She was followed up by telephone surveys and, in the following weeks, did not report any respiratory or other symptoms except anosmia and ageusia. These self-reported alterations began to gradually improve in May and had resolved by May 25. No VAS testing was possible due to the telephone interviews. As of August 29, 2020, the patient had no new self-reported alterations of taste and smell. After providing thorough information regarding the publication of this case, informed consent was gathered. To the best of our knowledge, this is the first report of a case of COVID-19 with no comorbidities and no medication history and without any symptoms except concomitant loss of smell and taste. A previous study described a patient with anosmia and ageusia as the only indicators of COVID-198Zhang Q Shan KS Abdollahi S Nace T. Anosmia and ageusia as the only indicators of coronavirus disease 2019 (COVID-19).Cureus. 2020; 12: e7918PubMed Google Scholar; however, that patient presented to the hospital with the chief complaint of headache, which is a well-known neurologic manifestation of COVID-19.9Almqvist J Granberg T Tzortzakakis A et al.Neurological manifestations of coronavirus infections – a systematic review.Ann Clin Transl Neurol. 2020; 7: 2057-2071Crossref PubMed Scopus (42) Google Scholar, 10Di Carlo DT Montemurro N Petrella G Siciliano G Ceravolo R Perrini P. Exploring the clinical association between neurological symptoms and COVID-19 pandemic outbreak: a systematic review of current literature.J Neurol. 2020; ([e-pub ahead of print])https://doi.org/10.1007/s00415-020-09978-yCrossref PubMed Scopus (38) Google Scholar, 11Chen X Laurent S Onur OA et al.A systematic review of neurological symptoms and complications of COVID‑19.J Neurol. 2020; ([e-pub ahead of print])https://doi.org/10.1007/s00415-020-10067-3Crossref Scopus (130) Google Scholar, 12Abdullahi A Candan SA Abba MA et al.Neurological and musculoskeletal features of COVID-19: a systematic review and meta-analysis.Front Neurol. 2020; 11: 687Crossref PubMed Scopus (91) Google Scholar Furthermore, the 60-year-old woman in the previous study had a history of vertigo, seasonal allergies, and trigeminal neuralgia. In contrast, our patient had no systemic diseases or allergies. In another report from Norway, a married couple in their 60s reported anosmia (wife) and ageusia (husband); however, there was no concurrent alteration of smell and taste.13Hjelmesæth J Skaare D. Loss of smell or taste as the only symptom of COVID-19.Tidsskr Nor Laegeforen. 2020; 140https://doi.org/10.4045/tidsskr.20.0287Crossref Google Scholar Finally, another peculiarity of our case was the unusually long duration of the symptoms, which lasted for approximately 12 weeks. We found retrospective studies where patients who had positive test results for SARS-CoV-2 appeared to have experienced chemosensory dysfunction in the absence of typical COVID-19 symptomatology.14Villarreal IM Morato M Martínez-RuizCoello M et al.Olfactory and taste disorders in healthcare workers with COVID-19 infection.Eur Arch Otorhinolaryngol. 2020; ([e-pub ahead of print])https://doi.org/10.1007/s00405-020-06237-8Crossref Scopus (21) Google Scholar,15Vaira LA Hopkins C Salzano G et al.Olfactory and gustatory function impairment in COVID-19 patients: Italian objective multicenter-study.Head Neck. 2020; 42: 1560-1569Crossref PubMed Scopus (202) Google Scholar For example, Villareal et al.14Villarreal IM Morato M Martínez-RuizCoello M et al.Olfactory and taste disorders in healthcare workers with COVID-19 infection.Eur Arch Otorhinolaryngol. 2020; ([e-pub ahead of print])https://doi.org/10.1007/s00405-020-06237-8Crossref Scopus (21) Google Scholar described taste and smell disorder as the only symptom in 3 cases (1.3% of the cohort). Other reports exist in which an altered sense of smell or taste is described as the only symptom in a small number of patients;16Carignan A Valiquette L Grenier C et al.Anosmia and dysgeusia associated with SARS-CoV-2 infection: an age-matched case-control study.CMAJ. 2020; 192: E702-E707Crossref PubMed Scopus (66) Google Scholar, 17Spinato G Fabbris C Polesel J et al.Alterations in smell or taste in mildly symptomatic outpatients with SARS-CoV-2 infection.JAMA. 2020; 323: 2089-2090Crossref PubMed Scopus (454) Google Scholar, 18Coelho DH Kons ZA Costanzo RM Reiter ER. Subjective changes in smell and taste during the COVID-19 pandemic: a national survey—preliminary results.Otolaryngol Head Neck Surg. 2020; 163: 302-306Crossref PubMed Scopus (25) Google Scholar however, there was no indication whether these manifestations occurred concurrently (both smell and taste, as opposed to either smell or taste) or were associated with comorbidities or other systemic conditions. Also, one study18Coelho DH Kons ZA Costanzo RM Reiter ER. Subjective changes in smell and taste during the COVID-19 pandemic: a national survey—preliminary results.Otolaryngol Head Neck Surg. 2020; 163: 302-306Crossref PubMed Scopus (25) Google Scholar included non–laboratory-confirmed cases, and participants were not required to have documented SARS-CoV-2 infection. These data suggest that the true prevalence of chemosensory dysfunction as the sole presenting symptom of COVID-19 could indeed be underreported. However, because of the nature of these studies, it is not possible to figure out whether these patients reported any comorbidity, history of medications, or the presence of sinus pathology. In addition, none of the studies published so far documented a follow-up of 6 months or longer. Hence, we believe that our patient is the first well-documented case of a COVID-19 with no concomitant disease presenting exclusively with smell and taste changes and is the one with the longest follow-up. Given the potential usefulness of smell and taste assessment in the diagnosis of asymptomatic patients, we undertook a review of high-level evidence on this topic. The data extracted from published systematic reviews are reported in Table I. The range of prevalence of olfactory and gustatory alterations, when reported individually, was 3.2%-100% and 0-92.6%, respectively. In the systematic reviews analyzing smell and/or taste together, the range was 5.6%-94%. The heterogeneity of these findings may be partially due to differences in the geographic distribution of this association.3Cirillo N. Taste alteration in COVID-19: a rapid review with data synthesis reveals significant geographical differences.medRxiv. 2020; https://doi.org/10.1101/2020.09.11.20192831Crossref Scopus (0) Google Scholar Interestingly, when the prevalence was pooled for the total number of cases examined, olfactory and gustatory alterations were found in approximately half of patients with COVID-19. In one systematic review,29Passarelli PC Lopez MA Mastandrea Bonaviri GN Garcia-Godoy F D'Addona A Taste and smell as chemosensory dysfunctions in COVID-19 infection.Am J Dent. 2020; 33: 135-137PubMed Google Scholar 81.6% (8823) and 74.8% (8088) of 10 818 patients with COVID-19 presented with ageusia and anosmia, respectively. Studies6Chi H Chiu NC Peng CC et al.One-seventh of patients with COVID-19 had olfactory and gustatory abnormalities as their initial symptoms: a systematic review and meta-analysis.Life (Basel). 2020; 10: 158Google Scholar also demonstrate that the same signs/symptoms are the initial manifestation in a sizable number of patients. In light of the data reported here, and given the high risk of work-related contagion,39Cirillo N COVID-19 outbreak: succinct advice for dentists and oral healthcare professionals.Clin Oral Investig. 2020; 24: 2529-2535Crossref PubMed Scopus (26) Google Scholar it is imperative for dentists and oral health care providers to recognize ageusia as a potential clinical manifestation of COVID-19.Table 1Systematic reviews assessing olfactory and gustatory alterations in COVID-19 patients.Systematic reviewStudy data collection (up to)Scope and prevalenceReferenceUp to MarAprMayJunJulRange (%)Pooled prevalenceFocusAlmqvist et al9Almqvist J Granberg T Tzortzakakis A et al.Neurological manifestations of coronavirus infections – a systematic review.Ann Clin Transl Neurol. 2020; 7: 2057-2071Crossref PubMed Scopus (42) Google Scholar2639-88 (ST)NRNChi et al6Chi H Chiu NC Peng CC et al.One-seventh of patients with COVID-19 had olfactory and gustatory abnormalities as their initial symptoms: a systematic review and meta-analysis.Life (Basel). 2020; 10: 158Google Scholar85.6-94 (ST)48.5%(ST)STSamaranayake et al19Samaranayake LP Fakhruddin KS Panduwawala C. Sudden onset, acute loss of taste and smell in coronavirus disease 2019 (COVID-19): a systematic review.Acta Odontol Scand. 2020; 78: 467-473Crossref PubMed Scopus (49) Google Scholar305.1-85.6 (S)5.6-88.8(T)48.8% (S)51.3%(T)STAgyeman et al20Agyeman AA Chin KL Landersdorfer CB Liew D Ofori-Asenso R. Smell and taste dysfunction in patients with COVID-19: a systematic review and meta-analysis.Mayo Clin Proc. 2020; 95: 1621-1631Abstract Full Text Full Text PDF PubMed Scopus (260) Google Scholar113.2-98.3 (S) 5.6-62.7(T)41% (S)38.2% (T)STDi Carlo et al10Di Carlo DT Montemurro N Petrella G Siciliano G Ceravolo R Perrini P. Exploring the clinical association between neurological symptoms and COVID-19 pandemic outbreak: a systematic review of current literature.J Neurol. 2020; ([e-pub ahead of print])https://doi.org/10.1007/s00415-020-09978-yCrossref PubMed Scopus (38) Google Scholar29NR46.8 (S) 52.3% (T)NChen et al11Chen X Laurent S Onur OA et al.A systematic review of neurological symptoms and complications of COVID‑19.J Neurol. 2020; ([e-pub ahead of print])https://doi.org/10.1007/s00415-020-10067-3Crossref Scopus (130) Google Scholar205.1-85.6 (S)5.6-88.8(T)59.2% (S)50.8% (T)NAbdullahi et al12Abdullahi A Candan SA Abba MA et al.Neurological and musculoskeletal features of COVID-19: a systematic review and meta-analysis.Front Neurol. 2020; 11: 687Crossref PubMed Scopus (91) Google Scholar175.1-85.6 (S)5.6-82 (T)35% (S) 33% (T)NStruyf et al21Struyf T Deeks JJ Dinnes J et al.Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19 disease.Cochrane Database Syst Rev. 2020; 7CD013665PubMed Google Scholar27NR18% (ST)GBorsetto et al22Borsetto D Hopkins C Philips V et al.Self-reported alteration of sense of smell or taste in patients with COVID-19: a systematic review and meta-analysis on 3563 patients.Rhinology. 2020; 58: 430-436PubMed Google Scholar411-84 (ST)47% (ST)STvon Bartheld et al23von Bartheld CS Hagen MM Butowt R. Prevalence of chemosensory dysfunction in COVID-19 patients: a systematic review and meta-analysis reveals significant ethnic differences.ACS Chem Neurosci. 2020; 11: 2944-2961Crossref PubMed Scopus (138) Google Scholar104.9-98 (S)0-88.8 (T)38.48%(S)30.37% (T)STCarrillo-Larco & Altez-Fernandez24Carrillo-Larco RM Altez-Fernandez C Anosmia and dysgeusia in COVID-19: a systematic review.Wellcome Open Res. 2020; 5: 94Crossref PubMed Scopus (57) Google Scholar205.1-68 (S)5.6-78.9 (T)NRSTda Costa et al25da Costa KVT Carnaúba ATL Rocha KW de Andrade KCL Ferreira SMS Menezes PL. Olfactory and taste disorders in COVID-19: a systematic review.Braz J Otorhinolaryngol. 2020; 86: 781-792Crossref PubMed Scopus (42) Google Scholar255.1-98.3 (S)5.6-82 (T)NRSTHoang et al26Hoang MP Kanjanaumporn J Aeumjaturapat S Chusakul S Seresirikachorn K Snidvongs K. Olfactory and gustatory dysfunctions in COVID-19 patients: a systematic review and meta-analysis.Asian Pac J Allergy Immunol. 2020; 38: 162-169PubMed Google Scholar305.6-85.6(S)5.1-88.8(T)45.7%(S)47%(T)STWang et al27Wang L Shen Y Li M et al.Clinical manifestations and evidence of neurological involvement in 2019 novel coronavirus SARS-CoV-2: a systematic review and meta-analysis.J Neurol. 2020; 267: 2777-2789Crossref PubMed Scopus (87) Google Scholar335.7-85.6(S)33.3-88.8(T)NRG, NRomoli et al28Romoli M Jelcic I Bernard-Valnet R et al.A systematic review of neurological manifestations of SARS-CoV-2 infection: the devil is hidden in the details.Eur J Neurol. 2020; 27: 1712-1726Crossref PubMed Scopus (71) Google Scholar2448.2-85(S)39.2-88(T)NRNPassarelli et al29Passarelli PC Lopez MA Mastandrea Bonaviri GN Garcia-Godoy F D'Addona A Taste and smell as chemosensory dysfunctions in COVID-19 infection.Am J Dent. 2020; 33: 135-137PubMed Google Scholar*305.1-85.6(S)5.6-88(T)74.8%(S)81.6%(T)STPrintza & Constantinidis30Printza A Constantinidis J. The role of self-reported smell and taste disorders in suspected COVID‑19.Eur Arch Otorhinolaryngol. 2020; 277: 2625-2630Crossref PubMed Scopus (53) Google Scholar35.1-100(S)5.6-88.8(T)NRSTWhittaker et al31Whittaker A Anson M Harky A. Neurological manifestations of COVID-19: a systematic review and current update.Acta Neurol Scand. 2020; 142: 14-22Crossref PubMed Scopus (241) Google Scholar**NR5-100(S)6-25(T)NRNTong et al32Tong JY Wong A Zhu D Fastenberg JH Tham T. The prevalence of olfactory and gustatory dysfunction in COVID-19 patients: a systematic review and meta-analysis.Otolaryngol Head Neck Surg. 2020; 163: 3-11Crossref PubMed Scopus (353) Google Scholar195.1-98.3(S)5.5-92.6(T)52.73%(S)43.93%(T)STSystematic reviews were sorted by date of publication on PubMed. S, smell; T, taste; ST, smell and taste; N, neurological; G, general symptoms; NR, not reported.*, exact date not specified, assumed 30 April. **, date(s) of data collection not specified Open table in a new tab Systematic reviews were sorted by date of publication on PubMed. S, smell; T, taste; ST, smell and taste; N, neurological; G, general symptoms; NR, not reported. *, exact date not specified, assumed 30 April. **, date(s) of data collection not specified Smell and taste disorders are not rare in the general population and have a wide range of recognized causes, including cigarette smoking, nasal and sinus disease, oral or upper respiratory infection, head trauma, neurodegenerative disorders, brain neoplasms, and aging.33Bromley SM. Smell and taste disorders: a primary care approach.Am Fam Physician. 2000; 61: 427-436PubMed Google Scholar Medications, chemotherapy, and radiotherapy are also associated with chemosensory dysfunction.34Gamper EM Zabernigg A Wintner LM et al.Coming to your senses: detecting taste and smell alterations in chemotherapy patients. A systematic review.J Pain Symptom Manage. 2012; 44: 880-895Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar It is not surprising, therefore, that changes of smell and/or taste were also found to be relatively common in patients with negative test results for SARS-CoV-2 infection.35Beltrán-Corbellini Á Chico-García JL Martínez-Poles J et al.Acute-onset smell and taste disorders in the context of COVID-19: a pilot multicentre polymerase chain reaction based case-control study.Eur J Neurol. 2020; 27: 1738-1741Crossref PubMed Scopus (277) Google Scholar In the case presented here, we ruled out smoking, trauma, medications, infections, and sinus disease on the basis of information gathered from the patient's medical history, clinical assessment, and radiographic investigations. Because of self-isolation, the patient could not undertake the neurologic assessment we prescribed, but given the transitory nature of her alteration and considering the positivity of her SARS-CoV-2 testing, it is unlikely that her disturbances were related to brain disease. The possible mechanisms of chemosensory dysfunction in COVID-19 are still being elucidated. The high incidence of smell loss without significant rhinorrhea or nasal congestion suggests that SARS-CoV-2 targets the chemical senses through mechanisms distinct from those used by endemic coronaviruses or other common cold–causing agents.36Cooper KW Brann DH Farruggia MC et al.COVID-19 and the chemical senses: supporting players take center stage.Neuron. 2020; 107: 219-233Abstract Full Text Full Text PDF PubMed Scopus (204) Google Scholar It has been proposed that the virus could bind to the olfactory and/or oral epithelium via the ACE2 receptor and induce cytolytic damage and inflammatory responses. In turn, this would lead to cellular and genetic changes that could ultimately alter taste and smell.37Lozada-Nur F Chainani-Wu N Fortuna G Sroussi H Dysgeusia in COVID-19: possible mechanisms and implications.Oral Surg Oral Med Oral Pathol Oral Radiol. 2020; 130: 344-346Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar The same mechanism could also directly affect the peripheral neuronal trajectory of the gustatory tract. Another study suggests that the rapid recovery of smell and taste functions in patients with COVID-19 could be attributed to a decrease in interleukin-6 levels.38Cazzolla AP Lovero R Lo Muzio L et al.Taste and smell disorders in COVID-19 patients: role of interleukin-6.ACS Chem Neurosci. 2020; 11: 2774-2781Crossref PubMed Scopus (115) Google Scholar Although intriguing, these reports are still very speculative and will need to be backed by further experimental and clinical evidence. Smell and taste alterations not only are associated with COVID-19 but also can be the first or sole manifestations of the disease. As of August 29, 2020, our patient had not developed any COVID-19–elated or other signs or symptoms. Hence, to the best of our knowledge, this is the first patient with COVID-19 presenting with prolonged ageusia and anosmia as the sole clinical manifestations of the disease during a 6-month follow-up." @default.
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• W3111989506 title "Self-reported smell and taste alteration as the sole clinical manifestation of SARS-CoV-2 infection" @default.
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