Case Report: COVID-19 Patient With Chief Complaint of Anosmia and Ageusia; a Unique Perspective on Atypical Symptomatology and Management in the Military

Abstract

A novel corona virus, severe acute respiratory syndrome coronavirus-2, found in Wuhan, China in December 2019 has since spread to multiple continents and has been implicated in thousands of deaths. This pandemic—causing virus has been initially described (corona virus disease 2019 [COVID-19]) with the presentation of fever, cough, and shortness of breath. The majority of studies published have been conducted on inpatient cases and a shortage of tests has encouraged screening only of patients with classic presentation. A positive COVID-19 case of a healthy military male, with the chief complaint of anosmia and ageusia, instigated local re-evaluation of the screening protocol for possible COVID-19 patients. Multiple studies in Europe have implicated anosmia and ageusia as symptoms associated with COVID-19, and subsequently, anosmia and ageusia have been added to Centers for Disease Control and Prevention screening guidelines as well. There should be a higher index of suspicion when evaluating a patient with high-risk activities, travel, and atypical symptoms. More studies need to be conducted with a healthy outpatient population to further understand this disease and decrease its impact.

Estimating the prevalence of oral manifestations in COVID-19 patients: a systematic review

“…This was followed by India with 8 studies [ 17 , 33 , 44 , 45 , 50 , 55 , 80 , 83 ], United States with 7 studies [ 21 , 25 ,, 30 , 31 , 54 , 62 , 79 ], Brazil with 7 studies [ 9 , 47 , 49 , 52 , 56 , 75 , 77 ], and both Egypt and Turkey with 5 studies each [ 34 , 38 , 41 , 68 , 71 ] and [ 26 , 39 , 42 , 48 , 64 ], respectively. Iran [ 5 , 53 , 59 , 60 ], Iraq [ 12 , 43 , 84 , 85 ], and Spain [ 27 , 57 , 65 , 67 ] contributed to 4 studies each. Saudi Arabia was represented by 3 studies [ 40 , 46 , 51 ], while China [ 15 , 35 ] and Israel each [ 13 , 74 ] had 2 studies.…”

“…We further subdivided the taste disorders into additional categories. These include complete loss of taste, or ageusia, as reported in 22 studies [ 12 , 14 , 20 , 23 , 35 , 40 − 42 , 44 , 49 , 53 , 55 , 56 , 58 , 63 , 65 , 67 , 70 , 72 , 74 , 85 ], taste alteration or dysfunction, as reported in 19 studies [ 5 , 13 , 16 − 19 , 21 , 22 , 29 , 36 , 38 , 46 , 51 , 54 , 66 , 78 , 84 − 86 ], dysgeusia, as reported in 7 studies [ 24 , 28 , 37 , 50 , 54 , 59 , 60 ], and amblygeustia, as reported in only one study [ 15 ].…”

SARS-CoV-2 Transmission in the Military during the Early Phase of the Pandemic—A Systematic Analysis

“…After accounting for potential overlap in cases, this study utilized 36 articles from 17 countries—the U.S. ( n = 17), Israel ( n = 2), Switzerland ( n = 2), and the United Kingdom ( n = 2) and one each from Belgium, Bolivia, Brazil, Canada, Djibouti, France, India, Italy, Norway, Philippines, South Korea, Sri Lanka, and Tunisia [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ]. The Israel-based study by Talmy et al was solely used for the meta-analysis of specific symptoms since it was the only Israeli study reporting symptoms breakdown [ 58 ].…”

“…The following supporting information can be downloaded at: . References [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ] are cited in the Supplementary Materials.…”

Cross sectional investigation of a COVID-19 outbreak at a London Army barracks: Neutralising antibodies and virus isolation

“…A gender difference in asymptomatic SARS-CoV-2 has not been reported [ 24 , 27 ], but universal screening of pregnant women found that the vast majority of SARS-CoV-2 positive women were asymptomatic [28] . In symptomatic personnel, fever and respiratory tract symptoms were the most common symptoms, although anosmia and ageusia had only just been identified as possible manifestations of COVID-19 and were not included in the case definition at the time [29] , which may partly have contributed to ongoing transmission within the barracks [30] .…”