Clinical and Radiological Evaluations of <scp>COVID</scp>‐19 Patients With Anosmia: Preliminary Report

Lechien, Jérôme R.; Michel, J.; Radulesco, Thomas; Chiesa‐Estomba, Carlos Miguel; Vaira, Luigi Angelo; Riu, Giacomo De; Sowerby, Leigh; Hopkins, Claire; Saussez, Sven

doi:10.1002/lary.28993

Cited by 54 publications

(65 citation statements)

References 27 publications

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“…Only one patient was hospitalized in a non-intensive COVID-19 ward for the management of his respiratory distress while all the other were outpatients. Overall, the clinical characteristics of our patients' population are in line with those of SARS-CoV-2-positive patients with loss of smell and taste as predominant symptoms [25][26][27][28]. They contrast (in terms of age, comorbidities, clinical presentation) with those of patients with severe forms of COVID-19 who died in the same institution (i.e., CUB Hôpital Erasme) during the same period [5].…”

supporting

confidence: 69%

Structural and metabolic brain abnormalities in COVID-19 patients with sudden loss of smell

Niesen

Trotta

Noël

et al. 2020

Preprint

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Objectives: Sudden loss of smell is a very common symptom of coronavirus disease 19 (COVID-19). This study characterizes the structural and metabolic cerebral correlates of dysosmia in patients with COVID-19. Methods: Structural brain magnetic resonance imaging (MRI) and positron emission tomography with [18F]-fluorodeoxyglucose (FDG-PET) were prospectively acquired simultaneously on a hybrid PET-MR in twelve patients (2 males, 10 females, mean age: 42.6 years, age range: 23-60 years) with sudden dysosmia and positive detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on nasopharyngeal swab specimens. FDG-PET data were analysed using a voxel-based approach and compared with that of a group of healthy subjects. Results: Bilateral blocking of the olfactory cleft was observed in six patients, while subtle olfactory bulb asymmetry was found in three patients. No MRI signal abnormality downstream of the olfactory tract was observed. Heterogeneous (decrease or increase) glucose metabolism abnormalities were observed in core olfactory and high-order neocortical areas. A modulation of regional cerebral glucose metabolism by the severity and the duration of COVID-19-related dysosmia was disclosed using correlation analyses. Conclusions: This PET-MR study shows that sudden loss of smell in COVID-19 is not related to central involvement due to SARS-CoV-2 neuroinvasiveness. Loss of smell is associated with heterogeneous cerebral metabolic changes in core olfactory and high-order cortical areas likely related to combined processes of deafferentation and active functional reorganisation secondary to the lack of olfactory stimulation.

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confidence: 69%

Structural and metabolic brain abnormalities in COVID-19 patients with sudden loss of smell

Niesen

Trotta

Noël

et al. 2020

Preprint

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“…This infection may cause rapid disruption of the olfactory epithelium structure and function with a possible inflammatory response inducing sudden onset smell loss. This inflammation is observed in a minority of patient with congested olfactory cleft who underwent CT scan [5,7,28,[30][31][32].…”

Section: Discussionmentioning

confidence: 97%

ACE2 & TMPRSS2 Expressions in Head & Neck Tissues: A Systematic Review

Lechien

Radulesco

Calvo‐Henríquez³

et al. 2020

Head and Neck Pathol

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To review the data regarding the expression of angiotensin converting enzyme-2 (ACE2) and transmembrane protease serine-2 (TMPRSS2) in head and neck tissue. Scopus, Cochrane Library, Medrxiv, Google Scholar and PubMED/MEDLINE were searched by four independent investigators for studies investigating ACE2 or TMPRSS2 expressions in head and neck tissues. The following outcomes were considered: sample origin (animal versus human); detection method; anatomical location and cell types. PRISMA checklist and modified population, intervention, comparison, outcome, timing and setting (PICOTS) framework were used to perform the review. Of the 24 identified studies, 17 met our inclusion criteria. Thirteen studies were conducted during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. ACE2 and TMPRSS2 were expressed in oral, pharyngeal, sinusonasal human mucosa. The following cell types expressed ACE2: basal, apical, goblet, minor salivary, and endothelial cells. TMPRSS2 was found in goblet and apical respiratory cells. ACE2 and TMPRSS2 were found in the olfactory region, especially in sustentacular non-neural and neural stem cells. Animal studies suggested that ACE2 expression may vary regarding age. There was an important heterogeneity between studies in the methods used to detect ACE2 and TMPRSS2, leading to a potential identification bias. The SARS-CoV-2 receptors, ACE2 and TMPRSS2, are both expressed in many head and neck tissues, enabling the viral entry into the host organism.

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“…Additionally, our team has just finalized olfactory cleft radiological evaluations on COVID-19- related anosmia patients. Interestingly, they demonstrated partial or total opacification of the olfactory cleft in some, but not all patients with COVID-19 related anosmia, corresponding to edema and inflammation in the neuroepithelium region [ 40 ]. Although the cellular mechanism of olfactory loss remains misunderstood, these observations suggest a potential viral entry through this specific tissue, which should continue to be investigated in the future.…”

Section: Discussionmentioning

confidence: 99%

ACE2 Protein Landscape in the Head and Neck Region: The Conundrum of SARS-CoV-2 Infection

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et al. 2020

Biology

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The coronavirus pandemic raging worldwide since December 2019 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which invades human cells via the angiotensin-converting enzyme 2 (ACE2) receptor. Although it has already been identified in many organs, ACE2 expression remains largely unknown in the head and neck (HN) sphere. Thus, this study aims to investigate its protein expression in several sites of the upper aerodigestive tract in order to highlight potential routes of infection. We compared ACE2 immunohistochemical expression between 70 paraffin-embedded specimens with two different antibodies and reported the quantified expression in each histological location. Surprisingly, we obtained different results depending on the antibody, an absence of labeling having been observed with a monoclonal antibody raised against the extracellular domain, whereas the polyclonal, against the cytoplasmic part of the protein, revealed enriched ACE2 expression, particularly in sinuses, vocal cords, salivary glands and oral cavity epithelial cells. The interpretation of these discordant results has brought several exciting lines of reflection. In conclusion, this study provides possible routes of entry for the SARS-CoV-2 in HN region and, above all, has led us to encourage caution when studying the ACE2 expression which is currently at the center of all attention.

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Clinical and Radiological Evaluations of COVID‐19 Patients With Anosmia: Preliminary Report

Cited by 54 publications

References 27 publications

Structural and metabolic brain abnormalities in COVID-19 patients with sudden loss of smell

Structural and metabolic brain abnormalities in COVID-19 patients with sudden loss of smell

ACE2 & TMPRSS2 Expressions in Head & Neck Tissues: A Systematic Review

ACE2 Protein Landscape in the Head and Neck Region: The Conundrum of SARS-CoV-2 Infection

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