Inflammatory olfactory neuropathy in two patients with COVID-19

Kirschenbaum, Daniel S.; Imbach, Lukas L.; Ulrich, Silvia; Rushing, Elisabeth J.; Keller, Emanuela; Reimann, Regina; Frauenknecht, Katrin; Lichtblau, Mona; Witt, Martin; Hummel, Thomas; Steiger, Peter; Aguzzi, Adriano; Frontzek, Karl

doi:10.1016/s0140-6736(20)31525-7

Cited by 93 publications

(106 citation statements)

References 6 publications

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“…Kirschenbaum et al . 22 reported on the post-mortem histological analysis of olfactory epithelium in two elderly male patients who died 6 and 8 days after hospital admission. They demonstrated findings consistent with an inflammatory neuropathy, with prominent leukocytic infiltrates in the lamina propria, focal atrophy of the mucosa, and digestion chambers in the olfactory nerve fibres suggestive of axonal damage.…”

Section: Discussionmentioning

confidence: 99%

“…17 This hypothesis is further supported by: radiological evidence of olfactory cleft oedema in some anosmic patients; 18,19 proof that the supporting cells of the olfactory epithelium have the highest concentration of viral receptors; 20 and findings from the first two histopathological reports on animal models 21 and samples taken from cadavers. 22…”

Section: Introductionmentioning

confidence: 99%

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Olfactory epithelium histopathological findings in long-term coronavirus disease 2019 related anosmia

et al. 2020

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Background. Olfactory dysfunction represents one of the most frequent symptoms of coronavirus disease 2019, affecting about 70 per cent of patients. However, the pathogenesis of the olfactory dysfunction in coronavirus disease 2019 has not yet been elucidated. Case report. This report presents the radiological and histopathological findings of a patient who presented with anosmia persisting for more than three months after infection with severe acute respiratory syndrome coronavirus-2. Conclusion. The biopsy demonstrated significant disruption of the olfactory epithelium. This shifts the focus away from invasion of the olfactory bulb and encourages further studies of treatments targeted at the surface epithelium.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Olfactory epithelium histopathological findings in long-term coronavirus disease 2019 related anosmia

et al. 2020

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“…Corona viruses are neurotropic and can be neuroinvasive [63,64]. An olfactory disorder in COVID-19 may reflect direct damage by SARS-CoV-2 at the olfactory epithelial or olfactory tract level [65] -or may indicate a more extensive invasion of the CNS via the olfactory tract into the CNS, as has been shown for other viruses [66]. SARS-CoV-2 has been detected in autopsies in the human brain [67].…”

Section: Disorders Of the Chemosensory System: Anosmia Ageusia Definmentioning

confidence: 96%

“Neurological manifestations of COVID-19” - guideline of the German society of neurology

Berlit

Bösel

Gahn

et al. 2020

Neurol. Res. Pract.

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Infection with the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leads to a previously unknown clinical picture, which is known as COVID-19 (COrona VIrus Disease-2019) and was first described in the Hubei region of China. The SARS-CoV-2 pandemic has implications for all areas of medicine. It directly and indirectly affects the care of neurological diseases. SARS-CoV-2 infection may be associated with an increased incidence of neurological manifestations such as encephalopathy and encephalomyelitis, ischemic stroke and intracerebral hemorrhage, anosmia and neuromuscular diseases.In October 2020, the German Society of Neurology (DGN, Deutsche Gesellschaft für Neurologie) published the first guideline on the neurological manifestations of the new infection. This S1 guideline provides guidance for the care of patients with SARS-CoV-2 infection regarding neurological manifestations, patients with neurological disease with and without SARS-CoV-2 infection, and for the protection of healthcare workers.This is an abbreviated version of the guideline issued by the German Neurological society and published in the Guideline repository of the AWMF (Working Group of Scientific Medical Societies; Arbeitsgemeinschaft wissenschaftlicher Medizinischer Fachgesellschaften).

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“…One recent study showed that, based on bulk and single-cell RNA sequencing, ACE2 expressed in supporting and stem cells in the human/mouse olfactory epithelium, as well as vascular pericytes in the mouse olfactory bulb, however, was not detected in olfactory sensory or bulb neurons (40). Furthermore, autopsy studies of COVID-19 patients found that olfactory epithelium showed prominent leukocytic infiltrates in the lamina propria and focal atrophy of the mucosa, and olfactory nerve fibers in the lamina propria were lack of myelin, suggestive of axonal damage (41). However, the clear evidence is still lacking to confirm whether the olfactory neuropathy is due to direct viral infection or mediated by perturbing supporting non-neural cells.…”

Section: Neurological Manifestationsmentioning

confidence: 99%

Revisiting the Immune Balance Theory: A Neurological Insight Into the Epidemic of COVID-19 and Its Alike

Tang

2020

Front. Neurol.

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As the pandemic of COVID-19 is raging around the world, the mysteriousness of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) coronavirus is being revealed by the concerted endeavors of scientists. Although fever and pneumonia are typical symptoms, COVID-19 patients exhibit multiple neurological complications. In this interim review, we will summarize the neurological manifestations and their potential causes in COVID-19. Similar to the other two fatal respiratory coronaviruses, SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV-2 also shows to be neuroinvasive that may spread from the periphery to brain, probably by the retrograde axonal transport. The invaded viruses may directly disrupt the complex neural circuits, and raise a chronic activation of immune responses. In another hand, multiple organ failure in severe COVID-19 is caused by the systemic acute immune responses, and unsurprisingly caused the brain inflammation and led to encephalitis. However, in the central nervous system (CNS), the activation of resident immune cells including microglia and astrocytes may lead to chronic immune imbalance, which underlies the potential long-term effects in synaptic changes and neuropsychiatric impairments. The neuroinvasive biology also provides a possible link with the Braak staging of neurodegenerative diseases such as Parkinson's disease (PD). Although with considerable advances, the neurotropic potential and chronic neurological effects caused by SARS-CoV-2 infections merit further investigations.

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Inflammatory olfactory neuropathy in two patients with COVID-19

Cited by 93 publications

References 6 publications

Olfactory epithelium histopathological findings in long-term coronavirus disease 2019 related anosmia

Olfactory epithelium histopathological findings in long-term coronavirus disease 2019 related anosmia

“Neurological manifestations of COVID-19” - guideline of the German society of neurology

Revisiting the Immune Balance Theory: A Neurological Insight Into the Epidemic of COVID-19 and Its Alike

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