12 Ιουν 2020 / COVID-19 updates
COVID-19 and loss of smell and taste
Loss of smell and taste in COVID-19 patients may be more common than previously reported. In one recent study 87% of COVID-19 patients reported loss of smell which in the majority developed at the same time as, or after, other COVID-19 symptoms. The loss of smell lasted about 8 days on average and the majority of the patients had the smell eventually returned to normal. Additionally, 56% of patients reported impaired taste.
Data from another recent study showed similar results. COVID-19 positive patients were more likely to have loss of smell or taste (67% vs. 14%) and fever (65% vs. 44%) than COVID-19 negative patients. There was no significant difference between COVID-19 positive and negative patients regarding the median duration of symptoms before COVID-19 testing. Also the study showed that there was no significant difference in COVID-19 patients with or without any gastrointestinal symptoms regarding hospitalization and mean days to testing. Men tested positive more often for COVID-19. Loss of smell or taste and fever were symptoms that more likely correlated with COVID-19. The specificity for COVID-19 infection was 99% when patients had diarrhea and anorexia in addition to fever, loss of smell and taste.
COVID-19 and liver complications
Data from studies of infection by other types of highly pathogenic coronaviruses, severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV) have shown that liver damage was common in these patients, and the liver damage was associated with the severity of the diseases.
COVID-19 affects the liver injury in similar incidence, which ranges between14.8% and 53%. The insult on the liver mainly manifests by abnormal ALT and AST levels and by slightly elevated bilirubin levels. The albumin is decreased in severe cases. Liver injury was more pronounced in cases of severe COVID-19 infection than that in mild cases.
Currently, studies on the mechanisms of SARS-CoV-2-related liver injury are limited.
There is evidence that SARS-CoV-2 enters cells via the angiotensin I converting enzyme 2 (ACE2). This enzyme is expressed everywhere in the gastrointestinal system and in the bile duct cells of the liver. It is suggested that the liver injury may be mainly due to the damage to bile duct cells or maybe due to the inflammatory cytokines that are produced in response to the infection or a combination of these factors. Additionally the wide use of antibiotics, antivirals and steroids in cases of COVID-19 may be additional causes of liver injury.
Alan Chen, MD, Amol Agarwal, MD, Nishal Ravindran, MD, Chau To, MD, Talan Zhang, MS, Paul J. Thuluvath, MD., FRCP