RESUMEN
Long COVID presents with diverse symptoms after COVID-19. Different clusters of symptoms have been reported; however, their persistence beyond 2 years after COVID-19 remains unclear. In this cohort study, we prospectively evaluated individuals with previous severe COVID-19 presenting with long COVID at a two-year follow-up. We characterized the included patients and performed a cluster analysis of symptoms through multiple correspondence analysis and hierarchical clustering. A total of 199 patients with long COVID were included. The median age was 58 years (48-69), 56% were male, and the median follow-up time since the COVID-19 diagnosis was 26 months (IQR: 25, 27). Three symptom clusters were identified: Cluster 1 is characterized by fatigue, myalgia/arthralgia, a low prevalence of symptoms, and a lack of specific symptoms; Cluster 2 is defined by a high prevalence of fatigue, myalgia/arthralgia, and cardiorespiratory symptoms, including palpitations, shortness of breath, cough, and chest pain; and Cluster 3 is demonstrated a high prevalence of ageusia, anosmia, fatigue, and cardiorespiratory symptoms. Our study reinforces the concept of symptom clustering in long COVID, providing evidence that these clusters may persist beyond two years after a COVID-19 diagnosis. This highlights the chronic and debilitating nature of long COVID and the importance of developing strategies to mitigate symptoms in these patients.
Asunto(s)
Artralgia , COVID-19 , Fatiga , Mialgia , Síndrome Post Agudo de COVID-19 , Sistema de Registros , SARS-CoV-2 , Humanos , COVID-19/epidemiología , COVID-19/complicaciones , Masculino , Persona de Mediana Edad , Femenino , Anciano , Fatiga/etiología , Mialgia/etiología , Mialgia/fisiopatología , Artralgia/virología , Artralgia/etiología , Estudios Prospectivos , Prevalencia , Análisis por Conglomerados , Ageusia/epidemiología , Ageusia/etiología , Ageusia/virología , Anosmia/epidemiología , Anosmia/etiología , Disnea/fisiopatología , Disnea/virología , Disnea/etiología , Estudios de Seguimiento , Tos , Factores de Tiempo , Estudios de CohortesRESUMEN
A 70-year-old right-handed housewife suffered an acute loss of taste, an unpleasant change in the taste of foods and liquids, and a strong aversion to all kinds of food due to a small lacune in the right dorsomedial pontine tegmentum. Eating became so unpleasant that she lost 7 kg in three weeks. Olfaction and the sensibility of the tongue were spared. The right medial longitudinal fascicle, the central tegmental tract, or both, were injured by the tegmental lesion. A discrete right-sided lesion in the upper pontine tegmentum may cause a reversible syndrome consisting of bilateral hypogeusia which is more severe ipsilaterally.
Asunto(s)
Ageusia , Tegmento Pontino , Accidente Vascular Cerebral Lacunar , Humanos , Femenino , Anciano , Ageusia/etiología , Ageusia/fisiopatología , Tegmento Pontino/patología , Tegmento Pontino/diagnóstico por imagen , Accidente Vascular Cerebral Lacunar/patología , Accidente Vascular Cerebral Lacunar/complicaciones , Accidente Vascular Cerebral Lacunar/etiología , Accidente Vascular Cerebral Lacunar/diagnóstico por imagen , Imagen por Resonancia MagnéticaRESUMEN
BACKGROUND: Scientific data regarding the prevalence of COVID-19 neurological manifestations and prognosis in Latin America countries is still lacking. Therefore, the study aims to understand neurological manifestations of SARS-CoV 2 infection and outcomes in the Brazilian population. METHODS: This study is part of the Brazilian COVID-19 Registry, a multicentric cohort, including data from 37 hospitals. For the present analysis, patients were grouped according to the presence of reported symptoms (i.e., headache; anosmia and ageusia; syncope and dizziness) vs. clinically-diagnosed neurological manifestations (clinically-defined neurological syndrome: neurological signs or diagnoses captured by clinical evaluation) and matched with patients without neurological manifestations by age, sex, number of comorbidities, hospital of admission, and whether or not patients had underlying neurological disease. RESULTS: From 6,635 hospitalized patients with COVID-19, 30.8% presented reported neurological manifestations, 10.3% were diagnosed with a neurological syndrome and 60.1% did not show any neurological manifestations. In patients with reported symptoms, the most common ones were headache (20.7%), ageusia (11.1%) and anosmia (8.0%). In patients with neurological syndromes, acute encephalopathy was the most common diagnosis (9.7%). In the matched analysis, patients with neurological syndromes presented more cases of septic shock (17.0 vs. 13.0%, p = 0.045), intensive care unit admission (45.3 vs. 38.9%, p = 0.023), and mortality (38.7 vs. 32.6%, p = 0.026; and 39.2 vs. 30.3%, p < 0.001) when compared to controls. CONCLUSION: COVID-19 in-hospital patients with clinically defined neurological syndromes presented a higher incidence of septic shock, ICU admission and death when compared to controls.
Asunto(s)
Ageusia , COVID-19 , Choque Séptico , Humanos , COVID-19/complicaciones , COVID-19/epidemiología , Ageusia/epidemiología , Ageusia/etiología , SARS-CoV-2 , Anosmia , Choque Séptico/complicaciones , Brasil/epidemiología , Cefalea/epidemiología , Cefalea/etiología , HospitalesRESUMEN
In early 2020, one of the most prevalent symptoms of SARS-CoV-2 infection was the loss of smell (anosmia), found in 60-70% of all cases. Anosmia used to occur early, concomitantly with other symptoms, and often persisted after recovery for an extended period, sometimes for months. In addition to smell disturbance, COVID-19 has also been associated with loss of taste (ageusia). The latest research suggests that SARS-CoV-2 could spread from the respiratory system to the brain through receptors in sustentacular cells localized to the olfactory epithelium. The virus invades human cells via the obligatory receptor, angiotensin-converting enzyme II (ACE2), and a priming protease, TMPRSS2, facilitating viral penetration. There is an abundant expression of both ACE2 and TMPRSS2 in sustentacular cells. In this study, we evaluated 102 COVID-19 hospitalized patients, of which 17.60% presented anosmia and 9.80% ageusia. ACE1, ACE2, and TMPRSS2 gene expression levels in nasopharyngeal tissue were obtained by RT-qPCR and measured using ΔCT analysis. ACE1 Alu287bp association was also evaluated. Logistic regression models were generated to estimate the effects of variables on ageusia and anosmia Association of ACE2 expression levels with ageusia. was observed (OR: 1.35; 95% CI: 1.098-1.775); however, no association was observed between TMPRSS2 and ACE1 expression levels and ageusia. No association was observed among the three genes and anosmia, and the Alu287bp polymorphism was not associated with any of the outcomes. Lastly, we discuss whetherthere is a bridge linking these initial symptoms, including molecular factors, to long-term COVID-19 health consequences such as cognitive dysfunctions.
Asunto(s)
Ageusia , Enzima Convertidora de Angiotensina 2/genética , COVID-19 , Trastornos del Olfato , Ageusia/etiología , Anosmia , COVID-19/genética , Cognición , Expresión Génica , Humanos , Trastornos del Olfato/genética , Receptores de Angiotensina , SARS-CoV-2RESUMEN
It is postulated that the inflammatory process resulting from SARS-CoV-2 infection is the main cause of smell and taste dysfunctions in patients. In view of this, photobiomodulation, due to its anti-inflammatory and antioxidant effects, may be a promising therapeutic modality to treat these disorders. In the present case report, we observed clinical improvement in the symptoms of anosmia and ageusia related to COVID-19 after treatment with photobiomodulation. Due to the inflammatory nature of COVID-19 and the anti-inflammatory effects, photobiomodulation antioxidants already proven in the literature make it a promising therapeutic modality, especially sequela COVID-related, including olfactory (anosmia) and taste (ageusia) dysfunction. In the present case report, the patient's olfactory and gustatory functions were re-established after 10 treatment sessions with photobiomodulation.
Asunto(s)
Ageusia , COVID-19 , Terapia por Luz de Baja Intensidad , Trastornos del Olfato , Ageusia/etiología , Anosmia , COVID-19/complicaciones , COVID-19/radioterapia , Humanos , Trastornos del Olfato/complicaciones , SARS-CoV-2 , Olfato , Trastornos del Gusto/complicacionesAsunto(s)
Humanos , Evaluación de Síntomas/estadística & datos numéricos , Atención Ambulatoria , COVID-19/diagnóstico , Servicio Ambulatorio en Hospital/estadística & datos numéricos , Examen Físico , Atención Primaria de Salud , Sesgo , Sesgo de Selección , Tos/diagnóstico , Tos/etiología , Ageusia/diagnóstico , Ageusia/etiología , Pandemias , Fiebre/diagnóstico , Fiebre/etiología , Evaluación de Síntomas/clasificación , Revisiones Sistemáticas como Asunto , SARS-CoV-2 , Anosmia/diagnóstico , Anosmia/etiología , COVID-19/complicacionesRESUMEN
Objective: To report two patients who developed systemic neurotoxicity after consecutive bites by the same coral snake.Case report: Two previously healthy men (32-year-old and 34-year-old) found a coral snake in a woodpile while collecting wood for a barbecue. During the barbecue, both men became drunk and "played" with the snake, believing that they were handling a false coral snake, and were bitten within a few minutes of each other. Both patients were admitted to a referral tertiary care hospital (175 km from where the bites occurred) 16 hours and 19 hours postbite; both showed similar features of envenomation: palpebral ptosis, muscle weakness, dysphagia, and generalized myalgia. No fang marks or local pain were detected in either case. The patients were successfully treated with Brazilian coral snake antivenom (Fab´2) and discharged one-day postadmission, with improvement of myasthenia, but still showing palpebral ptosis. The offending snake was identified as a 42-cm-long Micrurus corallinus. During follow-up, both patients reported a transitory loss of taste that lasted approximately 3-4 weeks postbite.Conclusion: Consecutive bites by the same coral snake may cause systemic neurotoxicity (acute myasthenia) in more than one person, as well as transitory loss of taste, an underreported complication of snakebites.
Asunto(s)
Ageusia/prevención & control , Antivenenos/uso terapéutico , Serpientes de Coral , Síndromes de Neurotoxicidad/prevención & control , Mordeduras de Serpientes/terapia , Adulto , Ageusia/diagnóstico , Ageusia/etiología , Animales , Antivenenos/administración & dosificación , Brasil , Humanos , Masculino , Síndromes de Neurotoxicidad/diagnóstico , Síndromes de Neurotoxicidad/etiología , Mordeduras de Serpientes/diagnóstico , Mordeduras de Serpientes/etiologíaRESUMEN
Five percent of the general population has olfactory or gustatory disorders, although most do not complain about it. However, in some cases, these symptoms can be disabling and may affect quality of life. Anosmia was reported as a possible complication following head injury and neurosurgical procedures, particularly after the resection of tumors located in the anterior fossa and the treatment of aneurysms in the anterior circulation. Nonetheless, in all of these situations, olfactory dysfunction could be explained by damage to the peripheral olfactory system. Here, the authors report a case of complete anosmia associated with ageusia following awake resection of a low-grade glioma involving the left temporoinsular region, with no recovery during a follow-up of 3 years. The frontal lobe was not retracted, and the olfactory tract was not visualized during surgery; therefore, postoperative anosmia and ageusia are likely explained by damage to the cortex and central pathways responsible for these senses. The authors suggest that the patient might have had a subclinical right hemianosmia before surgery, which is a common condition. After resection of the central structures critical for smell and taste processing in the left hemisphere, the patient could have finally had bilateral and complete olfactory and gustatory loss. This is the first known report of permanent anosmia and ageusia following glioma surgery. Because these symptoms might have been underestimated, more attention should be devoted to olfaction and taste, especially with regard to possible subclinical preoperative deficit.
Asunto(s)
Ageusia/etiología , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/cirugía , Glioma/patología , Glioma/cirugía , Procedimientos Neuroquirúrgicos/efectos adversos , Trastornos del Olfato/etiología , Complicaciones Posoperatorias/patología , Anestesia , Neoplasias Encefálicas/complicaciones , Corteza Cerebral/patología , Craneotomía , Vías Eferentes/lesiones , Vías Eferentes/patología , Femenino , Glioma/complicaciones , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Vías Olfatorias/patología , Complicaciones Posoperatorias/psicología , Convulsiones/etiología , Lóbulo Temporal/patología , Lóbulo Temporal/cirugíaRESUMEN
OBJECTIVE: Benign migratory glossitis (BMG) is a disease that affects the tongue and is considered an inflammatory disorder well recognized. It is characterized by the appearance of erosive areas on the dorsum and lateral border of the tongue that can be isolated or multiple. The aim of this study was to assess whether the perception of taste to the four basic tastes is altered due to the presence of BMG. METHODS: Forty individuals of both sexes with a mean age of 12.1 years were divided into two groups (20 BMG patients and 20 healthy controls) and had their taste function assessed in relation to four basic tastes: bitter, sour, sweet, and salty. RESULTS: All participants in the case group exhibited lesions over the dorsum, edges and tip of the tongue with a possible extension to the surface below. No statistic difference was observed between BMG patients and controls for the taste scores (Mann-Whitney U test: P=0.0955). The percentage of correctly identified taste strips for the highest concentrations was 100% for all tastes. For the lowest concentrations it was 85% for sweet, 50% for sour, 95% for salty, and 95% for bitter. Three patients with BMG and three control subjects showed hypogeusia. CONCLUSION: This study revealed that BMG is not able to change the perception of taste for salty, sweet, sour and bitter.