key: cord-0942496-sh038dpq
authors: Jolobe, Oscar M.P.
title: Oligosymptomatic COVID-19 infection also needs to be recognised
date: 2021-03-14
journal: Am J Emerg Med
DOI: 10.1016/j.ajem.2021.03.030
sha: a986971215dea1cc084259f751a11f84c4e60fa8
doc_id: 942496
cord_uid: sh038dpq

nan

Oligosymptomatic COVID-19 infection also needs to be recognised For the sake of completeness chief complaint data presented by Clifford et al. [1] ought to take cognisance of the entity of oligosymptomatic or even single symptom COVID-19 clinical presentation. Whether or not oligosymptomatic clinical presentation foretells a more benign outcome will then need to be evaluated by a prospective study.

In one report, a married couple noticed that the wife had developed anosmia and the husband had developed agneusia after close contact with a person who had proven COVID-19 infection, the latter characterised by fever, cough, breathlessness, and a positive test for SARS-CoV2-2RNA. The married couple experienced no other symptoms for 16 and 10 days, respectively, in spite of testing positive for SARS-CoV-2-RNA. Furthermore, no new symptoms developed after remission of their single symptom experience of COVID-19 infection [2] . Heidari et al. prospectively enrolled 23 cases with a chief complaint of recent anosmia, and in whom the real-time reverse-transcriptase polymerase chain reaction(RT-PCR) test on nasal and pharyngeal samples was positive. Mean age was 37.4 years. There were 15 women and 8 men. Sixteen had only anosmia as a presenting symptom but the duration of anosmia as the sole symptom was not reported [3] .

In another report, a 48 year old man who also had a positive RT-PCR test experienced anosmia as his only symptom for an entire 6 days during which he was being monitored [4] .

Conjunctivitis was an isolated symptom of COVID-19 infection in a 32 year old otherwise healthy healthcare worker who also had a positive RT-PCR test. The duration of his symptoms was not reported [5] .

Fatigue was the sole symptom in 7.6% of 268 healthcare workers who were seropositive for COVID-19-related Immunoglobulin G. The duration of the "stand alone" malaise was not reported [6] .

Although a self-limited course was reported in the married couple [2] , and in the 48 year old man who had been monitored for 6 days [4] , an unfavourable outcome was documented in a 59 year old lady who experienced agneusia as the sole symptom for approximately week before she presented to hospital with breathlessness. Further investigations disclosed a C Reactive protein of 192.1(? units), positive RT-PCR test on a nasopharyngeal swab, and a computed tomography evaluation which showed multiple patchy ground glass opacities in bilateral subpleural location. She subsequently experienced severe hypoxemia necessitating admission to Intensive Care and administration of oxygen by continuous positive airways pressure. She ultimately made a good recovery [7] .

Anosmia, ageunusia, conjunctivitis, and malaise can be "stand alone" presenting symptoms of COVID-19 infection. Patients with this presentation need to be recognised, and their viral load documented to ascertain to what extent they may infect others. Furthermore the duration of "stand alone" symptoms should be documented, and its final outcome ascertained.

I have no funding and no conflict of interest.

Association between COVID-19 diagnosis and presenting chief complaint from New York City triage data

Loss of smell or tase as the only symptom of COVID-19

Anosmia as a prominent symptom of COVID 19 infection

Isolated sudden onset anosmia in COVID-19 infection. A novel syndrome?

Conjunctivitis as sole symptom of COVID-19: a case report and review of literature

SARS-CoV-2 exposure, symptoms, and seroprevalence in healthcare workers in Sweden

Hypogeusia as the initial presenting symptom of COVID-19