Abstract
COVID-19, an ongoing world pandemic, is caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). Many organizations have recognized that COVID-19 patients may have sudden loss of smell or taste and have included these symptoms in their diagnostic guidelines. However, the occurrence of anosmia and dysgeusia in COVID-19 reinfection is yet to be ascertained.
COVID-19, an ongoing world pandemic, is caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). Many organizations have recognized that COVID-19 patients may have sudden loss of smell or taste and have included these symptoms in their diagnostic guidelines. However, the occurrence of anosmia and dysgeusia in COVID-19 reinfection is yet to be ascertained.
A 21-year-old female developed sore throat. Her hostel roommate was positive for COVID-19 by reverse transcription polymerase chain reaction (RT-PCR). She underwent nasopharyngeal test by RT-PCR in July, 2020. She did not have any comorbidities and had no other symptoms. She tested positive for COVID-19, with a cycle threshold of 31.29. The COVID-19 infection resolved in 10 days, and nasopharyngeal swab test by RT-PCR was negative. This was followed by an asymptomatic period. In September 2020, she developed sudden onset complete loss of smell. She had no other symptoms. Given the current pandemic situation, she was advised COVID-19 testing by RT-PCR. The nasopharyngeal swab test was positive, with a cycle threshold of 20.31. The anosmia lasted for 2 weeks and thereafter, spontaneously resolved. Follow-up nasopharyngeal swab test, 2 weeks after symptom onset, was negative.
As the COVID-19 pandemic is evolving, now cases of reinfection from SARS-CoV-2 are being reported. 1 -5 The timing, symptoms, and severity of reinfection are still being studied. In this case, the patient was only mildly symptomatic during the first infection and the symptom resolved with the infection. However, the second infection was more severe than the initial one and the patient had complete loss of smell (anosmia), with a lower cycle threshold value. This highlights probable SARS-CoV-2 reinfection only 50 days after resolution of the initial infection in an immunocompetent girl. The reinfection may be more severe due to immune enhancement or infection by a more pathogenic strain. 2 Although the reinfection was more severe, the anosmia resolved spontaneously in 2 weeks. The higher viral load during reinfection highlights the need for continuous surveillance.
This case highlights that COVID-19 reinfection may also present as sudden loss of smell in an otherwise asymptomatic patient. This may help in diagnosing asymptomatic patients and thereby reducing disease transmission. At this time of ongoing pandemic, all patients presenting with sudden olfactory loss should undergo nasopharyngeal test for COVID-19.
