Acute Parotitis: A Possible Precocious Clinical Manifestation of SARS‐CoV‐2 Infection?

Since February 2020, the COVID-19 outbreak has spread rapidly in Northern Italy, determining an immediate rise in case numbers that have been accompanied by an unprecedented public health action.Due to the continuous admissions of patients with SARS-CoV-2 infection at San Gerardo Hospital in Monza, our ear, nose, and throat team visited a large number of patients with SARS-CoV-2 infection and noted a high frequency of presenting olfactory dysfunctions.In this cohort of patients, we observed the following: (1) anosmia or hyposmia usually occurred after fever but could also occur isolated (ie, without any systemic symptom); (2) most patients were young; and (3) there were no sex differences.The early outcome (from 1 to 3 weeks of follow-up) showed absence or only partial recovery.Due to the current health emergency, we reported our first clinical observations informally, as it was not possible to systematically collect and analyze the data.Awareness of this neglected association may be of great help in clinical practice, allowing one to promptly identify patients without respiratory symptoms who could nonetheless inadvertently spread the disease or subsequently worsen into a frank acute respiratory syndrome.Anosmia or hyposmia could be explained by the neurotropism of SARS-CoV-2. 1,2 Given available evidence on the evolutionary related SARS-CoV, Li et al suggested that the neurologic damage may play a role in the development of acute respiratory failure as well as other neurologic symptoms of COVID-19, such as headache, nausea, and vomiting. 1 The brain dissemination may occur via circulation and/or a nasal transcribrial route.This latter pathway may explain the frequently observed smell alterations.In fact, transient secondary olfactory dysfunction after upper respiratory tract infection is common, with reported incidences between 38% 3 and 50%. 4 The most common pathogens include viruses such those causing common cold and human influenza, rarely human coronavirus. 5 Considering the large number of patients with COVID-19 presenting anosmia or hyposmia, we presumed that the incidence of postinfectious olfactory dysfunctions could be higher and clinically more relevant in these patients.In light of this, anosmia or hyposmia should promptly trigger suspected COVID-19 for general practitioners during this current epidemic phase.Further studies are needed to quantify this early clinical evidence and to disentangle the long-term evolution.

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