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대한악안면성형재건외과학회 Maxillofacial Plastic Reconstructive Surgery Maxillofacial Plastic Reconstructive Surgery 제42권 제4호
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2020.1
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Coronaviruses are known as enveloped viruses with apositive-sense single-stranded RNA genome that theirhelical symmetry nucleocapsid is about 26–32 kilobasesin size, making it the largest investigated genome amongRNA viruses. The disease caused by 2019 new coronavirus(2019-nCoV) was named coronavirus disease-19(COVID-19) by the World Health Organization in February2020. The 2019-nCoV is phylogenetically relatedto severe acute respiratory syndrome-coronavirus(SARS-CoV) [1]. It has been shown that 2019-nCov entersthe cell through the ACE2 cell receptor in the sameway as the severe acute respiratory syndrome (SARS)coronavirus [2]. 2019-nCoV effectively uses angiotensinconvertingenzyme 2 receptor (ACE2) as a receptor forcell invasion [3]. Primary non-specific reported symptomsof 2019-nCoV infection at the prodromal phaseare malaise, fever, and dry cough. The most commonlyreported signs and symptoms are fever (98%), cough(76%), dyspnea (55%), and myalgia or fatigue (44%) [4]. Our information on the probability and effect of 2019-nCoV on the peripheral and central nervous system is stillscarce and therefore unreliable. There have been variousstudies evaluating coronavirus’s effects on the central nervoussystem. These studies suggest that the human centralnervous system (CNS)may be susceptible to coronavirus infection[5]. Routes intended for central nervous system infectionwith coronaviruses are peripheral trigeminal or olfactorynerves following intranasal inoculation [6, 7]. The findings ofstudies on rodents show that these viruses cause demyelinationand stimulate T cell-mediated autoimmune reactionsagainst CNS antigens producing the question about the relationbetween coronaviruses especially the 2019-nCoV andneurologic disorder in humans. Given that the peripheral trigeminalor olfactory nerves are pathways of penetration ofthe coronaviruses into the central nervous system, and basedon animal studies, it may be hypothesized that complicationssuch as demyelination and stimulation of T cell-mediatedautoimmune reactions may occur in the path of the infectionspreading, so the occurrence of dysosmia and dysgeusia canbe considered potential consequences of these nerve injuries. Numerous reports of loss of sense of smell and tastehave been received from Iranian people as one of themost heavily involved countries with COVID-19 duringthe outbreak of the disease [8, 9]. Significant numbers ofpeople with confirmed COVID-19 also reported acomplete or partial loss of their sense of smell and tastein the early stages. Initial investigations also indicate thatin some cases, if one member of a family has experiencedsuch symptoms, other family members have experiencedsimilar symptoms over a short period of time. Another primary point that needs further investigationis that in confirmed COVID-19 patients with reporteddysosmia and dysgeusia, often, other manifestations wereless severe and the patients frequently recovered morequickly. In addition to what has been said that requirefurther investigations to establish their validity, the timelinessor permanence of these complications, as well ashow they are likely to be managed and treated, are ofparticular importance and require thoughtful scrutiny. Although there is not sufficient evidence to make a definitivejudgment and need more comprehensive investigations,two scenarios are more likely to be suggested asthe cause of such an incident. The appearance of dysosmiaand dysgeusia whether can be attributed to olfactorynerve and trigeminal nerve damage caused by the 2019-nCoV infection or excessive exposure to chemicals anddisinfectants that are more commonly used by peopledue to the viral epidemic. Designing a study to assess the validity of such a hypothesis is important in that itcan be considered a relatively acceptable diagnostic criterionfor both the individual and the physicians. Sincethe existence of such a relationship is likely, it alsoseems likely that during the COVID-2019 outbreak,those who experience complications such as dysosmiaand dysgeusia should be considered potential carriers ofthe virus and that in addition to necessary hygiene measurements,they must quarantine themselves.

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참고문헌 (9)

참고문헌 신청
Gorbalenya A / 2020 / The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2 / Nature Microbiology 5(4):536~544 Crossref Letko MC / 2020 / Functional assessment of cell entry and receptor usage for lineage B β-coronaviruses, including 2019-nCoV / bioRxiv google schola Zhou P / 2020 / A pneumonia outbreak associated with a new coronavirus of probable bat origin / Nature 579:270~273 google schola Chen N / 2020 / Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China : a descriptive study / Lancet 395(10223):507~513 google schola Bergmann CC / 2006 / Coronavirus infection of the central nervous system : host–virus stand-off / Nat Rev Microbiol 4(2):121~132 google schola

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