COVID-19 Damage Seen in Olfactory System: JAMA study
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SARS-CoV-2 particles and associated inflammation were seen in the olfactory nervous system of patients who had severe COVID-19, a report from Italy showed.

Minimally invasive autopsy with nasal endoscopic dissection showed viral particles and CD163-positive microglial cells in the olfactory complex of two COVID patients, reported authors in JAMA Otolaryngology.

These finding is important because it is the first evidence of a direct SARS-CoV-2 infection in cells of the olfactory bulb, in the central nervous system.

In the olfactory bulb of the first patient, who died of COVID-19 pneumonia in the ICU, authors found intracytoplasmic viral inclusion bodies, interstitial viral particles, and marked CD163-positive/CD68-negative microglial cell infiltration.

In the second COVID-19 patient, who died of cardiopulmonary transthyretin amyloidosis, they found viral particles on the cell membrane of ciliated respiratory cells in the olfactory mucosa. The researchers also saw CD163-positive microglial cells and CD3-positive/CD8-positive perivascular lymphocytes in the olfactory bulb, but no ultrastructural evidence of viral particles.

These findings suggest that passive diffusion and axonal transport through the olfactory complex may be a major route of SARS-CoV-2 entry into the central nervous system, as it was previously shown in animal studies with a human coronavirus strain, human coronavirus OC43.

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