PAROSMIA

A side e ect of COVID-19

Vanshika and Sreeya

B.Sc II | GCZ (010, 011)

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Abstract

In this report, we present two cases of delayed parosmia, a rare complication that occurs in the
later period after COVID-19. A 19-year-old female and their sibling, a 17-year-old female, found to
be positive in rRT-PCR tests for SARS-CoV-2 a couple days apart, had a loss of taste and
smell, during the period of infection. Following the regaining of their ability to smell after the
recovery, both the patients have reported to have smelt burning flesh/rubber. Following months of the
same, a self-diagnosis of delayed parosmia was made by the patients -which then later was confirmed
by a general physician- occurring in the late period secondary to SARS-CoV-2 infection. Although
anosmia is a common symptom in the early phase of COVID-19, olfactory damage due to Sars-CoV-2
can be persistent, and distorted sense of smell can be prolonged and as a result can lead to parosmia.

Keywords: Parosmia, SARS-CoV-2, COVID-19, Olfactory dysfunction.

Introduction

Parosmia is a debilitating disease in which familiar smells become distorted and unpleasant. Prior to
[1]

COVID-19 little was known about such olfactory disorder and often cases such as these would be
dismissed by medical health care professionals. With the rise of SARS-CoV-2, they have been
gathering attention more than ever. Traditionally parosmia is caused due to damage in the olfactory
bulb or neurons pertaining to olfactory regions of the nose and brain and a few studies have shown the
pathological pathways that might cause these disorders. These damages can sometimes be caused by
infections in the upper respiratory tract, head injuries, radiation and chemotherapy, and a few
neurological conditions like Parkinson’s and Alzheimer’s. Parosmia is usually seen after COVID-19
as it is, in some cases, caused by a virus.

Although COVID-19 is predominantly associated with fever, fatigue, generalized body ache, and
pulmonary symptoms, smell and taste disorders are also common in most patients. COVID is
[2]

accompanied by initial anosmia followed by parosmia. The suspected reason for this is the persistent
degeneration of neurons and the low number of partially healing neurons. Parosmia can cause
physical and psychological torment to its patients.

The following hypothesis deals with two cases who have dealt with parosmia. Case 1 and Case 2 are
biologically related; they are siblings.

Case 1

Case 1 is a female aged 19 and suffered from COVID in the second wave and got diagnosed on 24
April 2021. It took her one month to recover from COVID after which for more than 2 weeks she
suffered from anosmia but retained her sense of taste. A few weeks later she regained her sense of
smell but the smells around her were disoriented. She describes the initial smells, after regaining her
ability to smell, like that of burning rubber. This distorted smell developed nausea and a gagging
sensation which was not followed by emesis. This led to a repulsive feeling towards food. Case 1 lost
6 kilograms in less than a month due to a lack of food and proper nutrition. The sudden loss in weight
was accompanied by joint ache, inability to do basic daily tasks and it made the body physically
weaker than before. She had an irregular menstrual cycle due to PCOD and this isn’t related to her
physical condition post-COVID. When she went to the doctor no medication was prescribed and was
suggested to eat while covering the nose which aided in regaining some of the flavour of the food
back. In addition to food, she also started with a protein supplement powder which made the recovery
process a lot faster than before.

The condition still exists even after the passage of 5 months. However, the peak of the condition is
over after reaching the three-month mark. Some of the triggers in the initial stages included body
odour, pungent smell while micturating, onion, cumin, cooked vegetables, milk and dry fruits. The
fruits eaten during the initial phases of parosmia tasted like chemicals. Now the only triggers that
remain are body odour, which isn’t as strong as before, pungent smell while micturating, sewer water
smell. Dry fruits like cashew nuts don’t taste the same but no notable smell can be detected from
them. . Most of the triggers have subsided as time passed.

Psychologically case 1 experienced many changes such as hysteria at the thought of eating and
occasional peaks of mild depression. The news of being diagnosed with parosmia was a shock as well
as she wasn’t informed about it beforehand. Parosmia caused frustration due to the inability to do
basic tasks like texting and eating and sleep deprivation due to terrible joint aches which caused
difficulty in falling asleep. Through trial and error, she figured which food items can be eaten. She is
slowly going back to her normal lifestyle of eating and sleeping regularly.

Case 2

Case 2 is a female aged 17 and also suffered from COVID during the second wave. She was
diagnosed with COVID-19 on 21 April 2021 and recovered around mid-May. She had self-diagnosed
herself with parosmia a few weeks after recovering from COVID when she experienced a disoriented
smell and food taste. Her first account was anosmia which was followed by parosmia where she also
smelt burning rubber. The smells caused nausea which was not followed by emesis. Throughout the
whole experience Case 2 checked her weight twice and found it to be fairly consistent. She also has a
regular menstrual cycle. She, however, did experience foggy memory and forgot simple things such as
charging her phone or instructions given at home. She hasn’t had issues remembering important
information. When she consulted her general physician, she was advised to eat food while covering
her nose which helped her to eat. She was not prescribed any medication; rather she was advised to
take a protein supplement which aided in her recovery. She started showing progress two weeks after
taking the supplement.

Her condition also persists three months after initially discovering parosmia. The peak of her
condition was around three months where it was mentally and physically hard for her. Case 2’s initial
triggers included onions, fried food, steamed food, milk, body odor and pungent while micturating.
She also felt a heightened taste of chemicals in fruits. Currently, the only strong triggers that remain
include body odor, pungent smell while micturating and onions among the others which aren’t as
strong anymore.

Psychologically Case 2 underwent mild depression and hysteria at the thought of not being able to eat.
She was frustrated more than usual and was easily irritated. Like Case 1 she followed the trial and
error method and was soon is almost back to normal.

Both Case 1 and Case 2 have almost recovered their sense of smell and are slowly going back to their
lifestyle in terms of eating pre-COVID i.e. their lifestyle before they got affected by COVID.
Conclusion

Parosmia causes distortion of smell and although it has been proved that olfactory neurons do play a
part in causing this condition the exact causes of how distorted smell can be related back to the neuron
remains unknown. Parosmia seems to arise in only some of those suffering COVID-19-related
anosmia and occurs later on in the course of the disease or during recovery. [3]

With SARS-CoV-2 still persisting, and numerous people still showing various complications and
different responses to the said complications, it is hard to come to a definitive conclusion. From the
surveys we have conducted we concluded that different individuals have reported having smelt
different smells, like burning flesh/rubber, chemically smell or pungent scent of the sewer which can
further be explained by a possible theory that is attributed to the unique regenerating capability of the
olfactory neurons, whereby the new regenerated olfactory neurons sprouts and reconnects to the brain
results in a trial-and-error process thereby sending wrong signals and getting distorted responses.
[3]

Since the subjects we have conducted a detailed survey on are siblings and show similar paths of
effects and recovery, we have a basis for considering that genetics is a potential factor for parosmia.
Also, we have noted that several individuals who were infected by the SARS-CoV-2 during the first
wave of the viral outbreak in our country India, have not shown parosmia as a side effect of
COVID-19. Parosmia seems to be unique to the individuals who were infected in the second wave of
the viral outbreak in the country. We have also concluded that the peak of parosmia seems to be
similar with the individuals who were affected- around 3 months after initial observation of distorted
sense of smell.

References

1. Molecular Mechanism of Parosmia Jane K. Parker, Christine E. Kelly, Simon B. Gane

medRxiv 2021.02.05.21251085;

2. Duyan, M., Ozturan, I.U. & Altas, M. Delayed Parosmia Following SARS-CoV-2 Infection: a
Rare Late Complication of COVID-19. SN Compr. Clin. Med. 3, 1200–1202 (2021). https://
doi.org/10.1007/s42399-021-00876-6

3. Saniasiaya J, Narayanan PParosmia post COVID-19: an unpleasant manifestation of long COVID

syndromePostgraduate Medical Journal

4. Konstantinidis I, Tsakiropoulou E, Hähner A, de With K, Poulas K, Hummel T. Olfactory

dysfunction after coronavirus disease 2019 (COVID-19) vaccination. Int Forum Allergy Rhinol.
2021;11(9):1399-1401. doi:10.1002/alr.22809