SARS-CoV-2 infection has caused an estimated 360 million illnesses and 5.6 million deaths since the start of the COVID-19 pandemic. Although vaccine coverage against the SARS-CoV-2 virus is increasing globally, the first incident of Omicron, a new form of concern, has been reported. Since then, Omicron has spread rapidly around the world, transforming Delta and creating new outbreaks in several countries.
“Since the pandemic began, ZOE has consistently documented the most common COVID symptoms and how they have changed over time,” according to the ZOE Health Study, which collects data on patients’ symptoms.
“These symptoms have evolved due to a variety of factors, including the introduction of vaccines and the appearance of new variants.”
“The SARS-CoV-2 coronavirus that causes COVID-19, like all viruses, is constantly evolving in terms of its transmissibility and the symptoms it causes.”
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A case series of COVID-19-positive patients presenting to the ENT for acute odynophagia, severe sore throat, and fever is presented.
In the first weeks of the Omicron wave in Sweden, “we saw a large number of young patients with this clinical sign of SARS-CoV-2 infection. Acute laryngitis and/or pharyngitis associated with COVID-19 occurred in all subjects.”
The triad of clinical symptoms presented by these patients indicated that they were suffering from potentially fatal epiglottitis. As a result, an urgent clinical examination, including laryngoscopy, was required to establish the diagnosis and guide treatment.
“None of the subjects in this trial had a swollen or edematous epiglottis that required airway care. Only one patient had edema in the arytenoid region.”
“However, we found seven cases of acute epiglottitis with concurrent COVID-19 infection in the literature, so this diagnosis should be investigated and quickly excluded, especially if the patient presents with a characteristic clinical triad,” ZOE health research claimed.
The clinical presentation of SARS-CoV-2 infection has evolved into a common COVID-19 symptom of the Omicron form with acute odynophagia, severe sore throat, and fever. Symptoms such as cough, fever, and loss of taste or smell were more common in past waves. Currently, patients infected with Omicron rarely report these symptoms.
Preliminary studies show that Omicron causes milder symptoms than Delta, although it is not clear whether the lower severity is due to the characteristics of the variant or to increased global vaccine immunity. Although early studies show that Omicron is milder, a significant number of patients need to be hospitalized to manage their symptoms. In the described cohort, 20% required hospitalization for symptomatic treatment. All patients received at least two doses of the COVID-19 vaccine.
The study author added: “After ruling out epiglottitis, patients in the described cohort were diagnosed with acute viral laryngitis or acute viral pharyngitis based on laryngoscopy images of the larynx and hypopharynx.”
A few patients with secondary bacterial infections were given oral antibiotics. Acute laryngitis is traditionally treated with voice rest, analgesic medications, and hydration. According to the results of a Cochrane review of the benefits of antibiotic treatment for acute laryngitis in adults, antibiotics do not appear to be effective in treating this condition.
Finally, we present a case series of 20 patients presented to our ENT ED with COVID-19-related laryngotracheitis and pharyngitis during the SARS-CoV-2 Omicron wave. The most common symptoms in these patients were acute odynophagia, severe sore throat, and fever.
Most of the patients were young, healthy and had received the COVID-19 vaccine. This clinical manifestation of COVID-19 was uncommon in previous waves. Since similar symptoms are associated with the potentially fatal disease epiglottitis, a rapid examination of the larynx is recommended to rule out inflammatory emphysema of the upper respiratory tract.
None of the patients with odynophagia associated with COVID-19 had edema of the larynx or epiglottis, resulting in airway obstruction. Despite being vaccinated against COVID-19, 20% of patients need to be hospitalized for treatment of symptoms. In the absence of airway edema, acute odynophagia is treated with high-dose analgesics, NSAIDs, and local anesthetics to numb the mucous membranes of the mouth and throat. In severe cases, inhaled epinephrine and oral/intravenous corticosteroids may be required to relieve symptoms.
Reference:
- Acute odynophagia: a new symptom of COVID-19 during the SARS-CoV-2 Omicron variant wave in Sweden – (https:pubmed.ncbi.nlm.nih.gov/35170099/)
Source: Medium
