Activity

Activity ID

12879

Expires

April 13, 2025

Format Type

Journal-based

CME Credit

1

Fee

$30

CME Provider: JAMA Neurology

Description of CME Course

Importance  Loss of smell is an early and common presentation of COVID-19 infection. Although it has been speculated that viral infection of olfactory neurons may be the culprit, it is unclear whether viral infection causes injuries in the olfactory bulb region.

Objective  To characterize the olfactory pathology associated with COVID-19 infection in a postmortem study.

Design, Setting, and Participants  This multicenter postmortem cohort study was conducted from April 7, 2020, to September 11, 2021. Deceased patients with COVID-19 and control individuals were included in the cohort. One infant with congenital anomalies was excluded. Olfactory bulb and tract tissue was collected from deceased patients with COVID-19 and appropriate controls. Histopathology, electron microscopy, droplet digital polymerase chain reaction, and immunofluorescence/immunohistochemistry studies were performed. Data analysis was conducted from February 7 to October 19, 2021.

Main Outcomes and Measures  (1) Severity of degeneration, (2) losses of olfactory axons, and (3) severity of microvasculopathy in olfactory tissue.

Results  Olfactory tissue from 23 deceased patients with COVID-19 (median [IQR] age, 62 [49-69] years; 14 men [60.9%]) and 14 control individuals (median [IQR] age, 53.5 [33.25-65] years; 7 men [50%]) was included in the analysis. The mean (SD) axon pathology score (range, 1-3) was 1.921 (0.569) in patients with COVID-19 and 1.198 (0.208) in controls (P < .001), whereas axon density was 2.973 (0.963) × 104/mm2 in patients with COVID-19 and 3.867 (0.670) × 104/mm2 in controls (P = .002). Concomitant endothelial injury of the microvasculature was also noted in olfactory tissue. The mean (SD) microvasculopathy score (range, 1-3) was 1.907 (0.490) in patients with COVID-19 and 1.405 (0.233) in control individuals (P < .001). Both the axon and microvascular pathology was worse in patients with COVID-19 with smell alterations than those with intact smell (mean [SD] axon pathology score, 2.260 [0.457] vs 1.63 [0.426]; P = .002; mean [SD] microvasculopathy score, 2.154 [0.528] vs 1.694 [0.329]; P = .02) but was not associated with clinical severity, timing of infection, or presence of virus.

Conclusions and Relevance  This study found that COVID-19 infection is associated with axon injuries and microvasculopathy in olfactory tissue. The striking axonal pathology in some cases indicates that olfactory dysfunction in COVID-19 infection may be severe and permanent.

Disclaimers

1. This activity is accredited by the American Medical Association.
2. This activity is free to AMA members.

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Educational Objectives

o Recognize the importance of managing diabetes and obesity in patients with serious mental illness
o Compare and contrast the physiologic roles of the incretin hormones GLP-1 and GIP
o List the FDA-approved indications for GLP-1 receptor agonists and dual GLP-1/GIP receptor agonists
o Critically assess the therapeutic benefits and potential risks of
o GLP-1 receptor agonists and GLP-1/GIP receptor agonists in
o mental health patients

Keywords

Coronavirus (COVID-19), Pathology and Laboratory Medicine, Olfaction and Taste, Otolaryngology, Infectious Diseases

Competencies

Medical Knowledge

CME Credit Type

AMA PRA Category 1 Credit

DOI

10.1001/jamaneurol.2022.0154

Practice Setting

Academic Medicine, Inpatient, Outpatient, Rural, Urban, VA/Military

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