Olfaktorni bulbus – ulaz za SARS-Cov-2?
Sažetak
Uvod. Gubitak čula mirisa i ukusa spadaju u najčešće i najtipičnije simptome infekcije izazvane virusom SARS-Cov-2 (severe acute respiratory syndrome coronavirus 2), sa učestalošću od skoro 50% kod obolelih u zemljama Zapada. Javlja se sve više hipoteza o potencijalnim infekcijama centralnog nervnog sistema (CNS) tim virusom. Pretpostavlja se da virus ulazi u organizam preko nosne sluzokože, pa zatim putem laminae cribrosae ulazi u olfaktorni bulbus, sa daljom diseminacijom u CNS. Prikaz bolesnika. Bolesnica, stara 34 godine, žalila se na gubitak čula mirisa i ukusa oko dva meseca pre nego što je test pokazao da je bila pozitivna na SARS-Cov-2. Bolest koju izaziva SARS-Cov-2 (COVID-19) se ispoljila blagom pneumonijom i smanjenom osetljivosti čula mirisa i ukusa. Nakon lečenja, bolesnica se oporavila, ali su se gubitak čula mirisa i ukusa ponovo pojavili, sa varijacijama u intenzitetu, da bi od februara 2021. postali uporni. Bolesnica je praćena od strane otorinolaringologa, pulmologa i, na kraju, neurologa. U međuvremenu, test je pokazao da je bolesnica bila negativna na SARS-Cov-2, posle čega je primila dve doze vakcine Sputnik V. Urađena je magnetna rezonanca (MR) mozga, koja je jasno pokazala izraženu obostranu atrofiju olfaktornog bulbusa. Bolesnica do danas ima gubitak čula mirisa i ukusa i planirano je dalje praćenje MR-om. Zaključak. Gubitak čula mirisa i ukusa mogu biti prediktori dalje CNS diseminacije virusa i potencijalnih neuroloških komplikacija (što je još uvek predmet razmatranja). Olfaktorni bulbus bi mogao predstavljati mesto ulaska virusa u CNS, a atrofija bulbusa bi mogla biti indikator tog procesa. Za definitivne zaključke potrebna su dalja istraživanja na tu temu, uključujući i širu primenu snimanja MR-om.
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