Giving a Voice to Patients With Smell Disorders Associated With COVID-19: Cross-Sectional Longitudinal Analysis Using Natural Language Processing of Self-Reports

BACKGROUND

Smell disorders are commonly reported with COVID-19 infection. The smell-related issues associated with COVID-19 may be prolonged, even after the respiratory symptoms are resolved. These smell dysfunctions can range from anosmia (complete loss of smell) or hyposmia (reduced sense of smell) to parosmia (smells perceived differently) or phantosmia (smells perceived without an odor source being present). Similar to the difficulty that people experience when talking about their smell experiences, patients find it difficult to express or label the symptoms they experience, thereby complicating diagnosis. The complexity of these symptoms can be an additional burden for patients and health care providers and thus needs further investigation.

OBJECTIVE

This study aims to explore the smell disorder concerns of patients and to provide an overview for each specific smell disorder by using the longitudinal survey conducted in 2020 by the Global Consortium for Chemosensory Research, an international research group that has been created ad hoc for studying chemosensory dysfunctions. We aimed to extend the existing knowledge on smell disorders related to COVID-19 by analyzing a large data set of self-reported descriptive comments by using methods from natural language processing.

METHODS

We included self-reported data on the description of changes in smell provided by 1560 participants at 2 timepoints (second survey completed between 23 and 291 days). Text data from participants who still had smell disorders at the second timepoint (long-haulers) were compared with the text data of those who did not (non-long-haulers). Specifically, 3 aims were pursued in this study. The first aim was to classify smell disorders based on the participants' self-reports. The second aim was to classify the sentiment of each self-report by using a machine learning approach, and the third aim was to find particular food and nonfood keywords that were more salient among long-haulers than those among non-long-haulers.

RESULTS

We found that parosmia (odds ratio [OR] 1.78, 95% CI 1.35-2.37; P<.001) as well as hyposmia (OR 1.74, 95% CI 1.34-2.26; P<.001) were more frequently reported in long-haulers than in non-long-haulers. Furthermore, a significant relationship was found between long-hauler status and sentiment of self-report (P<.001). Finally, we found specific keywords that were more typical for long-haulers than those for non-long-haulers, for example, fire, gas, wine, and vinegar.

CONCLUSIONS

Our work shows consistent findings with those of previous studies, which indicate that self-reports, which can easily be extracted online, may offer valuable information to health care and understanding of smell disorders. At the same time, our study on self-reports provides new insights for future studies investigating smell disorders.

Evaluation of a Push-Pull Strategy for Spotted-Wing Drosophila Management in Highbush Blueberry

We evaluated a novel push-pull control strategy for protecting highbush blueberry, Vaccinium corymbosum, against spotted-wing drosophila (SWD), Drosophila suzukii. Methyl benzoate (MB) was used as the pushing agent and a previously tested SWD attractive blend of lure-scents was used as the pulling agent. MB dispensers (push) were hung in the canopy and lure-scent dispensers (pull) were hung in yellow jacket traps filled with soapy water around the blueberry bushes. Blueberries were sampled weekly, and any infestation was inspected by examining the breathing tubes of SWD eggs which protrude through the skin of infested fruit. The frequency of infestation, i.e., the proportion of berries infested with at least one egg, and the extent of infestation, i.e., the mean number of eggs in infested berries, were significantly reduced in treatments receiving MB dispensers as a pushing agent when infestation rates were very high. However, the mass trapping devices as a pulling agent did not provide comparable protection on their own and did not produce additive protection when used in combination with the MB dispensers in push-pull trials. We conclude that MB has the potential to be implemented as a spatial repellent/oviposition deterrent to reduce SWD damage in blueberry under field conditions and does not require the SWD attractant as a pulling agent to achieve crop protection.

Endocannabinoid-mediated neuromodulation in the main olfactory bulb at the interface of environmental stimuli and central neural processing

The olfactory system has become an important functional gateway to understand and analyze neuromodulation since olfactory dysfunction and deficits have emerged as prodromal and, at other times, as first symptoms of many of neurodegenerative, neuropsychiatric and communication disorders. Considering olfactory dysfunction as outcome of altered, damaged and/or inefficient olfactory processing, in the current review, we analyze how olfactory processing interacts with the endocannabinoid signaling system. In the human body, endocannabinoid synthesis is a natural and on-demand response to a wide range of physiological and environmental stimuli. Our current understanding of the response dynamics of the endocannabinoid system is based in large part on research advances in limbic system areas, such as the hippocampus and the amygdala. Functional interactions of this signaling system with olfactory processing and associated pathways are just emerging but appear to grow rapidly with multidimensional approaches. Recent work analyzing the crystal structure of endocannabinoid receptors bound to their agonists in a signaling complex has opened avenues for developing specific therapeutic drugs that could help with neuroinflammation, neurodegeneration, and alleviation/reduction of pain. We discuss the role of endocannabinoids as signaling molecules in the olfactory system and the relevance of the endocannabinoid system for synaptic plasticity.

Recent Smell Loss Is the Best Predictor of COVID-19 Among Individuals With Recent Respiratory Symptoms

In a preregistered, cross-sectional study, we investigated whether olfactory loss is a reliable predictor of COVID-19 using a crowdsourced questionnaire in 23 languages to assess symptoms in individuals self-reporting recent respiratory illness. We quantified changes in chemosensory abilities during the course of the respiratory illness using 0-100 visual analog scales (VAS) for participants reporting a positive (C19+; n = 4148) or negative (C19-; n = 546) COVID-19 laboratory test outcome. Logistic regression models identified univariate and multivariate predictors of COVID-19 status and post-COVID-19 olfactory recovery. Both C19+ and C19- groups exhibited smell loss, but it was significantly larger in C19+ participants (mean ± SD, C19+: -82.5 ± 27.2 points; C19-: -59.8 ± 37.7). Smell loss during illness was the best predictor of COVID-19 in both univariate and multivariate models (ROC AUC = 0.72). Additional variables provide negligible model improvement. VAS ratings of smell loss were more predictive than binary chemosensory yes/no-questions or other cardinal symptoms (e.g., fever). Olfactory recovery within 40 days of respiratory symptom onset was reported for ~50% of participants and was best predicted by time since respiratory symptom onset. We find that quantified smell loss is the best predictor of COVID-19 amongst those with symptoms of respiratory illness. To aid clinicians and contact tracers in identifying individuals with a high likelihood of having COVID-19, we propose a novel 0-10 scale to screen for recent olfactory loss, the ODoR-19. We find that numeric ratings ≤2 indicate high odds of symptomatic COVID-19 (4 < OR < 10). Once independently validated, this tool could be deployed when viral lab tests are impractical or unavailable.

More Than Smell-COVID-19 Is Associated With Severe Impairment of Smell, Taste, and Chemesthesis

Recent anecdotal and scientific reports have provided evidence of a link between COVID-19 and chemosensory impairments such as anosmia. However, these reports have downplayed or failed to distinguish potential effects on taste, ignored chemesthesis, and generally lacked quantitative measurements. Here, we report the development, implementation and initial results of a multi-lingual, international questionnaire to assess self-reported quantity and quality of perception in three distinct chemosensory modalities (smell, taste, and chemesthesis) before and during COVID-19. In the first 11 days after questionnaire launch, 4039 participants (2913 women, 1118 men, 8 other, ages 19-79) reported a COVID-19 diagnosis either via laboratory tests or clinical assessment. Importantly, smell, taste and chemesthetic function were each significantly reduced compared to their status before the disease. Difference scores (maximum possible change ±100) revealed a mean reduction of smell (-79.7 ± 28.7, mean ± SD), taste (-69.0 ± 32.6), and chemesthetic (-37.3 ± 36.2) function during COVID-19. Qualitative changes in olfactory ability (parosmia and phantosmia) were relatively rare and correlated with smell loss. Importantly, perceived nasal obstruction did not account for smell loss. Furthermore, chemosensory impairments were similar between participants in the laboratory test and clinical assessment groups. These results show that COVID-19-associated chemosensory impairment is not limited to smell, but also affects taste and chemesthesis. The multimodal impact of COVID-19 and lack of perceived nasal obstruction suggest that SARS-CoV-2 infection may disrupt sensory-neural mechanisms.

The best COVID-19 predictor is recent smell loss: a cross-sectional study

BACKGROUND

COVID-19 has heterogeneous manifestations, though one of the most common symptoms is a sudden loss of smell (anosmia or hyposmia). We investigated whether olfactory loss is a reliable predictor of COVID-19.

METHODS

This preregistered, cross-sectional study used a crowdsourced questionnaire in 23 languages to assess symptoms in individuals self-reporting recent respiratory illness. We quantified changes in chemosensory abilities during the course of the respiratory illness using 0-100 visual analog scales (VAS) for participants reporting a positive (C19+; n=4148) or negative (C19-; n=546) COVID-19 laboratory test outcome. Logistic regression models identified singular and cumulative predictors of COVID-19 status and post-COVID-19 olfactory recovery.

RESULTS

Both C19+ and C19- groups exhibited smell loss, but it was significantly larger in C19+ participants (mean±SD, C19+: -82.5±27.2 points; C19-: -59.8±37.7). Smell loss during illness was the best predictor of COVID-19 in both single and cumulative feature models (ROC AUC=0.72), with additional features providing no significant model improvement. VAS ratings of smell loss were more predictive than binary chemosensory yes/no-questions or other cardinal symptoms, such as fever or cough. Olfactory recovery within 40 days was reported for ~50% of participants and was best predicted by time since illness onset.

CONCLUSIONS

As smell loss is the best predictor of COVID-19, we developed the ODoR-19 tool, a 0-10 scale to screen for recent olfactory loss. Numeric ratings ≤2 indicate high odds of symptomatic COVID-19 (10<OR<4), especially when viral lab tests are impractical or unavailable.

Neurophysiological and behavioral responses of gypsy moth larvae to insect repellents: DEET, IR3535, and picaridin

The interactions between insect repellents and the olfactory system have been widely studied, however relatively little is known about the effects of repellents on the gustatory system of insects. In this study, we show that the gustatory receptor neuron (GRN) located in the medial styloconic sensilla on the maxillary palps of gypsy moth larvae, and known to be sensitive to feeding deterrents, also responds to the insect repellents DEET, IR3535, and picaridin. These repellents did not elicit responses in the lateral styloconic sensilla. Moreover, behavioral studies demonstrated that each repellent deterred feeding. This is the first study to show perception of insect repellents by the gustatory system of a lepidopteran larva and suggests that detection of a range of bitter or aversive compounds may be a broadly conserved feature among insects.

Glomerular interactions in olfactory processing channels of the antennal lobes

An open question in olfactory coding is the extent of interglomerular connectivity: do olfactory glomeruli and their neurons regulate the odorant responses of neurons innervating other glomeruli? In the olfactory system of the moth Manduca sexta, the response properties of different types of antennal olfactory receptor cells are known. Likewise, a subset of antennal lobe glomeruli has been functionally characterized and the olfactory tuning of their innervating neurons identified. This provides a unique opportunity to determine functional interactions between glomeruli of known input, specifically, (1) glomeruli processing plant odors and (2) glomeruli activated by antennal stimulation with pheromone components of conspecific females. Several studies describe reciprocal inhibitory effects between different types of pheromone-responsive projection neurons suggesting lateral inhibitory interactions between pheromone component-selective glomerular neural circuits. Furthermore, antennal lobe projection neurons that respond to host plant volatiles and innervate single, ordinary glomeruli are inhibited during antennal stimulation with the female's sex pheromone. The studies demonstrate the existence of lateral inhibitory effects in response to behaviorally significant odorant stimuli and irrespective of glomerular location in the antennal lobe. Inhibitory interactions are present within and between olfactory subsystems (pheromonal and non-pheromonal subsystems), potentially to enhance contrast and strengthen odorant discrimination.

Fine structure of the galeal styloconic sensilla of larval Lymantria dispar (Lepidoptera: Lymantriidae)

Lepidopteran larvae possess two pairs of styloconic sensilla located on the maxillary galea. These sensilla, namely the lateral and medial styloconic sensilla, are each comprised of a smaller cone, which is inserted into a style. They are thought to play an important role in host-plant selection and are the main organs involved in feeding. Ultrastructural examination of these sensilla of fifth instar Lymantria dispar (L.) larvae reveal that they are each approximately 70 um in length and 30 um in width. Each sensillum consists of a single sensory peg inserted into the socket of a large style. Each peg bears a slightly subapical terminal pore averaging 317 nm in lateral and 179 nm in medial sensilla. Each sensillum houses five bipolar neurons. The proximal dendritic segment of each neuron gives rise to an unbranched distal dendritic segment. Four of these dendrites terminate near the tip of the sensillum below the pore and bear ultrastructural features consistent with contact chemosensilla. The fifth distal dendrite terminates near the base of the peg and bears ultrastructural features consistent with mechanosensilla. Thus, these sensilla each bear a bimodal chemo-mechanosensory function. The distal dendrites lie within the dendritic channel and are enclosed by a dendritic sheath. The intermediate and outer sheath cells enclose a large sensillar sinus, whereas the smaller ciliary sinus is enclosed by the inner cell. The neurons are ensheathed successively by the inner, intermediate, and outer sheath cells.

Feeding responses to selected alkaloids by gypsy moth larvae, Lymantria dispar (L.)

Deterrent compounds are important in influencing the food selection of many phytophagous insects. Plants containing deterrents, such as alkaloids, are generally unfavored and typically avoided by many polyphagous lepidopteran species, including the gypsy moth Lymantria dispar (L.) (Lepidoptera: Lymantriidae). We tested the deterrent effects of eight alkaloids using two-choice feeding bioassays. Each alkaloid was applied at biologically relevant concentrations to glass fiber disks and leaf disks from red oak trees (Quercus rubra) (L.), a plant species highly favored by these larvae. All eight alkaloids tested on glass fiber disks were deterrent to varying degrees. When these alkaloids were applied to leaf disks, only seven were still deterrent. Of these seven, five were less deterrent on leaf disks compared with glass fiber disks, indicating that their potency was dramatically reduced when they were applied to leaf disks. The reduction in deterrency may be attributed to the phagostimulatory effect of red oak leaves in suppressing the negative deterrent effect of these alkaloids, suggesting that individual alkaloids may confer context-dependent deterrent effects in plants in which they occur. This study provides novel insights into the feeding behavioral responses of insect larvae, such as L. dispar, to selected deterrent alkaloids when applied to natural vs artificial substrates and has the potential to suggest deterrent alkaloids as possible candidates for agricultural use.

Fine structure of antennal sensilla of the female sphinx moth, Manduca sexta (Lepidoptera: Sphingidae). II. Auriculate, coeloconic, and styliform complex sensilla

The antennal flagellum of the female sphinx moth, Manduca sexta, bears eight types of sensilla: two trichoid, two basiconic, one auriculate, two coeloconic, and one styliform complex. We previously described the fine structure of the trichoid and basiconic sensilla (Shields and Hildebrand 1999). In this paper, we describe one type of auriculate, two types of coeloconic, and one type of styliform complex sensilla. The auriculate (ear- or spoon-shaped) sensillum is a small peg that averages 4 µm in length, is innervated by two bipolar sensory cells, and has structural features characteristic of an insect olfactory sensillum. Each of the two types of coeloconic sensilla is a small peg that averages 2 µm in length and is recessed in a cuticular pit. One type of coeloconic sensillum is innervated by five bipolar sensory cells and has structural features characteristic of an insect olfactory sensillum or olfactory-thermosensillum, while the other is innervated by three bipolar sensory cells and has structural features characteristic of an insect thermo-hygrosensillum. The styliform complex sensillum is a large peg that averages 38-40 µm in length and is formed by several contiguous sensilla, the number of which depends on the location of the peg on the flagellum. Each unit of the styliform complex sensillum is innervated by three bipolar sensory cells and has structural features characteristic of a thermo-hygrosensillum. We also ascertained the number and distribution of each of the eight types of sensilla on a single flagellomere (annulus) about midway along the flagellum of a female antenna. A total of 2216 sensilla were found on the dorsal, ventral, and leading surfaces of that annulus.

Fine structure of antennal sensilla of the female sphinx moth, Manduca sexta (Lepidoptera: Sphingidae). I. Trichoid and basiconic sensilla

Olfaction is the principal sensory modality through which insects locate their food sources, mates, and oviposition sites. Insects offer certain advantages as experimental models for the study of mechanisms of olfaction, and a thorough knowledge of the antennal olfactory sensory cells is essential for such studies. While the sphinx moth, Manduca sexta, has proved to be an especially favorable experimental model in studies of pheromone processing in males, little is known about the female olfactory system, including the antennal olfactory sensilla. In this and another paper in this series, we present the first thorough investigation of the structure, innervation, number, and distribution of sensilla on the antennal flagellum of female M. sexta. The flagellum of the female moth bears eight morphological types of sensilla: two trichoid, two basiconic, one auriculate, two coeloconic, and one styliform complex. In this paper, we describe the two types of trichoid and two types of basiconic sensilla. The first type of trichoid sensillum, a long hairlike sensillum averaging 34 µm in length, is innervated by two bipolar sensory cells, and the second type, a shorter hairlike sensillum averaging 26 µm in length, is innervated by either one or three bipolar sensory cells. The first type of basiconic sensillum is a long peg, averaging 22 µm in length, and the second is a shorter peg, averaging 15 µm in length. Both types of basiconic sensilla are innervated by three bipolar sensory cells. These trichoid and basiconic sensilla have structural features characteristic of insect olfactory sensilla.

Comparative external ultrastructure and diffusion pathways in styloconic sensilla on the maxillary galea of larval Mamestra configurata (Walker) (Lepidoptera: Noctuidae) and five other species

The external ultrastructure of sensilla on the maxillary galea are investigated in Mamestra configurata and five other lepidopterous larvae using scanning electron microscopy. The galea and lacinia, comprising the mesal lobe of the maxilla, are either completely separate, fused, or incompletely fused in these species. The distal surface of the mesal lobe of all species examined bears two styloconic sensilla, three basiconic sensilla, and three trichoid sensilla, whereas the midventral wall of this lobe bears a campaniform sensillum. The latter sensillum is visible in only three of the six species examined. The styloconic and basiconic sensilla occupy a ventro anterior location, whereas the trichoid sensilla are positioned dorsoposteriorly. Interspecific comparisons of galeal size, as well as sensillar size, shape, and position are made for all species. The styloconic sensilla are the only sensillar type permeable to an aqueous solution of cobalt chloride when viewed by brightfield light microscopy in all species examined. Cobalt ions permeate through the terminal pore of each styloconic peg and percolate through the fenestrated fibrillar pore matrix, located directly below the pore. These ions permeate along the dendritic channel and accumulate in the adjacent sensillar sinus surrounding the peg and/or style by way of a presumably permeable dendritic sheath in all species, but to varying extents. The cuticular sidewall pores surrounding the terminal pore also appear to be permeable to cobalt ions in all the species examined. In most species examined, the styloconic sensilla are only minimally permeable to mercury ions. In these species, mercury ions permeate through the terminal pore, but become trapped within the plug of fenestrated fibrils within it. The sidewall pores are not permeable to mercury ions in any of the species examined. The styloconic sensilla are not permeable to lead ions in M. configurata or Malacosoma lutescens, the only species tested. © 1996 Wiley-Liss, Inc.

Ultrastructure of the uniporous sensilla on the galea of larval Mamestra configurata (Walker) (Lepidoptera: Noctuidae)

The structure and innervation of sensilla on the galea of fifth-instar Bertha armyworms, Mamestra configurata, were examined using bright-field light, scanning electron, and transmission electron microscopy. Four sensillar types were identified. The galea bears two uniporous styloconic sensilla, one aporous spire-shaped basiconic sensillum, two aporous basiconic sensilla, and one campaniform sensillum. The uniporous styloconic sensillum consists of a small socketed peg inserted into a large cone or style. Each styloconic sensillum is innervated by five bipolar neurons and associated with three sheath cells. Four distal dendrites end in the peg at various levels beneath the pore and the fifth ends in a tubular body at the base of the peg. The intermediate and outer sheath cells enclose a very large liquor-filled sensillar sinus. The inner sheath cell forms a nonlapped cylindrical sleeve around the neurons. These sensilla exhibit features of contact chemosensilla.

Ultrastructure of the aporous sensilla on the galea of larval Mamestra configurata (Walker) (Lepidoptera: Noctuidae)

The galea of fifth-instar Bertha armyworms, Mamestra configurata, has three types of aporous sensilla: one spire-shaped basiconic peg, two short basiconic pegs, and one campaniform sensillum. The spire-shaped peg is set in an inflexible socket, innervated by three bipolar neurons, and enveloped by three sheath cells. One microtubule-laden dendrite completely fills the distal portion of the dendritic sheath and ends within the peg. It is joined by a lamellate and a scolopidium-like dendrite that end near and below the base of the peg, respectively. The ciliary sinus is large and the membrane of the enveloping inner sheath cell is highly elaborate. This sensillum exhibits features characteristic of thermo-hygrosensilla. The short basiconic pegs and campaniform sensillum are each innervated by a single bipolar neuron and each is associated with three sheath cells. In both sensilla, the dendrite ends in a tubular body, typical of mechanosensilla.