Gender Disparity between Cutaneous and Non-Cutaneous Manifestations of Lyme Borreliosis

Abstract

Cutaneous manifestations of Lyme borreliosis in Europe include erythema migrans (EM) and acrodermatitis chronica atrophicans (ACA); the most common non-cutaneous manifestations are Lyme neuroborreliosis (LNB) and Lyme arthritis. The purpose of this study was to evaluate the gender distribution of patients with these clinical manifestations of Lyme borreliosis. Data on gender were obtained from the clinical records of patients with Lyme borreliosis aged ≥15 years who had been evaluated at the University Medical Center Ljubljana, Ljubljana, Slovenia.Among 10,539 patients diagnosed with EM, 6,245 (59.3%) were female and among 506 ACA patients 347 (68.6%) were female. In contrast, among the 60 patients with Lyme arthritis only 15 (25%) were female (p<0.0001 for the comparison of gender with EM or ACA) and among the 130 patients with LNB only 51 (39.2%) were females (p<0.0001for the comparison of gender with EM or ACA). Although the proportion that was female in the LNB group was greater than that of patients with Lyme arthritis, this difference did not reach statistical significance (p = 0.10). Although older individuals are more likely to be female in the general Slovenian population, the age of patients with cutaneous versus non-cutaneous manifestations was not the explanation for the observed differences in gender.In conclusion, patients with cutaneous manifestations of Lyme borreliosis were predominantly female, whereas those with non-cutaneous manifestations were predominantly male. This provocative finding is unexplained but may have direct relevance to the pathogenesis of Lyme borreliosis.

Epidemiology and cost of hospital care for Lyme borreliosis in Germany: Lessons from a health care utilization database analysis

“…The finding of a generally higher incidence of male LB patients among inpatients in our cohort is in contrast to the results of other German studies suggesting a female predominance in adult patients with LB (Fülöp and Poggensee, 2008). Our observations, however, parallel evidence from Slovenia demonstrating that patients with cutaneous LB manifestations are for the most part female, whereas those with non-cutaneous manifestations are predominantly male (Strle et al, 2013). Concordantly, our data further support the implication of an increased association of male gender with more severe or systemic LB manifestations in inpatients from Germany (Wilking and Stark, 2014).…”

In vitro evaluation of antibacterial activity of phytochemicals and micronutrients against Borrelia burgdorferi and Borrelia garinii

“…People of all ages and both genders are equally at risk, although the highest rates of infection have been reported in children ages 10–14 and in adults ages 45 and older (Strle et al . 2013; Robinson 2014). The newest estimates, which are calculated based on diagnostic test results and insurance records, indicate that the number of Lyme disease cases in the United States alone reaches 300 000 each year.…”

Characteristics of seroconversion and implications for diagnosis of post-treatment Lyme disease syndrome: acute and convalescent serology among a prospective cohort of early Lyme disease patients

“…Although it agrees with our prior retrospective chart review findings [10], it differs from those of Wormser et al [4], who found no difference by sex in 2-tier testing among patients compared pretreatment. Prior research in the US and European settings has suggested potential sex-based differences in the immunopathology and clinical presentation of early and later forms of Lyme disease [11][12][13][14]; however, further research is warranted.…”