Implications of Gender in Chronic Lyme Disease

Wormser, Gary P.; Shapiro, Eugene D.

doi:10.1089/jwh.2008.1193

Cited by 36 publications

(20 citation statements)

References 23 publications

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“…While CLD and PTLDS share many similarities in the subjective symptoms of fatigue, pain, neurocognitive dysfunction, and others, patients often seek care for or are given the diagnostic label of CLD when current or past evidence of Borrelia infection cannot be determined. A review of antibiotic treatment studies for CLD found female to male ratios which ranged from 1.8 to 2.8 (Wormser and Shapiro 2009). Similarly, in our retrospective chart review of patients, we found that women represented 66 % of patients with medically unexplained symptoms that could not be given a diagnosis using current CDC and IDSA guidelines for early Lyme disease, late Lyme disease, or PTLDS (Aucott et al 2012).…”

Section: Chronic Lyme Diseasesupporting

confidence: 57%

“…Several publications have asserted that the female predominance in CLD is a result of misdiagnosed fibromyalgia, chronic fatigue syndrome, or depression, all conditions with similarly high female to male ratios (Sigal 1990;Hsu et al 1993;Wormser and Shapiro 2009). There is considerable symptom overlap between CLD, PTLDS, and these other symptom-based syndromes, and it remains difficult if not impossible to separate them clinically.…”

Section: Chronic Lyme Diseasementioning

confidence: 99%

“…This represents a serious knowledge gap since region-specific sex-based disparities have been reported in Lyme disease clinical manifestations (Bacon et al 2008;Schwarzwalder et al 2010a;Strle et al 2013). Importantly, PTLDS, one of the confounding downstream outcomes of Lyme disease in which immunemediated processes are hypothesized to have a role, is clearly female biased (Wormser and Shapiro 2009). Moreover, it has been observed with a related Borrelia species (B. hermsii) that female mice control bacteria levels more effectively than males (Benoit et al 2010).…”

Section: Immune Responsementioning

confidence: 99%

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Sex and Gender Differences in Infection and Treatments for Infectious Diseases

Klein

Roberts

2015

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This book provides an overview of the underlying sex-based and hormone-based differences in immunity, wound healing and pharmacokinetics, while also exploring how pregnancy affects immunity. The second part of the book shows, for the first time in a single volume, the growing number of infectious diseases for which sex and gender differences are noted, identifies common as well as distinct mechanisms mediating these differences and illustrates how responses to treatments might differ between the sexes. The awareness that males and females differ in their response to specific pathogens as well as to treatments for infectious diseases may yield sex-specific personalized treatments. This book will be of interest to basic scientists and clinicians in the fields of microbiology, immunology and pharmacology. Individuals working in academia, government and industry will also benefit from the information presented

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Section: Chronic Lyme Diseasesupporting

confidence: 57%

Section: Chronic Lyme Diseasementioning

confidence: 99%

Section: Immune Responsementioning

confidence: 99%

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Sex and Gender Differences in Infection and Treatments for Infectious Diseases

Klein

Roberts

2015

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“…In the United States there is a male predominance of cases [2], [3]. This is not necessarily true in Europe where in some countries such as Germany there is a female predominance [4], [5].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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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.

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“…The reference cited to support this claim (12) actually shows that there is an equal gender distribution among patients diagnosed with PLDS. Also, the reference cited by Stricker and Winger (5) to support the claim that patients in their study (10) had a gender distribution consistent with CLD has no relevance to CLD whatsoever since it addresses a completely different issue in Lyme disease (reinfection).…”

Section: Authors' Replymentioning

confidence: 97%