Sex differences in the clinical and serologic presentation of early lyme disease: Results from a retrospective review

Schwarzwalder, Alison; Schneider, Michael; Lydecker, Alison D.; Aucott, John N.

doi:10.1016/j.genm.2010.08.002

Cited by 24 publications

(9 citation statements)

References 36 publications

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“…The borderline significant difference between males and females in final serostatus group is interesting and may be clinically meaningful, as females were overrepresented in the final negative group by approximately 20 percentage points. 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.…”

supporting

confidence: 88%

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

Rebman¹,

Crowder²,

Kirkpatrick³

et al. 2014

Clin Rheumatol

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Two-tier serology is often used to confirm a diagnosis of Lyme disease. One hundred and four patients with physician diagnosed erythema migrans rashes had blood samples taken before and after 3 weeks of doxycycline treatment for early Lyme disease. Acute and convalescent serologies for Borrelia burgdorferi were interpreted according to the 2-tier antibody testing criteria proposed by the Centers for Disease Control and Prevention. Serostatus was compared across several clinical and demographic variables both pre- and post-treatment. Forty-one patients (39.4%) were seronegative both before and after treatment. The majority of seropositive individuals on both acute and convalescent serology had a positive IgM western blot and a negative IgG western blot. IgG seroconversion on western blot was infrequent. Among the baseline variables included in the analysis, disseminated lesions (p < 0.0001), a longer duration of illness (p < 0.0001), and a higher number of reported symptoms (p = 0.004) were highly significantly associated with positive final serostatus, while male sex (p = 0.05) was borderline significant. This variability, and the lack of seroconversion in a subset of patients, highlights the limitations of using serology alone in identifying early Lyme disease. Furthermore, these findings underline the difficulty for rheumatologists in identifying a prior exposure to Lyme disease in caring for patients with medically unexplained symptoms or fibromyalgia-like syndromes.

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supporting

confidence: 88%

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

Rebman¹,

Crowder²,

Kirkpatrick³

et al. 2014

Clin Rheumatol

Self Cite

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“…, ). Sexually dimorphic outcomes of B. burgdorferi infection have been reported in the clinical and epidemiological literature (Bennet & Berglund, ; Bennet, Stjernberg, & Berglund, ; Schwarzwalder, Schneider, Lydecker, & Aucott, ; Forrester et al . , ), but not in mouse studies.…”

Section: Discussionmentioning

confidence: 96%

Infection with the Lyme disease pathogen suppresses innate immunity in mice with diet-induced obesity

Zlotnikov

Javid

Ahmed

et al. 2016

Cellular Microbiology

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Obesity is a major global public health concern. Immune responses implicated in obesity also control certain infections. We investigated the effects of high-fat diet-induced obesity (DIO) on infection with the Lyme disease bacterium Borrelia burgdorferi in mice. DIO was associated with systemic suppression of neutrophil- and macrophage-based innate immune responses. These included bacterial uptake and cytokine production, and systemic, progressive impairment of bacterial clearance, and increased carditis severity. B. burgdorferi-infected mice fed normal diet also gained weight at the same rate as uninfected mice fed high-fat diet, toll-like receptor 4 deficiency rescued bacterial clearance defects, which greater in female than male mice, and killing of an unrelated bacterium (Escherichia coli) by bone marrow-derived macrophages from obese, B. burgdorferi-infected mice was also affected. Importantly, innate immune suppression increased with infection duration and depended on cooperative and synergistic interactions between DIO and B. burgdorferi infection. Thus, obesity and B. burgdorferi infection cooperatively and progressively suppressed innate immunity in mice.

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“…In our retrospective chart review of patients with early Lyme disease in a community setting (Schwarzwalder et al 2010a), we found that women had a significantly lower ELISA value and a significantly lower total number of reactive IgG Western blot bands than men. Figure 12.7 shows enhanced box plots of the difference in results by sex for these two tests.…”

Section: Laboratory Testingmentioning

confidence: 87%

“…The elevated Th2 response would predict that females display a heightened antibody response. Surprisingly, in the study of a smaller cohort in the United States, the opposite is observed with women displaying a lower magnitude antibody response than men (Schwarzwalder et al 2010a). There are numerous possibilities that can account for this seemingly disparate outcome including differences in study group, size of the cohorts, tick species involved in transmission, and the Borrelia species that causes Lyme disease.…”

Section: Immune Responsementioning

confidence: 91%

“…A broad search of PubMed using the terms gender/ sex, immunity, and Lyme revealed a total of five papers, two of which were relevant. 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).…”

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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Sex differences in the clinical and serologic presentation of early lyme disease: Results from a retrospective review

Cited by 24 publications

References 36 publications

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

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

Infection with the Lyme disease pathogen suppresses innate immunity in mice with diet-induced obesity

Sex and Gender Differences in Infection and Treatments for Infectious Diseases

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