Lyme Disease Presents Differently in Men and Women

Medical topics with questions, information and discussion related to Lyme disease and other tick-borne diseases.
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rlstanley
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Joined: Mon 3 Dec 2007 2:53

Lyme Disease Presents Differently in Men and Women

Post by rlstanley » Wed 28 Mar 2012 2:39

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http://www.internalmedicinenews.com/new ... 578d5.html

Lyme Disease Presents Differently in Men and Women

By: SHARON WORCESTER, Internal Medicine News Digital Network

3/22/2012

ATLANTA – Women with Lyme disease display more clinical symptoms than do men with the disease and also are less likely to seroconvert following treatment, according to findings from a prospective cohort study involving 77 patients.

Numerous symptoms were reported more often by the 37 women in the study than by the 40 men. For example, significantly more women than men reported joint pain, muscle pain, headache, back pain, heart palpitations, nausea, vomiting, anxiety, numbness and tingling, and changes in vision during at least one of six preplanned study visits with a physician, Lauren A. Crowder, M.P.H. reported in a poster at the International Conference on Emerging Infectious Diseases.

Joint pain, heart palpitations, nausea, vomiting, and changes in vision were reported significantly more often by women at two of the six visits, and headache was reported significantly more often by women at four of the six visits.

"The second preliminary finding we observed in our cohort of patients was that women were less likely to seroconvert on the antibody tests for serodiagnosis of Lyme disease," Ms. Crowder of the Lyme Disease Research Foundation, Lutherville, Md., said in an interview.

At the initial study visit, a similar proportion of men and women (about 60% of each) tested negative for Lyme disease using the Centers for Disease Control and Prevention’s recommended two-tier testing criteria for serodiagnosis. However, at the second visit, which was performed immediately post treatment, 70% of women who tested negative at the first visit remained negative, compared with only 35% of the men who initially tested negative.

Additionally, polychromatic flow cytometry performed on patient samples indicated that women had significantly higher frequency of CD4+CCR5+ T-cells prior to treatment than did men (mean of 9.82% vs. 5.96%).

"These findings suggest to us that there may be a difference between how men and women respond to infection with Lyme disease. One hypothesis for these differences is that there may be an immunological variation in response to Borrelia burgdorferi, the bacterial infection that causes Lyme disease, between men and women," Ms. Crowder said.

Study participants had early, untreated erythema migrans and clinically confirmed Lyme disease. At the first of the six study visits, they were tested using the CDC criteria by a commercial laboratory. All were treated with 3-week course of doxycycline and were then followed for up to 2 years. At each study visit, participants underwent a physical examination and interval history, reported clinical symptoms and completed self-administered surveys, and underwent repeat laboratory evaluations.

The findings highlight a need for additional research on sex-based differences in the effects of early Lyme disease. Such differences have been seen in other infectious disease, but have not been thoroughly explored in early Lyme disease, Ms. Crowder noted.

Such study is important given that Lyme disease is the most common vector-borne infectious disease in the United States. Although most patients recover from acute infection with proper antibiotic treatment, a subset of patients develop Post-Treatment Lyme Disease Syndrome. The CDC defines this syndrome as involving lingering symptoms of fatigue, pain, or joint and muscle aches. In some cases, these can last for more than 6 months.

"We will continue to explore these suggested differences both in this cohort and in future research studies," she said.

Ms. Crowder also stressed the importance of encouraging patients to look for ticks if they live in Lyme endemic areas.

This study was supported by the Lyme Disease Research Foundation. Ms. Crowder had no disclosures to report.

rlstanley
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Joined: Mon 3 Dec 2007 2:53

Re: Lyme Disease Presents Differently in Men and Women

Post by rlstanley » Wed 28 Mar 2012 3:02

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SEE page 151 of ICEID 2012 Abstracts
March 11-14, 2012 | Hyatt Regency Atlanta | Atlanta, Georgia
(PDF) http://www.iceid.org/images/iceid_2012_ ... _final.pdf

Board 264. Another Difference between Boys and Girls: Sex-
Based Differences in Lyme Disease


L.A. Crowder1, A. Rebman1, V. Yedlin1, M. Soloski2, J.N. Aucott2; 1Lyme Disease
Research Foundation of Maryland, Lutherville, MD, USA, 2Johns Hopkins
University, School of Medicine, Baltimore, MD, USA.
Background:

Lyme disease is the most commonly reported vector-borne infectious disease in North America. Reported cases each year has been steadily increasing since 2006, with cases numbering over 38,000 in 2009.
Sex based differences have been seen in other infectious diseases, but have not been explored thoroughly in early Lyme disease.

Methods:

Seventy-six patients with clinically diagnosed early untreated Lyme disease were enrolled
in a prospective cohort study. Patients were treated with doxycycline and seen seven times over a two-year period. At each visit, a physical exam, interval history, clinical symptoms, and laboratory evaluation was performed. Blood was sent for ELISA and Western Blot to a commercial laboratory, PBLs
from whole blood are used for flow cytometry, and serum and plasma are frozen for future analysis.

Results:

While no significant differences were seen in the demographic variables of age, education, race, or income of our population, we noticed significant sex based differences in clinical and immune presentation in cases. We observed clinical differences by sex in symptoms recorded pre-treatment (V1): greater percentage in women of reported heart palpitations (24.32% vs. 0.0%, p=<0.001) and gastrointestinal symptoms (51.35% vs. 20.51% p=0.0079). A similar percentage of female and male patients were seropositive by 2-tier ELISA and western blot testing at V1, however 44% of females did not seroconvert by 2-tier testing when tested again 3 weeks post-treatment (V2), compared to 19% of males (p=<0.001). Significant differences by sex were seen in percentage of CD4 + CCR5 + T cells (female median (m) = 9.82 vs. male m= 5.96, p=0.0268) and in the CD4+ CCR5/CRTH2 ratio (female m=4.17, male m=2.91, p=0.0499). Monocyte values were lower in females when compared with the values in men (0.57vs. 0.71, p=0.0391).

Conclusions:

In a cohort of patients with a confirmed diagnosis of early Lyme disease, female patients display more clinical symptoms, have a greater chance of not seroconverting post-treatment and have evidence for altered CD4 effector responses. These findings suggest that there should be further research in the field of sex based differences in the effects of early Lyme disease in otherwise healthy populations.

Claudia
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Location: Connecticut, USA

Re: Lyme Disease Presents Differently in Men and Women

Post by Claudia » Wed 28 Mar 2012 15:44

This is interesting for a lot of reasons.

First, as a woman, it has always seemed misogynistic to me to read statements and comments by male doctors and others involved in Lyme disease research and treatment that have implied over the years that there is some sort of predominately female psychosis or hypochondria involved with Lyme disease. Even the use of the term "Lyme hysteria," with the negative female connotations of the word hysteria (in medical history a once-common medical diagnosis made exclusively in women). And all those snide, derogatory and dismissive comments about the middle-aged, menopausal, anxious and bored suburban housewives in LymeLand.

Second, I was very interested to note that the Western Blot antibody response in patients, and those of other immunological markers used, appears to have a statistically significant meaning in relationship to their illness/symptoms in these studies. The lack of seroconversion post-treatment, is especially noteworthy to me.

dlf
Posts: 294
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Re: Lyme Disease Presents Differently in Men and Women

Post by dlf » Tue 13 Oct 2015 15:46

A more recent study from some of the same authors as the study this thread is based on:

http://ofid.oxfordjournals.org/content/ ... 2f903dccd7

127
Sex-Based Differences in the Immune Response in Lyme Disease Over Time
Alison Rebman, MPH1, Kathleen Kortte, PhD2, William Robinson, MD/PhD3, Eric Weinstein, BA1, Lauren Lahey, BS3, Mark Soloski, PhD4, Catriona Wagner, BS3 and John Aucott, MD1,5

Session: 37. Immune Response to Microbial Infection

Thursday, October 9, 2014: 10:30 AM
Background. Lyme disease, caused by the spirochete Borrelia burgdorferi, is an inflammatory illness with early and late manifestations. Chemokines such as CCL19 are involved in directing the immunologic response in Lyme disease. Sex-based differences in immunologic response have been described in other infectious diseases. Despite its increasing prevalence, little research has been done regarding sex-based differences in the immune response or clinical symptoms in early Lyme disease.

Methods. Eighty-six participants (45 men and 41 women) with clinically diagnosed erythema migrans were enrolled in a prospective cohort study prior to standard antibiotic treatment and followed at five time points over one year. At every visit, a physical exam, health interview and blood draw were performed. Serum immune proteins were measured using a Luminex-based system. Data were analyzed using a statistical package for microarray analysis and SAS statistical software. Patient values were also compared to values from 26 matched controls.

Results. Male and female non-Lyme controls did not differ significantly in level of the chemokine CCL19 (p = 0.52). Female Lyme patients had a higher CCL19 level than male patients at the pre-treatment visit (figure, p = 0.003). A subset of largely female patients had elevated CCL19 values at one or more of the subsequent visits. This “tail” was not observed among non-Lyme controls of either sex. Using the third quartile (Q3) as a cut-off, female Lyme patients were significantly more likely to fall above the Q3 at the pre-treatment (p = 0.001), 4-week (p = 0.04), 3-month (p = 0.007) and 6-month visits (p = 0.02). Patients above the Q3 were also more likely to report persistent symptoms at each of the post-treatment follow-up visits, up to 6-months (p= 0.01, p = 0.02, p = 0.02, p = 0.04, respectively).

Conclusion. These results suggest clear sex-based differences in initial and later CCL19 reactivity to early Lyme disease. Post-treatment elevations of CCL19 may be a risk factor for development of persistent symptoms, which appear to be more common in women than men. Clinically relevant sex-based differences in the immune response to early Lyme disease merit future research and may call for different disease management and treatment approaches.

duncan
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Re: Lyme Disease Presents Differently in Men and Women

Post by duncan » Wed 14 Oct 2015 15:40

Thank you for posting, dlf. These sorts of studies always make me wonder Why they were conducted in the first place.

I am not sure an exclusive relationship between CCL19 and Bb has been established, and even if it is specific, what it is indicating. If there are cross-elasticities swirling about the chemokine, then those need to be factored in.

I suspect the authors are aware of this.

This is one step further removed from one step removed. We really don't have a good enough handle on cytokines and chemokines yet. And why bother to differentiate between the sexes anyway? Is our understanding of Borrelia so absolute that we can channel scarce resources to nuances that may or may not be relevant? Why not marshal our energies and limited funding to either developing a better culture mechanism, or better antibody tests that embrace all stages, species, and strains?

hv808ct
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Joined: Wed 30 Jul 2008 4:11

Re: Lyme Disease Presents Differently in Men and Women

Post by hv808ct » Thu 15 Oct 2015 1:51

Re: Lyme Disease Presents Differently in Men and Women
Post by duncan » Wed 14 Oct 2015 15:40
Thank you for posting, dlf. These sorts of studies always make me wonder Why they were conducted in the first place.
I’m sure someone asked that about autoimmune diseases and coronaries, for example.

And why bother to differentiate between the sexes anyway?
Sex Differences in Infectious Diseases–Common but Neglected
http://jid.oxfordjournals.org/content/2 ... 3/S79.long

Sex differences in immune responses to infectious diseases
http://link.springer.com/article/10.100 ... -9#/page-1

Why not marshal our energies and limited funding to either developing a better culture mechanism, or better antibody tests that embrace all stages, species, and strains?
Laboratory culture still butts up against the 12-18hr doubling time of Bb. Better Ab tests still have to await the formation of antibodies. And species and strains, while interesting epidemiologically, are usually irrelevant to treatment.

duncan
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Joined: Wed 5 Sep 2012 18:48

Re: Lyme Disease Presents Differently in Men and Women

Post by duncan » Thu 15 Oct 2015 3:03

hv808ct, if I suggest that the development of a better mouse trap would be helpful, you countering with an explanation as to why the current mouse trap is inadequate doesn't quite seem appropriate...Unless you are trying to support my suggestion - in which case, thank you.

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ChronicLyme19
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Re: Lyme Disease Presents Differently in Men and Women

Post by ChronicLyme19 » Fri 6 Nov 2015 2:59

Claudia wrote:"Second, I was very interested to note that the Western Blot antibody response in patients, and those of other immunological markers used, appears to have a statistically significant meaning in relationship to their illness/symptoms in these studies. The lack of seroconversion post-treatment, is especially noteworthy to me."
I'm new to this thread as it started before I joined, but that is definitely noteworthy. Most of the stuff I have seen about differences between men and women and disease has been chalked up to the fact that culturally women tend to be more vocal and more likely to report symptoms. Blood work like this however would not be skewed by that bias.
"Even the use of the term "Lyme hysteria," with the negative female connotations of the word hysteria (in medical history a once-common medical diagnosis made exclusively in women)."
On a side note, this could have a thread of it's on probably, but does anyone know if men and women experience the same symptoms from progesterone deficiency? The thought being, when women go through serious illness, it seems if their body is over taxed and cannot make both progesterone and cortisol at the same time the body opts for cortisol only. That then in turn leaves the women in question with a progesterone deficiency and or symptoms of estrogen dominance, which may explain why they are seen as being" hysterical" due to the hormone imbalance...or at least this is how it's been explained to me. Would the same thing happen in men?
Half of what you are taught is incorrect, but which half? What if there's another half missing?

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