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.
Highlights
Lyme borreliosis is transmitted by the bite of Ixodes ticks infected with Borrelia burgdorferi sensu lato [1]
In this study we have evaluated the gender distribution according to clinical manifestation among patients with Lyme borreliosis evaluated at the University Medical Center Ljubljana in Ljubljana, Slovenia
As the case definition for Lyme arthritis used in the present study conceivably could have included seropositive patients with arthritis caused by a condition other than Lyme borreliosis, we evaluated the gender distribution in the subgroup of these patients who had either a concomitant erythema migrans (EM) skin lesion or evidence of Lyme arthritis based on detection of B. burgdorferi sensu lato in joint fluid by culture or by polymerase chain reaction
Summary
Lyme borreliosis is transmitted by the bite of Ixodes ticks infected with Borrelia burgdorferi sensu lato (the term ‘‘sensu lato’’ refers to all of the species of Lyme borrelia) [1]. 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]. It has been presumed that the explanation for the unequal gender distribution is that the likelihood of tick exposure is greater for males in the United States and greater for females in certain European countries. In the United States, only B. burgdorferi sensu stricto (the term ‘‘sensu stricto’’ refers to one particular species of Lyme borrelia) causes Lyme borreliosis whereas in Europe the majority of cases of Lyme borreliosis are caused by B. afzelii and B. garinii, rather than B. burgdorferi sensu stricto [1].
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