Sex differences in clinical leptospirosis in Germany:: 1997-2005
Sex differences in clinical leptospirosis in Germany:: 1997-2005
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DOI：
10.1086/513431
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发表时间：
2007-05-01
影响因子：
11.8
通讯作者：
Schoeneberg, Irene
中科院分区：
文献类型：
--
作者：
Jansen, Andreas;Stark, Klaus;Schoeneberg, Irene
背景。尽管大多数报道的钩端螺旋体病患者是男性，但一些血清流行病学研究表明，两性之间的钩端螺旋体病血清阳性率至少相同。为了研究性别对钩端螺旋体病严重程度（以及可能的识别）的影响，我们对 1997 年至 2005 年德国报告的钩端螺旋体病患者的临床表现进行了性别特异性分析。方法。对 1997 年至 2005 年德国报告的实验室确诊的钩端螺旋体病患者的人口特征、症状、感染地点和感染发生时的居住地、可能的暴露风险、感染血清型和死亡率等数据进行了评估。根据年龄进行调整的 Mantel-Haenszel 比值比 (ORMH) 用于确定性别与报告症状频率之间的关联。结果。 1997年至2005年期间，德国报告了338名钩端螺旋体病患者（263名男性患者和75名女性患者），其中男性患者比女性患者更有可能住院（OR，2.6；P < .01）并表现出严重钩端螺旋体病伴黄疸（ORMH，3.7；P < .01）、肾功能损害（ORMH，3.4；P < .01）症状。 .01) 和出血 (ORMH, 7.8; P < .05)。这些与性别相关的差异与暴露风险、推定感染血清群或寻求健康行为的差异无关。结论。我们的结果表明男性与临床钩端螺旋体病的严重程度较高相关。因此，关于钩端螺旋体病男性占主导地位的报告可能反映了严重疾病发病率的性别相关变异，而不是不同的感染率。在临床实践中，钩端螺旋体病表现的性别差异可能导致女性患者对该疾病的系统调查和治疗不足。
Background. Although the majority of patients with reported leptospirosis are male, several seroepidemiologic studies demonstrated that leptospirosis seroprevalences are at least identical between both sexes. To study the effect of sex on the severity - and possibly, recognition - of leptospirosis, we conducted a sex-specific analysis of the clinical manifestations of the disease among patients with reported leptospirosis in Germany during 1997 - 2005.Methods. Data on demographic characteristics, symptoms, place of infection and place of residence when infection occurred, possible exposure risks, infecting serovars, and mortality were evaluated for patients with laboratory-confirmed leptospirosis reported in Germany during 1997 - 2005. Mantel-Haenszel odds ratios (ORMH), adjusted for age, were used to determine the association between sex and the frequency of reported symptoms.Results. Among 338 patients with leptospirosis ( 263 male patients and 75 female patients) reported in Germany during 1997 - 2005, male patients were more likely than female patients to be hospitalized (OR, 2.6; P < .01) and to exhibit symptoms of severe leptospirosis with jaundice (ORMH, 3.7; P < .01), renal impairment (ORMH, 3.4; P < .01), and hemorrhage (ORMH, 7.8; P < .05). These sex-related differences were not associated with differences in exposure risks, presumptive infecting serogroups, or health-seeking behavior.Conclusions. Our results indicate that male sex is associated with a higher severity of clinical leptospirosis. Reports on male predominance in leptospirosis may thus reflect sex-related variability in the incidence of severe disease, rather than different infection rates. In clinical practice, sex differences in the manifestation of leptospirosis may cause systematic underinvestigation and undertreatment of the disease in female patients.