ArticlePLoS neglected tropical diseases2020
Male predominance in reported Visceral Leishmaniasis cases: Nature or nurture? A comparison of population-based with health facility-reported data.
Article in PLoS neglected tropical diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 3 of them syntheses that pooled it.
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Who cites it
36 citing papers in PubMed, 3 syntheses or guidelines pooled it, 61 citations in OpenAlex.
- Clinical criteria for Mucosal Leishmaniasis diagnosis in rural South America: A systematic literature review.PLoS neglected tropical diseases · 2022Pooled it
- Visceral Leishmaniasis in pregnancy and vertical transmission: A systematic literature review on the therapeutic orphans.PLoS neglected tropical diseases · 2021Pooled it
- Gender disparity in cases enrolled in clinical trials of visceral leishmaniasis: A systematic review and meta-analysis.PLoS neglected tropical diseases · 2021Pooled it
- Diseases Caused by Parasites with Invertebrate Hosts in China: Burden and Trends of Leishmaniasis and Schistosomiasis.Pathogens (Basel, Switzerland) · 2026Article
- Comparison of efficacy of intravenous versus intramuscular injection meglumine antimoniate in patients of cutaneous leishmaniasis.Pakistan journal of medical sciences · 2026Article
- Risk factors for post-kala-azar dermal leishmaniasis (PKDL): Challenges in understanding pathophysiology.PLoS neglected tropical diseases · 2026Review
- Trends in Leishmaniasis: A 32-Year Review in an Endemic Area in the South of Madrid Region.Pathogens (Basel, Switzerland) · 2026Article
- Sex in Immune Cells and Parasitic Diseases - A Complex Relationship.Immunological reviews · 2026Review
- Leishmaniasis.Nature reviews. Disease primers · 2025Review
- Transcriptome profiling of L. infantum-infected human macrophages reveals sex-specific type I interferon induction.PLoS pathogens · 2025Article
- A 12-year analysis of seasonal patterns and disease dynamics ofSaudi medical journal · 2025Article
- Understanding Sex-biases in Kinetoplastid Infections: Leishmaniasis and Trypanosomiasis.Expert reviews in molecular medicine · 2025Review
- Demographic and Clinical Features of Visceral Leishmaniasis in Chad: A Prospective Cross-Sectional Survey.The American journal of tropical medicine and hygiene · 2024Article
- An epidemiological and spatiotemporal analysis of visceral leishmaniasis in West Pokot, Kenya, between 2018 and 2022.BMC infectious diseases · 2024Article
- The conneXion between sex and immune responses.Nature reviews. Immunology · 2024Review
- Epidemiological and clinical trends of visceral leishmaniasis in Portugal: retrospective analysis of cases diagnosed in public hospitals between 2010 and 2020.Infectious diseases of poverty · 2024Article
- Post-kala-azar dermal leishmaniasis (PKDL) drug efficacy study landscape: A systematic scoping review of clinical trials and observational studies to assess the feasibility of establishing an individual participant-level data (IPD) platform.PLoS neglected tropical diseases · 2024Article
- Sex-structured disease transmission model and control mechanisms for visceral leishmaniasis (VL).PloS one · 2024Article
- Knowledge, perceptions and practices of health students and professionals regarding leishmaniasis in Portugal: a cross-sectional study.Parasites & vectors · 2023Article
- Prevalence of asymptomatic Leishmania infection and knowledge, perceptions, and practices in blood donors in mainland Portugal.Parasites & vectors · 2023Article
Corrections and comments
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Authors and funding
12 authors at 6 institutions in 4 countries.
Funding
Abstract
backgroundBangladesh, India, and Nepal aim for the elimination of Visceral Leishmaniasis (VL), a systemic parasitic infectious disease, as a public health problem by 2020. For decades, male patients have comprised the majority of reported VL cases in this region. By comparing this reported VL sex ratio to the one observed in population-based studies conducted in the Indian subcontinent, we tested the working hypothesis that mainly socio-cultural gender differences in healthcare-seeking behavior explain this gender imbalance. METHODOLOGY/PRINCIPAL
findingsWe compared the observed sex ratio of male versus female among all VL cases reported by the health system in Nepal and in the two most endemic states in India with that observed in population-based cohort studies in India and Nepal. Also, we assessed male sex as a potential risk factor for seroprevalence at baseline, seroconversion, and VL incidence in the same population-based data. The male/female ratio among VL cases reported by the health systems was 1.40 (95% CI 1.37-1.43). In the population cohort data, the age- and study site-adjusted male to female risk ratio was 1.27 (95% CI 1.08-1.51). Also, males had a 19% higher chance of being seropositive at baseline in the population surveys (RR 1.19; 95% CI 1.11-1.27), while we observed no significant difference in seroconversion rate between both sexes at the DAT cut-off titer defined as the primary endpoint. CONCLUSIONS/SIGNIFICANCE: Our population-based data show that male sex is a risk factor for VL, and not only as a socio-cultural determinant. Biological sex-related differences likely play an important role in the pathogenesis of this disease.
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