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Sex and Gender Differences in Tuberculosis Pathogenesis and Treatment Outcomes

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Sex and Gender Differences in Infection and Treatments for Infectious Diseases

Part of the book series: Current Topics in Microbiology and Immunology ((CT MICROBIOLOGY,volume 441))

Abstract

Tuberculosis remains a daunting public health concern in many countries of the world. A consistent observation in the global epidemiology of tuberculosis is an excess of cases of active pulmonary tuberculosis among males compared with females. Data from both humans and animals also suggest that males are more susceptible than females to develop active pulmonary disease. Similarly, male sex has been associated with poor treatment outcomes. Despite this growing body of evidence, little is known about the mechanisms driving sex bias in tuberculosis disease. Two dominant hypotheses have been proposed to explain the predominance of active pulmonary tuberculosis among males. The first is based on the contribution of biological factors, such as sex hormones and genetic factors, on host immunity during tuberculosis. The second is focused on non-biological factors such as smoking, professional exposure, and health-seeking behaviors, known to be influenced by gender. In this chapter, we review the literature regarding these two prevailing hypotheses by presenting human but also experimental animal studies. In addition, we presented studies aiming at examining the impact of sex and gender on other clinical forms of tuberculosis such as latent tuberculosis infection and extrapulmonary tuberculosis, which both appear to have their own specificities in relation to sex. We also highlighted potential intersections between sex and gender in the context of tuberculosis and shared future directions that could guide in elucidating mechanisms of sex-based differences in tuberculosis pathogenesis and treatment outcomes.

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Acknowledgements

The authors gratefully acknowledge the support of NIH grants K43 TW011426, D43 TW010350, and R01 AI167750.

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Authors and Affiliations

  1. Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University Clinical Research Center (UCRC), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali

    Djeneba Dabitao

  2. Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA

    William R. Bishai

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Correspondence to William R. Bishai .

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  1. W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Sabra L. Klein

  2. Department of Parasitology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK

    Craig W. Roberts

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Dabitao, D., Bishai, W.R. (2023). Sex and Gender Differences in Tuberculosis Pathogenesis and Treatment Outcomes. In: Klein, S.L., Roberts, C.W. (eds) Sex and Gender Differences in Infection and Treatments for Infectious Diseases. Current Topics in Microbiology and Immunology, vol 441. Springer, Cham. https://doi.org/10.1007/978-3-031-35139-6_6

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