title: A male preponderance in patients with Indian post kala-azar dermal leishmaniasis is associated with increased circulating levels of testosterone.
abstract: BACKGROUND
  Post kala-azar dermal leishmaniasis (PKDL) is a neglected parasitic disease that occurs after apparent cure from visceral leishmaniasis (VL) and poses a challenge for elimination of VL, being its proposed reservoir. Several epidemiological studies have proposed that sex hormones may account for the increased susceptibility of males towards infectious diseases, including leishmaniasis; however, the role of testosterone and sex bias, if any, in PKDL has not been evaluated.
  
  
  METHODS
  The study population included 87 patients with PKDL and 39 with VL; levels of testosterone were measured by competitive enzyme-linked immunosorbent assay along with their levels of antileishmanial immunoglobulin and IgG. The association of testosterone, if any, was then correlated with age, gender, humoral response, lesional profile, disease duration, and lag period.
  
  
  RESULTS
  A male predominance was evident in PKDL, not in VL; importantly, this male bias was predominant postpubertal, strongly indicative of an association between sex hormone and disease progression. Male patients with PKDL had significantly higher levels of testosterone, which regressed significantly with miltefosine, not with sodium antimony gluconate. Additionally, a significant correlation was found between plasma testosterone and antileishmanial IgG.
  
  
  CONCLUSIONS
  Taken together, our study has established a male dominance in PKDL, which showed a strong association with testosterone. This information should be taken into consideration for disease monitoring and control.
authors.affiliation: Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, India.
authors.forename: Debanjan
authors.initials: D
authors.lastname: Mukhopadhyay
authors.affiliation: Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, India.
authors.forename: Shibabrata
authors.initials: S
authors.lastname: Mukherjee
authors.affiliation: Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, India.
authors.forename: Susmita
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, India.
authors.forename: Susmita
authors.initials: S
authors.lastname: Roy
authors.affiliation: Department of Tropical Medicine, Calcutta School of Tropical Medicine, Kolkata, India.
authors.forename: Bibhuti
authors.initials: B
authors.lastname: Saha
authors.affiliation: Department of Dermatology, Calcutta Medical College, Kolkata, India.
authors.forename: Nilay Kanti
authors.initials: NK
authors.lastname: Das
authors.affiliation: Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, India.
authors.forename: Mitali
authors.initials: M
authors.lastname: Chatterjee
mesh_terms: D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000913:Antibodies, Protozoan / Q000097:blood*; D000967:Antimony Sodium Gluconate / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007194:India; D007893:Leishmania donovani / Q000276:immunology*; D016773:Leishmaniasis, Cutaneous / Q000097:blood* / Q000188:drug therapy / Q000469:parasitology; D007898:Leishmaniasis, Visceral / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D008297:Male; D058069:Neglected Diseases / Q000097:blood* / Q000469:parasitology; D010767:Phosphorylcholine / Q000031:analogs & derivatives / Q000627:therapeutic use; D012737:Sex Factors; D013739:Testosterone / Q000097:blood*; D055815:Young Adult
chemical_list: D000913:Antibodies, Protozoan; D000981:Antiprotozoal Agents; D007074:Immunoglobulin G; C068538:liposomal amphotericin B; D010767:Phosphorylcholine; D013739:Testosterone; C039128:miltefosine; D000666:Amphotericin B; D000967:Antimony Sodium Gluconate