4.5 Review

Let's talk about sex characteristics-As a risk factor for invasive fungal diseases

Journal

MYCOSES
Volume 65, Issue 6, Pages 599-612

Publisher

WILEY
DOI: 10.1111/myc.13449

Keywords

animal model; immunity; invasive fungal diseases; sex characteristics

Funding

  1. Fundacao para a Ciencia e a Tecnologia (FCT) [UIDB/50026/2020, UIDP/50026/2020]
  2. Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (ERDF) [NORTE-01-0145-FEDER-000039]
  3. European Union's Horizon 2020 research and innovation programme [847507]
  4. 'la Caixa' Foundation [100010434]
  5. FCT [LCF/PR/HR17/52190003]
  6. Burden Family Gift Fund
  7. Astellas
  8. Euroimmun
  9. Gilead
  10. MSD
  11. Scynexis

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Biological sex has a significant impact on the epidemiology of invasive fungal diseases, with higher proportions of females in invasive candidiasis cases and higher proportions of males in other invasive fungal infections. Further investigations are needed to understand the association between biological sex/gender and the pathogenesis of these diseases.
Biological sex, which comprises differences in host sex hormone homeostasis and immune responses, can have a substantial impact on the epidemiology of infectious diseases. Comprehensive data on sex distributions in invasive fungal diseases (IFDs) are lacking. In this review, we performed a literature search of in vitro/animal studies, clinical studies, systematic reviews and meta-analyses of invasive fungal infections. Females represented 51.2% of invasive candidiasis cases, mostly matching the proportions of females among the general population in the United States and Europe (>51%). In contrast, other IFDs were overrepresented in males, including invasive aspergillosis (51% males), mucormycosis (60%), cryptococcosis (74%), coccidioidomycosis (70%), histoplasmosis (61%) and blastomycosis (66%). Behavioural variations, as well as differences related to biological sex, may only in part explain these findings. Further investigations concerning the association between biological sex/gender and the pathogenesis of IFDs are warranted.

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