{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:56:16Z","timestamp":1785412576187,"version":"3.56.0"},"reference-count":42,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["408003\/2023-5"],"award-info":[{"award-number":["408003\/2023-5"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["306628\/2025-2"],"award-info":[{"award-number":["306628\/2025-2"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"award":["408003\/2023-5"],"award-info":[{"award-number":["408003\/2023-5"]}],"id":[{"id":"https:\/\/ror.org\/03swz6y49","id-type":"ROR","asserted-by":"publisher"}]},{"award":["306628\/2025-2"],"award-info":[{"award-number":["306628\/2025-2"]}],"id":[{"id":"https:\/\/ror.org\/03swz6y49","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006162","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Ci\u00eancia e Tecnologia do Estado de Pernambuco","doi-asserted-by":"publisher","award":["APQ-0238-4.01\/24"],"award-info":[{"award-number":["APQ-0238-4.01\/24"]}],"id":[{"id":"10.13039\/501100006162","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006162","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Ci\u00eancia e Tecnologia do Estado de Pernambuco","doi-asserted-by":"publisher","award":["BPP-0003-4.01\/24"],"award-info":[{"award-number":["BPP-0003-4.01\/24"]}],"id":[{"id":"10.13039\/501100006162","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Background: Large language models (LLMs) are increasingly considered as adjuncts for differential diagnostic reasoning, yet their sensitivity to gender-attributed cues in the persona prompt\u2014particularly for neglected tropical diseases (NTDs) and in non-English clinical settings\u2014remains poorly characterised. Objective: The objective of this study was to compare the diagnostic accuracy of one proprietary and three open-weight LLMs for Chagas disease (CD) and visceral leishmaniasis (VL) under paired persona-prompt conditions in which the only manipulated variable was the linguistic gender of the simulated medical persona. Methods: This experimental, paired study evaluated ChatGPT-4o, LLaMA 3 70B, Meditron-70B, and Mixtral 8x7B across 12 cases per disease (n = 24) from real records at a Brazilian teaching hospital. The primary outcome was top-five diagnostic accuracy. A committee of five infectious-disease specialists assessed the biological plausibility of all differentials. Paired comparisons used Wilcoxon signed-rank tests; 95% confidence intervals were calculated using the Wilson-score method. Results: ChatGPT-4o achieved the highest accuracy (CD: 100% under both prompts; VL: 83.3\u201391.7%). LLaMA 3 70B and Mixtral 8x7B showed moderate performance (41.7\u201383.3%); the medically fine-tuned Meditron-70B exhibited paradoxically poor accuracy (16.7\u201325.0%) and the lowest committee-rated plausibility scores. A consistent small numerical trend favoured the female prompt across most model\u2013disease combinations (differences of 0\u201316.7 percentage points), but no comparison reached statistical significance (all p &gt; 0.05). Conclusions: Gender-attributed persona-prompt variation did not produce a systematic effect on LLM diagnostic accuracy for CD or VL. ChatGPT-4o outperformed the three evaluated open-weight alternatives, and medical-domain fine-tuning did not confer the expected advantage. Expert-validated assessment of hypothesis plausibility should complement target-disease accuracy in clinical LLM evaluation studies, particularly for NTDs.<\/jats:p>","DOI":"10.3390\/healthcare14101385","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T08:55:28Z","timestamp":1779180928000},"page":"1385","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Gender-Attributed Persona Prompts and the Diagnostic Accuracy of Proprietary and Open-Weight Large Language Models in Chagas Disease and Visceral Leishmaniasis: A Paired Experimental Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9308-866X","authenticated-orcid":false,"given":"Aline Rafaela Soares da","family":"Silva","sequence":"first","affiliation":[{"name":"AI-Assisted Diagnostics Research Group (AIDRG), University of Pernambuco (UPE), Petrolina 56328-900, PE, Brazil"},{"name":"Laborat\u00f3rio de Pesquisas em Desempenho Humano (LAPEDH), Universidade de Pernambuco (UPE), Petrolina 56328-900, PE, Brazil"},{"name":"Programa de P\u00f3s-Gradua\u00e7\u00e3o em Reabilita\u00e7\u00e3o e Desempenho Funcional (PPGRDF), Universidade de Pernambuco (UPE), Petrolina 56328-900, PE, Brazil"},{"name":"Hospital Universit\u00e1rio da Universidade Federal do Vale do S\u00e3o Francisco (HU-UNIVASF), Empresa Brasileira de Servi\u00e7os Hospitalares (EBSERH), Petrolina 56304-205, PE, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dino","family":"Schwingel","sequence":"additional","affiliation":[{"name":"AI-Assisted Diagnostics Research Group (AIDRG), University of Pernambuco (UPE), Petrolina 56328-900, PE, Brazil"},{"name":"Laborat\u00f3rio de Pesquisas em Desempenho Humano (LAPEDH), Universidade de Pernambuco (UPE), Petrolina 56328-900, PE, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6057-0414","authenticated-orcid":false,"given":"Samuel Ricarte","family":"de Aquino","sequence":"additional","affiliation":[{"name":"AI-Assisted Diagnostics Research Group (AIDRG), University of Pernambuco (UPE), Petrolina 56328-900, PE, Brazil"},{"name":"Hospital Universit\u00e1rio da Universidade Federal do Vale do S\u00e3o Francisco (HU-UNIVASF), Empresa Brasileira de Servi\u00e7os Hospitalares (EBSERH), Petrolina 56304-205, PE, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo Jos\u00e9 Videres Cordeiro de","family":"Brito","sequence":"additional","affiliation":[{"name":"AI-Assisted Diagnostics Research Group (AIDRG), University of Pernambuco (UPE), Petrolina 56328-900, PE, Brazil"},{"name":"Hospital Universit\u00e1rio da Universidade Federal do Vale do S\u00e3o Francisco (HU-UNIVASF), Empresa Brasileira de Servi\u00e7os Hospitalares (EBSERH), Petrolina 56304-205, PE, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e1rcio de Oliveira","family":"Silva","sequence":"additional","affiliation":[{"name":"AI-Assisted Diagnostics Research Group (AIDRG), University of Pernambuco (UPE), Petrolina 56328-900, PE, Brazil"},{"name":"Laborat\u00f3rio de Pesquisas em Desempenho Humano (LAPEDH), Universidade de Pernambuco (UPE), Petrolina 56328-900, PE, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2840-8561","authenticated-orcid":false,"given":"Fl\u00e1via Em\u00edlia Cavalcante Valen\u00e7a","family":"Fernandes","sequence":"additional","affiliation":[{"name":"AI-Assisted Diagnostics Research Group (AIDRG), University of Pernambuco (UPE), Petrolina 56328-900, PE, Brazil"},{"name":"Programa de P\u00f3s-Gradua\u00e7\u00e3o em Forma\u00e7\u00e3o de Professores e Pr\u00e1ticas Interdisciplinares (PPGFPPI), Universidade de Pernambuco (UPE), Petrolina 56328-900, 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Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"ref_1","first-page":"e02165","article-title":"An insight into the success, challenges, and future perspectives of eliminating neglected tropical disease","volume":"24","author":"Hudu","year":"2024","journal-title":"Sci. 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