Abstract
The biology of intraerythrocytic Babesia parasites presents unique challenges for the diagnosis of human babesiosis. Antibody-based assays are highly sensitive but fail to detect early stage Babesia infections prior to seroconversion (window period) and cannot distinguish between an active infection and a previously resolved infection. On the other hand, nucleic acid-based tests (NAT) may lack the sensitivity to detect window cases when parasite burden is below detection limits and asymptomatic low-grade infections. Recent technological advances have improved the sensitivity, specificity and high throughput of NAT and the antibody-based detection of Babesia. Some of these advances include genomics approaches for the identification of novel high-copy-number targets for NAT and immunodominant antigens for superior antigen and antibody-based assays for Babesia. Future advances would also rely on next generation sequencing and CRISPR technology to improve Babesia detection. This review article will discuss the historical perspective and current status of technologies for the detection of Babesia microti, the most common Babesia species causing human babesiosis in the United States, and their implications for early diagnosis of acute babesiosis, blood safety and surveillance studies to monitor areas of expansion and emergence and spread of Babesia species and their genetic variants in the United States and globally.
Highlights
Babesia microti is an intraerythrocytic, apicomplexan parasite that is the primary agent responsible for human babesiosis in the United States
Results from limited clinical observations and donor screening for Babesia by nucleic acid-based test (NAT) assays are beginning to shed some light on the duration of the persistence of B. microti infections in asymptomatic individuals living in endemic areas
It is anticipated that novel high-copy-number conserved gene targets identified by genome analyses, multiplexing for simultaneous detection of Babesia species and subpopulations circulating in an area and technological advances including detection target enrichment in a sample would further improve the sensitivity, specificity and applicability of B. microti nucleic acid-based tests (NAT) assays for diagnosis, surveillance and blood safety purposes
Summary
Babesia microti is an intraerythrocytic, apicomplexan parasite that is the primary agent responsible for human babesiosis in the United States. Infection transmitted via tick bite was established in four of five monkeys after a prepatent period of 13 to 28 days [16] In these studies, blood film microscopy was the only tool employed to determine the early infection, and it is not known when molecular assays would have become effective. Results from limited clinical observations and donor screening for Babesia by nucleic acid-based test (NAT) assays are beginning to shed some light on the duration of the persistence of B. microti infections in asymptomatic individuals living in endemic areas. A combination of detection biomarkers and further technological advances would be required for early diagnosis, epidemiology and to monitor the genetic diversity and geographical spread of human babesiosis in the United States and globally
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