Abstract
Babesiosis is an emerging tick-borne disease caused by apicomplexan parasites of the genus Babesia. With its increasing incidence worldwide and the risk of human-to-human transmission through blood transfusion, babesiosis is becoming a rising public health concern. The current arsenal for the treatment of human babesiosis is limited and consists of combinations of atovaquone and azithromycin or clindamycin and quinine. These combination therapies were not designed based on biological criteria unique to Babesia parasites, but were rather repurposed based on their well-established efficacy against other apicomplexan parasites. However, these compounds are associated with mild or severe adverse events and a rapid emergence of drug resistance, thus highlighting the need for new therapeutic strategies that are specifically tailored to Babesia parasites. Herein, we review ongoing babesiosis therapeutic and management strategies and their limitations, and further review current efforts to develop new, effective, and safer therapies for the treatment of this disease.
Highlights
Human babesiosis is a rapidly emerging tick-born infectious disease caused by intraerythrocytic parasites of the genus Babesia
In a lethal model of B. microti infection in hamsters, atovaquone monotherapy was found to be superior to a combination of clindamycin + quinine, resulting in low to undetectable parasitemia and extended survival [58]
The current therapies for the treatment of human babesiosis are based on drugs already in use against other apicomplexan parasites and tend to be associated with significant adverse effects and/or the development of drug resistance
Summary
Of several hundred Babesia species identified so far, only a few are known to infect humans These include Babesia microti, Babesia duncani, Babesia divergens and divergens-like species, Babesia crassa-like, and Babesia venatorum [1]. B. microti, but sporadic cases due to infection with B. duncani and B. divergens-like MO1 have been reported. An increasing number of transfusion-transmitted babesiosis cases have been reported in the US over the past 2–3 decades, making Babesia infections a major public health concern [1,3,4,5,6]. In. 2011, human babesiosis became a nationally notifiable disease in the US [5] and as one of the most common transfusion-transmitted pathogens in the US, B. microti was added to the list of significant threats to the blood supply [3,4]. We report on the development and evaluation of novel and highly promising antibabesial therapies
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