@article{5b1cf1c25724437f96eb700af31f4518,
title = "A global map of genetic diversity in Babesia microti reveals strong population structure and identifies variants associated with clinical relapse",
abstract = "Human babesiosis caused by Babesia microti is an emerging tick-borne zoonosis of increasing importance due to its rising incidence and expanding geographic range1. Infection with this organism, an intraerythrocytic parasite of the phylum Apicomplexa, causes a febrile syndrome similar to malaria2. Relapsing disease is common among immunocompromised and asplenic individuals3,4 and drug resistance has recently been reported5. To investigate the origin and genetic diversity of this parasite, we sequenced the complete genomes of 42 B. microti samples from around the world, including deep coverage of clinical infections at endemic sites in the continental USA. Samples from the continental USA segregate into a Northeast lineage and a Midwest lineage, with subsequent divergence of subpopulations along geographic lines. We identify parasite variants that associate with relapsing disease, including amino acid substitutions in the atovaquone-binding regions of cytochrome b (cytb) and the azithromycin-binding region of ribosomal protein subunit L4 (rpl4). Our results shed light on the origin, diversity and evolution of B. microti, suggest possible mechanisms for clinical relapse, and create the foundation for further research on this emerging pathogen.",
author = "Lemieux, {Jacob E.} and Tran, {Alice D.} and Lisa Freimark and Schaffner, {Stephen F.} and Heidi Goethert and Andersen, {Kristian G.} and Suzane Bazner and Amy Li and Graham McGrath and Lynne Sloan and Edouard Vannier and Dan Milner and Bobbi Pritt and Eric Rosenberg and Sam Telford and Bailey, {Jeffrey A.} and Sabeti, {Pardis C.}",
note = "Funding Information: The authors thank R. Tewhey, A. Piantadosi and J. Maguire for feedback and advice, and J. Robbins, J. Katz, J. Gelfand and T.Wieczorek for discussions and assistance with sample collection. The authors acknowledge members of the parasitology and haematology laboratories at Massachusetts General Hospital and Brigham and Women's Hospital for assistance with case identification. P.C.S. and this work are supported by the Broad Institute SPARC programme and the Bill and Melinda Gates Foundation and the Howard Hughes Medical Institute. This work was supported in part by an Infectious Disease Society of America Medical Scholars award, a MIT Division of Health Sciences and/MIT Division of Health Sciences and Technology Research Assistantship to J.E.L. and NIH MSTP grants T32GM007753 to J.E.L. and A.L. S.T. and H.K.G. are supported by NIH U01AI109656 and R41AI078631 and by grants from the Evelyn Lilly Lutz Foundation, the Dorothy Harrison Egan Foundation and the Bill and MelindaGates Foundation. E.V. was supported by a grant from the National Research Fund for Tick-Borne Diseases.",
year = "2016",
month = jun,
day = "13",
doi = "10.1038/nmicrobiol.2016.79",
language = "English (US)",
volume = "1",
journal = "Nature Microbiology",
issn = "2058-5276",
publisher = "Nature Publishing Group",
number = "7",
}