Furthermore, it is possible to distinguish these three species CAL-101 using meting curve following the PCR assay (Figure 7). Using similar strategy, additional Borrelia species, such as emerging B. miyamotoi, can be identified in the future with a little tweaking of the assay. The best time to develop an efficient diagnostic assay is when infections by a particular organism start emerging among human or animal populations, environment or in the vectors. This ensures that a well-standardized and efficient diagnostic test is available when significant population starts

getting affected by the emerging pathogen. The infections of tick populations by two tick-borne pathogens, A. phagocytophilum and Babesia species have been increasing in both Europe and the United States, and the cases of infections by these emerging pathogens are also getting reported at a higher numbers in both continents [1, 2]. Indeed, coinfections with these tick-borne pathogens have started appearing in the patients, and result in more severe illnesses IBET762 than those observed when the patient is infected by each pathogen individually [27, 81]. Therefore, we decided to expand our real-time PCR approach to include detection of these two emerging pathogens. Optimized PCR conditions for each emerging pathogen, B. microti and A. phagocytophilum BmTPK and APH1387 gene amplicons, respectively along with the human ACTA1

amplicon (Figures 3 and 4) worked well even in quadrupex assay in which serially diluted genomic DNA of B. burgdorferi and human could be accurately detected in addition to BmTPK and APH1387 containing plasmid DNA (Figure 5). Similarly, a 100-fold excess of B. microti

and A. phagocytophilum copy number did not affect accuracy of detection of B. burgdorferi (Figure 6B). Moreover, this test could detect as few as 103 copies of both APH1387 and BmTPK in mixed genomic DNA presence containing an excess (upto 103-fold higher or 106 copy number) of B. burgdorferi DNA indicating the sensitivity and accuracy of the assay is maintained irrespective of the different Niclosamide load of the pathogens presence in the sample (Figure 6A). These results demonstrate that we can use this assay to efficiently and relatively quickly detect individual pathogens, such as B. microti in blood bank samples using the approach used in the Figure 3. We can also diagnose coinfections with two or three pathogens in the endemic regions for these tick-borne diseases using the quadruplex assay (Figures 5 and 6). Finally, success of our assay with B. burgdorferi spiked human blood indicates that we will be able to use it for diagnostic purpose in human patients (Figure 8). Although real-time PCR and other techniques have been tested for identification of Lyme spirochetes and other tick-borne pathogens individually, albeit primarily in ticks [6, 78, 80, 82–86], this is the first comprehensive study to develop assay for sensitive detection of three tick-borne pathogens simultaneously.