TROPICAL, TRAVEL AND EMERGING INFECTIONS (L CHEN, SECTION EDITOR) Recent Advances in Clinical Parasitology Diagnostics Cedric P. Yansouni & Joanna Merckx & Michael D. Libman & Momar Ndao # Springer Science+Business Media New York 2014 Abstract Microscopy has several limitations in the diagnosis of parasitic infection. New technologies have emerged to address some of these limitations. We review recent advances in three key areas. The detection of enteric protozoa is a commonly requested test, particularly with increasing travel to and migration from endemic countries. Microscopy is slow and labor intensive and requires a high level of technical expertise. It also lacks both sensitivity and specificity. Recent- ly developed nucleic acid amplification tests are automated and rapid and show superior accuracy. Proteomics shows promise for both the diagnosis of infections where parasite detection is difficult and the potential for accurate assessment of cure in these cases. Finally, rapid and simple diagnostic tests suitable for use in low-resource settings are now allowing for improved study and control of infection in endemic regions. Keywords Parasitology . Diagnostics . Nucleic acid amplification techniques . Proteomics . Rapid diagnostic tests . Parasitic diseases Introduction and Scope The microscopic appearance of human intestinal parasites was first described and published in the seventeenth century, not long after the discovery of the microscope, by Francesco Redi, considered the grandfather of modern parasitology [1]. Al- though the instruments were refined, microscopy remained the principal tool for parasitological diagnosis over the next 350 years. Only in the past two decades have alternative technologies evolved to the stage of mainstream use. Micros- copy is labor and time intensive, requires extensive training and technical expertise, and lacks sensitivity and reproducibil- ity [2]. These new technologies afford improvement in all of these test parameters. In this review, we focus on three areas of innovation that are rapidly transforming clinical parasitology. The first is the use of nucleic acid amplification, particularly in the search for enteric pathogens. The second is proteomics, which allows the identification of disease states, rather than the simple documentation of the presence of a pathogen. The third is the development of rapid diagnostics suitable for use in low-resource settings under field conditions. Nucleic Acid Amplification Tests for Enteric Parasites The most promising alternative platform for the detection of pathogenic parasites in stool specimens is the nucleic acid amplification test (NAAT), with polymerase chain reaction (PCR) being the best described. Progress has been incremental but steady. Many “in-house” assays have been developed and This article is part of the Topical Collection on Tropical, Travel and Emerging Infections C. P. Yansouni : M. D. Libman : M. Ndao J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, 1650 Cedar Avenue, Room L10.509, Montreal H3G 1A4, Canada C. P. Yansouni : J. Merckx : M. D. Libman (*) Division of Infectious Diseases and Department of Medical Microbiology, McGill University Health Centre, 1650 Cedar Avenue, Room L10.509, Montreal H3G 1A4, Canada e-mail: michael.libman@mcgill.ca J. Merckx Division of Pediatric Infectious Diseases, McGill University Health Centre, Montreal, Canada M. Ndao National Reference Centre for Parasitology, Montreal, Canada Curr Infect Dis Rep (2014) 16:434 DOI 10.1007/s11908-014-0434-9