ArticleProceedings. Biological sciences2016
Within-host competition and drug resistance in the human malaria parasite Plasmodium falciparum.
Article in Proceedings. Biological sciences, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers.
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Who cites it
43 citing papers in PubMed, 65 citations in OpenAlex.
- Changes in molecular markers of Plasmodium falciparum drug resistance between 2017 and 2024 in Southern Benin.International journal for parasitology. Drugs and drug resistance · 2026Article
- Efficacy of artemether-lumefantrine combination for the treatment of uncomplicated Plasmodium falciparum malaria after 16 years of its introduction into Ghana's antimalarial medicines policy.Malaria journal · 2026Article
- Disentangling Environmental and Within-Host Drivers of Parasite Dynamics in Natural Populations.Molecular ecology · 2026Article
- Reversal of Chloroquine Resistance inInternational journal of molecular sciences · 2026Article
- Assessing fitness costs in malaria parasites: a comprehensive review and implications for drug resistance management.Malaria journal · 2025Review
- Gossypol is a natural product with good antimalarial activity against Plasmodium falciparum clinical isolates.Scientific reports · 2025Article
- Plasmodium falciparum genetic diversity and multiplicity of infection among asymptomatic and symptomatic malaria-infected individuals in Uganda.Tropical medicine and health · 2024Article
- Temporal genomics in Southern Zambia shows rising prevalence of Plasmodium falciparum mutations linked to delayed clearance after artemisinin-lumefantrine treatment.Scientific reports · 2024Article
- Temporal genomic analysis ofmedRxiv : the preprint server for health sciences · 2024Article
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- Antigenic strain diversity predicts different biogeographic patterns of maintenance and decline of anti-malarial drug resistance.bioRxiv : the preprint server for biology · 2023Article
- Effectiveness of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine in Pregnancy: Low Coverage and High Prevalence ofPathogens (Basel, Switzerland) · 2023Article
- coiaf: Directly estimating complexity of infection with allele frequencies.PLoS computational biology · 2023Article
- Dynamics of parasite growth in genetically diverse Plasmodium falciparum isolates.Molecular and biochemical parasitology · 2023Article
- Low genetic diversity of Plasmodium falciparum merozoite surface protein 1 and 2 and multiplicity of infections in western Ethiopia following effective malaria interventions.Malaria journal · 2022Article
- Resolving drug selection and migration in an inbred South American Plasmodium falciparum population with identity-by-descent analysis.PLoS pathogens · 2022Article
- Targeting malaria parasites inside mosquitoes: ecoevolutionary consequences.Trends in parasitology · 2022Review
- Genetic Diversity of Plasmodium falciparum and Distribution of Antimalarial Drug Resistance Mutations in Symptomatic and Asymptomatic Infections.Antimicrobial agents and chemotherapy · 2022Article
- Potential Emergence of Plasmodium Resistance to Artemisinin Induced by the Use of Artemisia annua for Malaria and COVID-19 Prevention in Sub-African Region.Acta parasitologica · 2022Review
- Antiplasmodial, Antitrypanosomal, and Cytotoxic Effects ofAdvances in pharmacological and pharmaceutical sciences · 2022Article
Corrections and comments
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Authors and funding
13 authors at 4 institutions in 3 countries.
Funding
Abstract
Infections with the malaria parasite Plasmodium falciparum typically comprise multiple strains, especially in high-transmission areas where infectious mosquito bites occur frequently. However, little is known about the dynamics of mixed-strain infections, particularly whether strains sharing a host compete or grow independently. Competition between drug-sensitive and drug-resistant strains, if it occurs, could be a crucial determinant of the spread of resistance. We analysed 1341 P. falciparum infections in children from Angola, Ghana and Tanzania and found compelling evidence for competition in mixed-strain infections: overall parasite density did not increase with additional strains, and densities of individual chloroquine-sensitive (CQS) and chloroquine-resistant (CQR) strains were reduced in the presence of competitors. We also found that CQR strains exhibited low densities compared with CQS strains (in the absence of chloroquine), which may underlie observed declines of chloroquine resistance in many countries following retirement of chloroquine as a first-line therapy. Our observations support a key role for within-host competition in the evolution of drug-resistant malaria. Malaria control and resistance-management efforts in high-transmission regions may be significantly aided or hindered by the effects of competition in mixed-strain infections. Consideration of within-host dynamics may spur development of novel strategies to minimize resistance while maximizing the benefits of control measures.
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Registered trials
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