{"doi":"10.1093/infdis/jiaa286","title":"Evolution of Antimalarial Drug Resistance Markers in the Reservoir of <i>Plasmodium falciparum</i> Infections in the Upper East Region of Ghana","abstract":"BACKGROUND: The majority of Plasmodium falciparum infections, constituting the reservoir in all ages, are asymptomatic in high-transmission settings in Africa. The role of this reservoir in the evolution and spread of drug resistance was explored. METHODS: Population genetic analyses of the key drug resistance-mediating polymorphisms were analyzed in a cross-sectional survey of asymptomatic P. falciparum infections across all ages in Bongo District, Ghana. RESULTS: Seven years after the policy change to artemisinin-based combination therapies in 2005, the pfcrt K76 and pfmdr1 N86 wild-type alleles have nearly reached fixation and have expanded via soft selective sweeps on multiple genetic backgrounds. By constructing the pfcrt-pfmdr1-pfdhfr-pfdhps multilocus haplotypes, we found that the alleles at these loci were in linkage equilibrium and that multidrug-resistant parasites have not expanded in this reservoir. For pfk13, 32 nonsynonymous mutations were identified; however, none were associated with artemisinin-based combination therapy resistance. CONCLUSIONS: The prevalence and selection of alleles/haplotypes by antimalarials were similar to that observed among clinical cases in Ghana, indicating that they do not represent 2 subpopulations with respect to these markers. Thus, the P. falciparum reservoir in all ages can contribute to the maintenance and spread of antimalarial resistance.","journal":"The Journal of Infectious Diseases","year":2020,"id":69781,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":20,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8502,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":270630,"name":"Anita Ghansah","orcid":"0000-0003-4639-1249","position":1,"is_corresponding":false},{"id":369426,"name":"Michael F. Duffy","orcid":"0000-0001-5635-4033","position":2,"is_corresponding":false},{"id":369427,"name":"Shazia Ruybal‐Pesántez","orcid":"0000-0002-0495-179X","position":3,"is_corresponding":false},{"id":370456,"name":"Christiana O Onwona","orcid":null,"position":4,"is_corresponding":false},{"id":231137,"name":"Abraham Oduro","orcid":"0000-0002-4191-7419","position":5,"is_corresponding":false},{"id":369428,"name":"Kwadwo Koram","orcid":"0000-0003-4274-6516","position":6,"is_corresponding":false},{"id":369429,"name":"Karen P. Day","orcid":"0000-0002-6115-6135","position":7,"is_corresponding":false},{"id":369430,"name":"Kathryn E. Tiedje","orcid":"0000-0003-3305-0533","position":8,"is_corresponding":false},{"id":369425,"name":"Charles A. Narh","orcid":"0000-0002-2018-5634","position":0,"is_corresponding":true}],"reference_count":54,"raw_metadata":null,"created_at":"2026-07-18T21:42:48.813846Z","pmid":"32459360","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}