Detection of the Dihydrofolate Reductase–164L Mutation in Plasmodium falciparum Infections from Malawi by Heteroduplex Tracking Assay

Jonathan J. Juliano Division of Infectious Diseases, University of North Carolina, School of Medicine, Chapel Hill, North Carolina; Department of Epidemiology, University of North Carolina, School of Public Health, Chapel Hill, North Carolina; Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi

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Paul Trottman Division of Infectious Diseases, University of North Carolina, School of Medicine, Chapel Hill, North Carolina; Department of Epidemiology, University of North Carolina, School of Public Health, Chapel Hill, North Carolina; Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi

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Victor Mwapasa Division of Infectious Diseases, University of North Carolina, School of Medicine, Chapel Hill, North Carolina; Department of Epidemiology, University of North Carolina, School of Public Health, Chapel Hill, North Carolina; Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi

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Steven R. Meshnick Division of Infectious Diseases, University of North Carolina, School of Medicine, Chapel Hill, North Carolina; Department of Epidemiology, University of North Carolina, School of Public Health, Chapel Hill, North Carolina; Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi

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Standard polymerase chain reaction methods often cannot detect drug-resistance mutations in Plasmodium falciparum infections if the mutation is present in ≤ 20% of the parasites. A heteroduplex tracking assay was developed that can detect dihydrofolate reductase 164-L mutations in variants representing 1% of the parasites in an individual host. Using this assay, we confirmed the presence of the mutation in P. falciparum infections in Malawi.

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