{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T01:52:01Z","timestamp":1777427521324,"version":"3.51.4"},"posted":{"date-parts":[[2025,5,2]]},"group-title":"Infectious Diseases (except HIV\/AIDS)","reference-count":66,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T00:00:00Z","timestamp":1746144000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,5,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>\n                  Mixed-species, mixed-strain\n                  <jats:italic>Plasmodia<\/jats:italic>\n                  infections are known to occur in humans in malaria endemic areas. To date, the true extent of this complexity has not been explored in high- burden countries of sub-Saharan Africa. Here we take a metagenomic lens to infections obtained by sampling variable blood volumes from residents living in high, seasonal transmission in northern Ghana. We identified significantly higher prevalence of\n                  <jats:italic>Plasmodium<\/jats:italic>\n                  spp. and inter-\/intra-species complexity in larger blood volumes. Overall, malaria infections displayed high levels of metagenomic complexity comprising single-, double-, and triple- species infections with varying levels of complexity for\n                  <jats:italic>P. falciparum, P. malariae, P. ovale curtisi, and P. ovale wallikeri.<\/jats:italic>\n                  We present evidence of individuals with greater susceptibility to highly-complex infections that cannot be explained by age or location. The implications of these findings to malaria epidemiology and control are illustrated by a geographic scaling exercise to district and region levels in Ghana.\n                <\/jats:p>","DOI":"10.1101\/2025.04.29.25326533","type":"posted-content","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T17:50:16Z","timestamp":1746208216000},"source":"Crossref","is-referenced-by-count":2,"title":["Metagenomic analysis reveals extreme complexity of\n                  <i>Plasmodium<\/i>\n                  spp. infections in high transmission in West Africa"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3396-8213","authenticated-orcid":false,"given":"Mun Hua","family":"Tan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oscar","family":"Bangre","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cecilia A.","family":"Rios-Teran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn E.","family":"Tiedje","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha L.","family":"Deed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"Zhan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fathia","family":"Rasyidi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mercedes","family":"Pascual","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick O.","family":"Ansah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6115-6135","authenticated-orcid":false,"given":"Karen P.","family":"Day","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2025050518350516000_2025.04.29.25326533v1.1","doi-asserted-by":"crossref","unstructured":"Galen, S. 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