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Imported malaria remains one of the top causes of fever in Canadian returning travelers. Twelve sequential whole-blood samples before and after AP treatment failure were obtained from a patient diagnosed with\n            <jats:named-content content-type=\"genus-species\">P. falciparum<\/jats:named-content>\n            malaria upon their return from Uganda and Sudan. Ultradeep sequencing was performed on the\n            <jats:italic>cytb, dhfr,<\/jats:italic>\n            and\n            <jats:italic>dhps<\/jats:italic>\n            markers of treatment resistance before and during the episode of recrudescence. Haplotyping profiles were generated using three different approaches:\n            <jats:italic>msp2-3D7<\/jats:italic>\n            agarose and capillary electrophoresis, and\n            <jats:italic>cpmp<\/jats:italic>\n            using amplicon deep sequencing (ADS). A complexity of infection (COI) analysis was conducted.\n            <jats:italic>De novo cytb<\/jats:italic>\n            Y268C mutants strains were observed during an episode of recrudescence 17\u2009days and 16\u2009h after the initial malaria diagnosis and AP treatment initiation. No Y268C mutant reads were observed in any of the samples prior to the recrudescence. SNPs in the\n            <jats:italic>dhfr<\/jats:italic>\n            and\n            <jats:italic>dhps<\/jats:italic>\n            genes were observed upon initial presentation. The haplotyping profiles suggest multiple clones mutating under AP selection pressure (COI\u2009&gt;\u20093). Significant differences in COI were observed by capillary electrophoresis and ADS compared to the agarose gel results. ADS using\n            <jats:italic>cpmp<\/jats:italic>\n            revealed the lowest haplotype variation across the longitudinal analysis. Our findings highlight the value of ultra-deep sequencing methods in the understanding of\n            <jats:named-content content-type=\"genus-species\">P. falciparum<\/jats:named-content>\n            haplotype infection dynamics. Longitudinal samples should be analyzed in genotyping studies to increase the analytical sensitivity.\n          <\/jats:p>","DOI":"10.1128\/aac.01709-22","type":"journal-article","created":{"date-parts":[[2023,5,8]],"date-time":"2023-05-08T14:14:42Z","timestamp":1683555282000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":6,"title":["Amplicon Deep Sequencing Reveals Multiple Genetic Events Lead to Treatment Failure with Atovaquone-Proguanil in Plasmodium falciparum"],"prefix":"10.1128","volume":"67","author":[{"given":"Daniel","family":"Casta\u00f1eda-Mogoll\u00f3n","sequence":"first","affiliation":[{"name":"Cumming School of Medicine, Department of Pathology &amp; Laboratory Medicine, the University of Calgary, Calgary, Alberta, Canada"},{"name":"Cumming School of Medicine, Department of Microbiology, Immunology, and Infectious Diseases, the University of Calgary, Calgary, Alberta, Canada"},{"name":"Calvin, Phoebe &amp; Joan Snyder Institute for Chronic Diseases, the University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noah B.","family":"Toppings","sequence":"additional","affiliation":[{"name":"Cumming School of Medicine, Department of Pathology &amp; Laboratory Medicine, the University of Calgary, Calgary, Alberta, Canada"},{"name":"Cumming School of Medicine, Department of Microbiology, Immunology, and Infectious Diseases, the University of Calgary, Calgary, Alberta, Canada"},{"name":"Calvin, Phoebe &amp; Joan Snyder Institute for Chronic Diseases, the University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire","family":"Kamaliddin","sequence":"additional","affiliation":[{"name":"Cumming School of Medicine, Department of Pathology &amp; Laboratory Medicine, the University of Calgary, Calgary, Alberta, Canada"},{"name":"Cumming School of Medicine, Department of Microbiology, Immunology, and Infectious Diseases, the University of Calgary, Calgary, Alberta, Canada"},{"name":"Calvin, Phoebe &amp; Joan Snyder Institute for Chronic Diseases, the University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raynell","family":"Lang","sequence":"additional","affiliation":[{"name":"Cumming School of Medicine, Department of Medicine, the University of Calgary, Calgary, Alberta, Canada"},{"name":"Cumming School of Medicine, Department of Community Health Sciences, the University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Kuhn","sequence":"additional","affiliation":[{"name":"Cumming School of Medicine, Department of Pediatrics, the University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9518-5551","authenticated-orcid":true,"given":"Dylan R.","family":"Pillai","sequence":"additional","affiliation":[{"name":"Cumming School of Medicine, Department of Pathology &amp; Laboratory Medicine, the University of Calgary, Calgary, Alberta, Canada"},{"name":"Cumming School of Medicine, Department of Microbiology, Immunology, and Infectious Diseases, the University of Calgary, Calgary, Alberta, Canada"},{"name":"Calvin, Phoebe &amp; Joan Snyder Institute for Chronic Diseases, the University of Calgary, Calgary, Alberta, Canada"},{"name":"Alberta Precision Laboratories, Diagnostic &amp; Scientific Centre, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"key":"e_1_3_4_2_2","unstructured":"Public Health Agency of Canada. 2021. 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