Circulation of an indigenous pfkelch13 A675V malaria lineage in a traveler returning from East Africa to France. Uganda_pfk13_A675V

Artemisinin resistance is primarily conferred by mutations in the P. falciparum kelch13 gene (pfk13). Herein we explored the genetic variation of pfk13 in isolates from 127 patients who experienced malaria in France after returning from a travel to Eastern Africa from January 2006 to December 2020. By Sanger sequencing, we found the R255K mutation in three isolates, and L258M and A675V each in one isolate. We tested the origin of the isolate carrying the artemisinin-resistant A675V mutation by whole-genome sequencing. Compared with 118 previously published P. falciparum genomes from African and Southeast Asian parasites, both the whole-genome and pfk13 backgrounds of the A675V isolate clustered with the ones of East African isolates and were highly related to those of a previously reported A675V isolate from Uganda. These data support the circulation of a pfk13 A675V mutation that originated locally in East Africa.