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There is a large genetic diversity of  Plasmodium falciparum  strains that infect people causing diverse malaria symptoms. This study was carried out to explore the effect of mixed-strain infections and the extent to which some specific  P. falciparum  variants are associated with particular malaria symptoms.  P. falciparum  isolates collected during pharmacovigilance study in Nanoro, Burkina Faso were used to determine allelic variation in two polymorphic antigens of the merozoite surface ( msp1  and  msp 2). Overall, parasite density did not increase with additional strains, suggesting the existence of within-host competition. Parasite density was influenced by  msp1  allelic families with highest parasitaemia observed in MAD20 allelic family. However, when in mixed infections with allelic family K1, MAD20 could not grow to the same levels as it would alone, suggesting competitive suppression in these mixed infections. Host age was associated with parasite density. Overall, older patients exhibited lower parasite densities than younger patients, but this effect varied with the genetic composition of the isolates for the  msp1  gene. There was no effect of  msp1  and  msp 2 allelic family variation on body temperature. Haemoglobin level was influenced by  msp 2 family with patients harboring the FC27 allele showing lower haemoglobin level than mono-infected individuals by the 3D7 allele. This study provides evidence that  P. falciparum  genetic diversity influenced the severity of particular malaria symptoms and supports the existence of within-host competition in genetically diverse  P. falciparum .

Genetically diverse Plasmodium falciparum infections, within-host competition and symptomatic malaria in humans