Immune Response
P. falciparum creates protein knobs on the surfaces of the red blood cells it attacks. These knobs attach the cell to the lining of the blood vessel, preventing its removal to the spleen for destruction. The parasite slows detection by the immune system by changing the makeup of the knobs periodically, substituting or rearranging its 150 “var” (variability) genes, a strategy unique to malaria. A pattern of remission and relapse results as the immune system learns each new “code” only to have it again changed. Patients with malaria gradually do develop immunity that modifies the course of the disease, but this immunity has a degree of strain specificity. Some of the Plasmodium species have the ability to persist in the liver and cause a new infection years after the original one.
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