Miller Figure 2 (in Weatherall et al). Parasite life cycle and pathogenesis of falciparum malaria.

The molecular and cellular events during the life cycle influence disease severity. Disease only occurs as a result of the asexual blood stage after the parasite leaves the liver and begins to invade and grow inside red cells (RBCs). All human Plasmodium spp. invade by the same mechanism, but P. falciparum reaches high parasitemia because of greater flexibility in receptor pathways that it can use to invade all RBCs. RBCs infected with P. falciparum must bind to endothelium or placenta for the parasite to avoid spleen-dependent killing mechanisms, but this binding also leads to much of the pathology (see Miller Figure 3F4).