**30. Host erythrocyte modification**

Once inside of the erythrocyte, the parasite undergoes a trophic phase followed by replicative phase. During this intra-erythrocytic period, the parasite modifies the host to make it a more suitable habitat. For example, the erythrocyte membrane becomes more permeable to small molecular weight metabolites, presumably reflecting the needs of an actively growing parasite.

Another modification of the host cell concerns cytoadherence of *P. falciparum*- infected erythrocyte to endothelial cells and the resulting sequestration of the mature parasite in capillaries and post-capillary veinules. This sequestration likely leads to microcirculatory alteration and metabolic dysfunctions which could be responsible for many of the manifestation of severe falciparum malaria. The cytoadherence to endothelial cells confers at least two advantages for the parasite: 1) a microaerophilic environment which is better suited for parasite metabolism, and 2) avoidance of the spleen and subsequent destruction.
