Editing Plasmodium falciparum (section)

===Immune response===
A single anopheline mosquito can transmit hundreds of ''P. falciparum'' sporozoites in a single bite under experimental conditions, but, in nature, the number is generally less than 80.<ref>{{cite journal|last1=Beier|first1=JC|last2=Onyango|first2=FK|last3=Koros|first3=JK|last4=Ramadhan|first4=M|last5=Ogwang|first5=R|last6=Wirtz|first6=RA|last7=Koech|first7=DK|last8=Roberts|first8=CR|title=Quantitation of malaria sporozoites transmitted in vitro during salivation by wild Afrotropical Anopheles|journal=Medical and Veterinary Entomology|date=1991|volume=5|issue=1|pages=71–9|doi=10.1111/j.1365-2915.1991.tb00523.x|pmid=1768903|s2cid=27449694}}</ref> The sporozoites do not enter the bloodstream directly, but rather remain in the skin for two to three hours. About 15–20% of the sporozoites enter the lymphatic system, where they activate [[dendritic cells]], which send them for destruction by T lymphocytes ([[Cytotoxic T cell|CD8+ T cells]]). At 48 hours after infection, ''Plasmodium''-specific CD8+ T cells can be detected in the [[lymph nodes]] connected to the skin cells.<ref name=chakravarty>{{cite journal|last1=Chakravarty|first1=Sumana|last2=Cockburn|first2=Ian A|last3=Kuk|first3=Salih|last4=Overstreet|first4=Michael G|last5=Sacci|first5=John B|last6=Zavala|first6=Fidel|title=CD8+ T lymphocytes protective against malaria liver stages are primed in skin-draining lymph nodes|journal=Nature Medicine|date=2007|volume=13|issue=9|pages=1035–1041|doi=10.1038/nm1628|pmid=17704784|s2cid=17601147|doi-access=free}}</ref> Most of the sporozoites remaining in the skin tissue are subsequently killed by the [[innate immune system]]. The sporozoite glycoprotein specifically activates [[mast cells]]. The mast cells then produce [[Cytokine|signaling molecules]] such as [[TNFα]] and MIP-2, which activate cell eaters (professional phagocytes) such as [[neutrophils]] and [[macrophages]].<ref>{{cite journal|last1=Hopp|first1=Christine S.|last2=Sinnis|first2=Photini|title=The innate and adaptive response to mosquito saliva and Plasmodium sporozoites in the skin|journal=Annals of the New York Academy of Sciences|date=2015|volume=1342|issue=1|pages=37–43|doi=10.1111/nyas.12661|pmid=25694058|pmc=4405444|bibcode=2015NYASA1342...37H}}</ref>

Only a small number (0.5-5%) of sporozoites enter the bloodstream into the liver. In the liver, the activated CD8+ T cells from the lymph bind the sporozoites through the [[circumsporozoite protein]] (CSP).<ref name=chakravarty/> [[Antigen presentation]] by dendritic cells in the skin tissue to T cells is also a crucial process. From this stage onward, the parasites produce different proteins that help suppress communication of the immune cells.<ref>{{cite journal|last1=Gomes|first1=Pollyanna S.|last2=Bhardwaj|first2=Jyoti|last3=Rivera-Correa|first3=Juan|last4=Freire-De-Lima|first4=Celio G.|last5=Morrot|first5=Alexandre|title=Immune Escape Strategies of Malaria Parasites|journal=Frontiers in Microbiology|date=2016|volume=7|page=e1617|doi=10.3389/fmicb.2016.01617|pmid=27799922|pmc=5066453|doi-access=free}}</ref> Even at the height of the infection, when red blood cells (RBCs) are ruptured, the immune signals are not strong enough to activate macrophages or [[natural killer cells]].<ref>{{cite journal|last1=Artavanis-Tsakonas|first1=K|last2=Tongren|first2=JE|last3=Riley|first3=EM|title=The war between the malaria parasite and the immune system: immunity, immunoregulation and immunopathology|journal=Clinical and Experimental Immunology|date=August 2003|volume=133|issue=2|pages=145–152|doi=10.1046/j.1365-2249.2003.02174.x|pmid=12869017|pmc=1808775}}{{open access}}</ref>