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Parasitized red blood cells (PRBCs) were sequestered in microvessels of cerebral and subcutaneous tissues of a rhesus monkey infected with Plasmodium coatneyi. A similar sequestration rate (approximately 80%) was observed in both cerebral and subcutaneous microvessels. Electron microscopy showed knobs of the sequestrated PRBCs cytoadhered to endothelial cells. These results are consistent with the finding of PRBC sequestration in subcutaneous tissues in a comatose patient with cerebral malaria. Biopsy specimens of subcutaneous tissue may be useful as indicators of PRBC sequestration in the brain of cerebral malaria patients.

Sequestered parasitized erythrocytes were found in microvessels of subcutaneous tissues in a comatose patient with cerebral malaria even though the blood smears were negative after quinine treatment. This situation reflects the continued presence of sequestered parasites in the brain and suggests that negative parasitemia in peripheral blood does not necessarily mean the end point of malarial treatment has been reached. Our findings suggest that biopsy of subcutaneous tissue from severe malaria patients may be useful for determining the severity and prognosis of malaria patients.

The nature of erythrocyte membrane alterations in Plasmodium simium infections was determined employing light microscopy, carbon replication and transmission electron microscopy. Light microscopy of Giemsa stained preparations shows that infected cells initially acquire a faint stippling (schuffnerization) which becomes pronouced with subsequent parasite development. Enlargement of the host cell usually accompanied stippling. Both phenomena appear to depend on host cell age since infected mature erythrocytes were neither stippled nor enlarged. Carbon replicas show numerous indentations over the outer membrane surface of most infected cells. Their distribution suggests that they account for Schuffner's granules. The surface indentations are manifest as small infundibular which open to the infected cell's surface. Cytoplasmic microvesciles in the infected cell's stroma frequently are observed adjacent or catenated to the surface infundibula. Images suggest their funsion with the surface infundibula thus adding membrane to the cell's surface and accounting for host cell enlargement.

Erythrocytes infected with Plasmodium vivax and P cynomolgi, characterized by Schüffner's dots on Giemsa-stained thin films, were studied by electron microscopy and immunocytochemistry. A caveola-vesicle complex, which consisted of a caveola surrounded by vesicles, in an alveolar fashion, formed along the erythrocyte plasmalemma. Horseradish-peroxidase-labeled immunoglobulin from a monkey infected with P vivax bound to the vesicle membrane. Cationized ferritin appeared within the vesicles after incubation with viable parasitized erythrocytes, suggesting that these vesicles were pinocytotic in origin. This caveola-vesicle complex probably corresponds to Schüffner's dots because the alteration is unique to vivax- and ovale-type malarias, and its size and distribution are consistent with Schüffner's dots. Clefts observed within the cytoplasm of infected erythrocytes are present in all malarias and are unlikely candidates for Schüffner's data.

Morphological and cytochemical surface characteristics of isolated malaria parasites (Plasmodium berghei) and host erythrocytes were compared by electron microscopy by using thin section and carbon replica techniques. Erythrocytes were uniform in shape and had fine, granular surfaces. In contrast, free parasites exhibited a variety of sizes, shapes, and surface textures. Fine surface stippling was a common topographical feature of isolated parasites. Small, infective forms often had patterned surfaces resulting from the protuberance of an underlying thick intermediate layer. Results of cytochemical analysis using a sialophilic colloidal iron stain indicated that the malaria parasite's surface lacked exposed sialic acid groups which would normally give rise to a net negative surface charge common to erythrocytes. Biochemical assay demonstrated that malaria parasites contained about one-half the amount of sialic acid per unit weight as did control red cell extracts. Similarly, external acidic mucopolysaccharide coats of free parasites, as revealed by ruthenium red staining were extremely thin as compared with the thick glycocalyx layer of red cells. Lipid plaques at the surface of parasites and red cells were localized by lipophilic iron colloid staining. Although the gross patchwork distribution of plaques was somewhat similar for the two cell types, the parasites were stained more intensely and had a closer-knit patchwork pattern than those exhibited by the erythrocytes. Such findings indicate that there are slight differences in the arrangement of phospholipids at the surfaces of limiting membranes of host cells and parasites. The significance of the above cytochemical surface properties of the malaria parasite (which are seemingly akin to those of intracellular organelles is discussed in relation to certain host-parasite interactions, such as parasite adhesion to target cells and enhanced clearance of extracellular parasites.