Relationship of circulating Plasmodium falciparum lifecycle stage to circulating parasitemia and total parasite biomass

We previously showed in Papua that circulating Plasmodium falciparum causing severe malaria are younger than those causing uncomplicated malaria¹. Thomson-Luque et al.² subsequently claimed that in ours, and other datasets, circulating parasitemia inversely correlated with estimated parasite age and that this was because the P. falciparum that cause severe malaria express PfEMP1s that are more cytoadherent, leading to earlier parasite sequestration in the microvasculature and reduced splenic clearance. Here, we show that in our dataset circulating parasitemia and the proportion of total parasites that are circulating do not correlate with circulating parasite age, hence our data do not support their hypothesis.