Synchronous versus asynchronous oscillations for antigenically varying Plasmodium falciparum with host immune response

We consider a deterministic intra-host model for Plasmodium falciparum (Pf) malaria infection, which accounts for antigenic variation between n clonal variants of PfEMP1 and the corresponding host immune response (IR). Specifically, the model separates the IR into two components, specific and cross-reactive, respectively, in order to demonstrate that the latter can be a mechanism for the sequential appearance of variants observed in actual Pf infections. We show that a strong variant-specific IR relative to the cross-reactive IR favours the asynchronous oscillations (sequential dominance) over the synchronous oscillations in a number of ways. The decay rate of asynchronous oscillations is smaller than that for the synchronous oscillations, allowing for the parasite to survive longer. With the introduction of a delay in the stimulation of the IR, we show that only a small delay is necessary to cause persistent asynchronous oscillations and that a strong variant-specific IR increases the amplitude of the asynchronous oscillations.