The evaluation of a dipstick test for Plasmodium falciparum in mining areas of Venezuela

A field trial comparing a dipstick test, an antigen-capture test detecting trophozoite-derived histidine-rich protein-II, and the quantitative buffer coat (QBC(R)) (acridine orange staining technique) assay for the detection of Plasmodium falciparum was carried out on a population of 1,398 suspected malaria patients in gold mining areas of Venezuela. Sensitivity, specificity, and positive predictive values were higher for the dipstick test than for the acridine orange staining when compared with the thick blood smear. The sensitivity for the dipstick method was 86.7% (95% confidence interval [CI] = 82-90%), the specificity was 99.3% (95% CI = 98.5-99.7%), and the positive predictive value was 97.1% (95% CI = 94-98%) as compared with the thick blood smear. The sensitivity for acridine orange staining was 82.2% (95% CI = 77-86%), the specificity was 98.5% (95% CI = 97.6-99.1%), and the positive predictive value was 94.1% (95% CI = 90-97%); with a P. falciparum asexual parasitemia higher than 21 parasites/mu l, the dipstick was 100% sensitive, when parasitemia was 10-20/mu l, sensitivity was 88%, and when parasitemia was less than 10/mu l, it was only 13.4%. The dipstick assay meets the criteria for an appropriate, rapid, and reliable test for the diagnosis of P. falciparum and has advantages over the acridine orange staining method. Nonetheless, its effectiveness seems limited in areas with low prevalence and among patients with low levels of parasitemia.