Field evaluation of the ICT malaria PF/PV immunochromatographic test for the detection of asymptomatic malaria in a Plasmodium falciparum/vivax endemic area in Thailand

Rapid antigen assays provide an effective tool for the detection of malaria in symptomatic patients. However, the efficacy of these devices for detecting asymptomatic malaria, where parasite levels are normally significantly lower than in symptomatic patients, is less well established. We evaluated the efficacy of a new combined Plasmodium falciparum-Plasmodim vivax immunochromatographic test (ICT Malaria Pf/Pv) in a cross-sectional malaria survey of the village of Ban Kong Mong Tha, Kanchanaburi Provice, Thailand, from August to December 2000. A total of 1,976 bleeds were made from 559 individuals over the course of the study. Blinded microscopy of thick and thin blood films was used as the gold standards all discordant and 10% of concordant results were cross-checked. Of 1,976 ICT Malaria Pf/Pv dipsticks tested, 98.3% (n = 1,943) performed as expected, as evidenced by the appearance of the control line. The ICT Malaria Pf/Pv test was both sensitive (100.0%) and specific (99.7%) for the diagnosis of falciparum malaria with parasitemias of greater than or equal to500 trophozoites/muL; however only 15.9% (13/82) of infected individuals had parasitemia rates this high. When P. falciparum parasitemia rates were <500/mu L, the sensitivity of the diagnosis was only 23.3%, with a positive predictive value (PPV) and a negative predictive value (NPV) of 76.2 and 97.2%. respectively. The ICT Malaria Pf/Pv test was specific, but not sensitive. for the diagnosis of vivax malaria with parasite rates of : 500 trophozoites/mu l, with sensitivity, specificity, PPV. and NPV of 66.7%, 99.9%, 66.7%, and 99.9%, respectively. At parasite rates of <500/muL, corresponding values were 0.0%, 99.9%, 0%, and 95.1%. Because of the relatively high cost of these assays, low parasite rates found in the majority of asymptomatic individuals. and low sensitivity of this assay with rates of <50/mu l, use of this assay as a tool for active case detection is of limited value in western Thailand.