1.Granulicatella adiacens, the Elusive Endocarditis Causative Agent: Highlighting the Challenges Faced by Microbiology Laboratory
Noraziah Sahlan ; Farah Roslinda Mohd Rustam
Malaysian Journal of Medicine and Health Sciences 2023;19(No.2):350-353
A 58-year-old man with history of mitral valve prolapse and previous motor vehicle accident presented with one
week history of lower back pain and fever. He was initially treated for pyelonephritis and given ceftriaxone. Blood
culture grew Granulicatella adiacens after 7 days of incubation. The laboratory then referred the case to infectious
disease team in view of possible infective endocarditis. Urgent echocardiogram was done and confirmed the diagnosis. His antibiotic was changed to intravenous benzylpenicillin and gentamicin. Granulicatella adiacens are difficult
to be isolated in the laboratory hence they imposed certain challenges in laboratory identification. Most patients with
Granulicatella adiacens infective endocarditis present with non-specific symptoms, imposing further challenge in
recognizing the condition. These factors posed significant challenges in diagnosing Granulicatella adiacens endocarditis. This case highlighted challenges faced by the laboratories and the need of high index of clinical suspicion
and prompt communication to ensure optimum patient care and management.
2.Rapid Molecular Point of Care Testing for Detection of Influenza A, B Viruses and Respiratory Syncytial Virus Versus Multiplex PCR
Fadzilah Mohd Nor ; Wan Azlirull Aini Ahmad Ghazali ; Farah Roslinda Mohd Rustam ; Chen Xin Wee ; Navindra Kumari Palanisamy
Malaysian Journal of Medicine and Health Sciences 2022;18(No.5):165-170
Introduction: Rapid detection of influenza viruses and respiratory syncytial virus (RSV) can be achieved by having
rapid molecular point of care tests (POCTs). This expedites the diagnosis attributed by having similar clinical presentations leading to facilitation of precision medicine and reduction of antimicrobial resistance. The growing number
of POCTs foster the need to ensure that these POCTs have satisfactory and reliable performance. With that the aim
of this study is to evaluate the performance of rapid molecular POCT regarded as ‘X’ for the detection of Influenza
viruses and RSV in comparison to multiplex PCR. Methods: A laboratory-based study was conducted from January to
December 2020 which involved analysis of 116 nasopharyngeal swabs, tested using POCT X and multiplex PCR as
a method of reference. The performance analysis incorporated the sensitivity, specificity, positive and negative predicted values determination. The cycle threshold values were reviewed for discordant results. Results: The POCT X
demonstrated sensitivity of 88.57% with 100% specificity for Influenza A virus, and 85.71% of sensitivity with 100%
specificity for influenza B virus detection. Meanwhile it revealed 100% sensitivity and specificity for RSV detection.
There were ten specimens demonstrating discordant results whereby viruses were not detected by POCT X, however
detected by multiplex PCR. The POCT X was not able to detect eight (12.9%) and two (16.7%) influenza A and B
viruses respectively. Conclusion: The overall performance of POCT X was corresponded to multiplex PCR. This best
served as a steadfast ancillary test for influenza and RSV infection.