INCONSISTENCIES IN DETECTING RDRP GENE BY RDRP CONFIRMATORY ASSAY LEADING TO FALSE NEGATIVE COVID-19 RESULTS: A CASE REPORT FROM A DISTRICT REFERRAL HOSPITAL

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Yong Jo Yen
Mangalam Sinniah
Joash Tan-Loh
Nor Akmal Mokhtar
Brian Cheong Mun Keong

Abstract

Reverse transcriptase polymerase chain reaction (RT-PCR) assays for coronavirus disease 2019 (COVID-19) should be interpreted with clinical, epidemiological history and exposure risk to avoid misdiagnosis. We report a cruise-ship worker with significant travelling history, presented with acute respiratory symptoms and radiographic evidence of viral pneumonia. Initial RNA-dependent RNA polymerase (RdRp) gene confirmatory assay was negative. Use of a more robust RT-PCR assay detected ORF1ab, N and S genes for COVID-19, and the diagnosis was supported by an IgM and IgG positive COVID-19 serology. Subsequent follow up samples which reported inconsistencies in detecting RdRp gene also raise the concern of reliability of RdRp gene as the confirmatory assay for diagnosis of COVID-19. Patient later had prolonged viral shedding beyond serological recovery, with a negative viral culture reflecting non-infectivity.

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