Fungal diagnostics capacity in Malaysia: A survey across 48 laboratories

Fungal infections affect 2% of Malaysia's population, yet little is known about mycology laboratory practices in the country. This study surveyed 48 medical institutions, including 14 state hospitals, 26 major specialist hospitals, 4 minor specialist hospitals, 3 university hospitals, and 1 reference laboratory, to assess current practices and identify areas for improvement. Nearly all hospitals performed germ tube testing for Candida albicans (87.5%, 42/48). Yeast identification was conducted using API® (52%, 25/48) or VITEK® (52%, 25/48), with two institutions employing both methods. Advanced methods like matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) were used in only 39.6% (19/48) of institutions, while PCR and DNA sequencing (6.3%, 3/48 each) were limited to university and reference labs. Mould identification primarily relied on the tease mount method (91.7%, 44/48), indicating widespread capability for morphological identification. Antifungal susceptibility testing for yeast was available in all hospitals except minor specialist hospitals, using VITEK® (35.4%, 17/48), Sensititre® (20.8%, 10/48), or Etest® (8.3%, 4/48). Serology testing focused on opportunistic mycoses, particularly Cryptococcus spp. (50.0%, 24/48), while testing for endemic pathogens like Histoplasma was rare (2.1%, 1/48). Aspergillosis testing was limited to galactomannan enzyme immunoassay and lateral flow assay (6.3%, 3/48 each), and no institutions performed (1,3)-beta-d-glucan testing. While advanced diagnostics were available in state and major hospitals, minor specialist hospitals lacked access. These findings highlight the urgent need to enhance laboratory infrastructure, expand access to advanced diagnostics like MALDI-TOF, and train personnel to improve fungal infection management in Malaysia.