Comparison between methods for serotyping of Candida albicans produces discrepancies in results

Serotyping of 101 clinical isolates of Candida albicans was done with two sets of Hasenclever original anti-Candida typing sera (HSN 1 and 2) and Iatron Candida Check factor 6 typing serum (IF6). The results of these two methods were compared with slide agglutination reactions of yeast with monoclonal antibody H9. Agglutination reactions with this antibody have been previously shown to correlate with serotype. Results indicate the following correlations: between HSN 1 and HSN 2 serotyping, 93% (kappa = 0.85; 95% confidence interval [CI], 0.70 to 0.99); between IF6 and HSN 1, 60% (kappa = 0.39, 95% CI, 0.19 to 0.58); and between IF6 and HSN 2, 74% (kappa = 0.77; 95% CI, 0.64 to 0.90). Results with HSN 1 and 2 antisera correlated with H9 reactivity at 85 and 89% (kappa = 0.88; 95% CI, 0.75 to 1.00; and kappa = 0.85; CI, 0.70 to 0.99, respectively), while agreement between IF6 and H9 reactivities was less than or equal to 64% (kappa less than or equal to 0.43; 95% CI, 0.14 to 0.60). Autoagglutination of yeast during IF6 serotyping occurred with 21 of the 101 (20.8%) yeast strains. In every case, these yeast strains were serotyped by the HSN methods without autoagglutination and were uniformly type B. This study implies that it may not be possible to make valid comparisons between studies which compare serotype prevalence unless the same methods are used to serotype the yeast. The practicality and utility of serotyping in epidemiological studies are discussed, as are some of the problems associated with the available methods.