A combined rapid phenotypic strategy for the identification of Candida albicans: Performance evaluation against PCR

Accurate identification of Candida albicans is essential in clinical mycology due to its high prevalence in human infections and its close phenotypic similarity to Candida dubliniensis. Misidentification between these two species can lead to inappropriate treatment and inaccurate epidemiological data. Rapid phenotypic assays are widely used in routine laboratories, but their diagnostic performance requires careful evaluation. This study assessed the diagnostic accuracy of a combined rapid phenotypic approach using the Bichro-latex albicans and Bichro-Dubli tests for the identification of Candida albicans. A total of 180 archived clinical Candida isolates from oral samples, including Candida albicans and non-albicans species, were analyzed. All isolates were cultured under standard conditions and tested with the Bichro-latex albicans and Bichro-Dubli assays according to manufacturer instructions. Molecular identification by polymerase chain reaction served as the reference method. According to the manufacturer's diagnostic algorithm, isolates showing a positive Bichro-latex albicans result combined with a negative Bichro-Dubli result were interpreted as Candida albicans. The combined interpretation of these results showed high diagnostic performance, with sensitivity and specificity exceeding 90 % and overall accuracy above 94 %. Few discordant results were observed, including false-negative reactions among polymerase chain reaction-confirmed Candida albicans isolates and occasional false-positive reactions among non-albicans Candida species, reflecting limitations of antigen-based phenotypic assays. The results indicate that combining Bichro-latex albicans and Bichro-Dubli provides a rapid, reliable, and cost-effective method for identifying Candida albicans in routine clinical mycology laboratories.