Galactomannan, β-D-Glucan, and Polymerase Chain Reaction-Based Assays for the Diagnosis of Invasive Fungal Disease in Pediatric Cancer and Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis

Thomas Lehrnbecher, Paula D Robinson, Brian T Fisher, Elio Castagnola, Andreas H Groll, William J Steinbach, Theoklis E Zaoutis, Zelalem F Negeri, Joseph Beyene, Bob Phillips, Lillian Sung

Research output: Contribution to journalReview articlepeer-review


We systematically reviewed and analyzed the available data for galactomannan (GM), beta-D-glucan (BG), and polymerase-chain reaction (PCR)-based assays to detect invasive fungal disease (IFD) in pediatric cancer or hematopoietic stem cell transplantation (HSCT) patients when used as screening tools during immunosuppression or as diagnostic tests in patients presenting with symptoms such as fever during neutropenia (FN). Out of 1,532 studies screened, 25 studies reported on GM (n=19), BG (n=3) and PCR (n=11). All fungal biomarkers demonstrated highly variable sensitivity, specificity and positive predictive values, and these were generally poor in both clinical settings. GM negative predictive values were high, ranging from 85-100% for screening and 70-100% in the diagnostic setting, but failure to identify non-Aspergillus molds limits its usefulness. Future work could focus on the usefulness of combinations of fungal biomarkers in pediatric cancer and HSCT.

Original languageEnglish
Article numberciw592
Pages (from-to)1340-1348
Number of pages9
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
Issue number10
Early online date27 Aug 2016
Publication statusPublished - 15 Nov 2016

Bibliographical note

© The Authors, 2016. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details. Embargo period: 12 months.


  • invasive fungal disease
  • galactomannan
  • ?-D-glucan
  • polymerase chain reaction
  • pediatric
  • Invasive Fungal Infections/diagnosis
  • Humans
  • Child, Preschool
  • Hematopoietic Stem Cell Transplantation
  • Infant
  • beta-Glucans/analysis
  • Young Adult
  • Neoplasms/therapy
  • Polymerase Chain Reaction/methods
  • Mannans/analysis
  • Adolescent
  • Adult
  • Child
  • Infant, Newborn

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