title: 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.
abstract: We systematically reviewed and analyzed the available data for galactomannan (GM), β-D-glucan (BG), and polymerase chain reaction (PCR)-based assays to detect invasive fungal disease (IFD) in patients with pediatric cancer or undergoing hematopoietic stem cell transplantation when used as screening tools during immunosuppression or as diagnostic tests in patients presenting with symptoms such as fever during neutropenia (FN). Of 1532 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% to 100% for screening and 70% to 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.
authors: Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany.
authors: Thomas
authors: T
authors: Lehrnbecher
authors: Pediatric Oncology Group of Ontario, Toronto, Canada.
authors: Paula D
authors: PD
authors: Robinson
authors: Division of Pediatric Infectious Diseases, The Children's Hospital of Philadelphia, Pennsylvania.
authors: Brian T
authors: BT
authors: Fisher
authors: Infectious Diseases Unit, Istituto Giannina Gaslini, Genova, Italy.
authors: Elio
authors: E
authors: Castagnola
authors: Infectious Disease Research Program, Center for Bone Marrow Transplantation, Department of Pediatric Hematology/Oncology, University Children's Hospital Muenster, Albert Schweitzer Campus 1, Germany.
authors: Andreas H
authors: AH
authors: Groll
authors: Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina.
authors: William J
authors: WJ
authors: Steinbach
authors: Division of Pediatric Infectious Diseases, The Children's Hospital of Philadelphia, Pennsylvania.
authors: Theoklis E
authors: TE
authors: Zaoutis
authors: Department of Mathematics and Statistics.
authors: Zelalem F
authors: ZF
authors: Negeri
authors: Department of Mathematics and Statistics.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
authors: Joseph
authors: J
authors: Beyene
authors: Leeds General Infirmary, Leeds Teaching Hospitals, NHS Trust.|Centre for Reviews and Dissemination, University of York, United Kingdom.
authors: Bob
authors: B
authors: Phillips
authors: Division of Haematology/Oncology, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.
authors: Lillian
authors: L
authors: Sung
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005690:Galactose / Q000031:analogs & derivatives; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D000072742:Invasive Fungal Infections / Q000175:diagnosis*; D008351:Mannans / Q000032:analysis*; D009369:Neoplasms / Q000628:therapy*; D016133:Polymerase Chain Reaction / Q000379:methods*; D055815:Young Adult; D047071:beta-Glucans / Q000032:analysis*
chemical_list: D008351:Mannans; D047071:beta-Glucans; C012990:galactomannan; D005690:Galactose
keywords: galactomannan, β-D-glucan; invasive fungal disease; pediatric; polymerase chain reaction