A clinical study of diagnostic efficacy of interferon gamma and adenosine deaminase in exudative pleural effusion

Lira Hakani, Anila Mitre


Background: The aim of the study was to investigate the clinical utility of biomarkers, interferon gamma (INF- γ) and adenosine deaminase (ADA) in the differential diagnosis between tuberculosis and non-tuberculosis pleural effusion.

Methods: The present study enrolled 130 patients with pleural effusion that were admitted to hospital between 2012- 2015. From the patients were obtained pleural fluid and serum which were administrated to test analyses within 24 hours.

Results: Based on Light's criteria, biochemical, cytological etc. analyses were established the pleural effusion as exudative and the etiology of the effusion, 40 malign, 48 tuberculosis, 42 parapneumonic. Pleural fluid, serum and pleural fluid/serum ADA and INF-γ pleural fluid results differ significantly between the different types of exudative effusion. For the difference of tuberculosis and non-tuberculosis pleural effusion ADA pleural fluid, ADA serum and INF- γ pleural fluid showed significance for this difference, meanwhile ADA pleural fluid/serum do not contribute in the difference.

Conclusions: The study conducted that ADA and INF-γ markers can be used for the differential diagnosis of exudative pleural effusion and tuberculosis from non-tuberculosis. INF-γ even if it has a higher specificity than ADA, due to its cost we recommend that it cannot be promoted as the only solution that facilitate the different diagnosis, other markers need to be taken into consideration to assist the results.


Pleural effusion, Exudative effusion, Adenosine deaminase, Interferon gamma

Full Text:



Light RW. Clinical practice. Pleural effusion. New England J Med. 2002;346:1971-7.

Light RW. Macgregor MI, Luchsinger PC, Ball WC. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med. 1972;77 (4):507-13.

Light RW. Pleural diseases. 3rd ed. Baltimore, MD: Williams and Wilkins; 1995.

World Health Organization Tuberculosis. Fact sheet N°104 Available at Accessed on 30 October 2015

World Bank. World development indicators Health risk factors and future challenges. Available at Accessed on 20 February 2016.

Wayne PA. Laboratory detection and identification of mycobacteria; approved standard-first edition. CLSI document M48-A. Clinical and laboratory standards. Institute clinical and laboratory standards institute. 2008.

Genetic home reference. Available at Accessed on 20 February 2016.

Billiau A, Matthys P. Interferon-gamma: a historical perspective. Cytokine Growth Factor Rev. 2009;20(2):9-113.

Schoenborn JR, Wilson CB. Regulation of interferon-gamma during innate and adaptive immune responses. Adv Immunol. 2007;96:41-101.

Mitcham C. Encyclopedia of science, technology, and ethics. Detroit: Macmillan Reference; 2005:2378.

Roth BJ. Searching for tuberculosis in pleural space. Chest. 1999;116:3-5.

Kapisyzi P, Argjiri Dh, Aliko A, Beli J, Vakeflliu Y, Kore R et al. The use of different cutoff values of ada liquid level in diagnosis of tuberculous pleurisy in countries with different incidence of tuberculosis. Chest. 2011;140(4):703A.

Tay TR, Tee A. Factors affecting pleural fluid adenosine deaminase level and the implication on the diagnosis of tuberculous pleural effusion: a retrospective cohort study. BMC Infect Dis. 2013;13:546.

Burgess LJ, Maritz FJ, Le Roux I, Taljaard JJ. Combined use of pleural adenosine deaminase with lymphocyte/neutrophil ratio: increased specificity for the diagnosis of tuberculous pleuritis. Chest. 1996;109:414-9.

Mehta A, Gupta SA, Subin Ahmed S, Rajesh V. Diagnostic utility of adenosine deaminase in exudative pleural effusions. Lung India. 2014;31(2):142-4.

Helmya NA, Eissab SA, Masouda HH, Elessawyc AF, Ahmedc RI. Diagnostic value of adenosine deaminase in tuberculous and malignant pleural effusion. 2012;61(4):413-7.

Kapisyzi P, Argjiri Dh, Byrazeri G, Mitre A, Beli J, Vakeflliu Y et al. Use of pleural fluid c-reactive protein level as a diagnostic marker for pleural effusions. Chest. 2009;136(4):30S.

Verma SK, Dubey AL, Singh PA, Tewerson SL, Sharma D. Adenosine deaminase (ADA) level in tubercular pleural effusion. Lung India. 2008;25(3):109-10.

Ghanem M, Eldin EN, Omar A, Khairy M, Mekawy A. Diagnostic value of quantitative measurement of pleural fluid interferon-gamma (IFN-gamma) versus quantiferon-TB gold in tube assays (QFT-IT) in blood, pleural fluid and isolated pleural fluid cells in tuberculous pleural effusion. Ann Thorac Med. 2012;7(4):220-5.

Liu F, Gao M, Zhang X, Du F, Jia H, Yang X et al. Interferon-gamma release assay performance of pleural fluid and peripheral blood in pleural tuberculosis. PLoS One. 2013;e83857. pii:PONE-D-13-33281.

Villegas MV, Labrada LA, Saravia NG. Evaluation of polymerase chain reaction, adenosine deaminase, and interferon-γ in pleural fluid for the differential diagnosis of pleural tuberculosis. Chest. 200;118:1355-64.

Sharma SK, Banga A. Pleural fluid interferon-gamma and adenosine deaminase levels in tuberculosis pleural effusion: a cost-effectiveness analysis. J Clin Lab Anal. 2005;19:40-6.