Diagnostic value of pleural fluid adenosine deaminase level in patients of tubercular pleural effusion
Keywords:Adenosine deaminase, Pleural effusion, Tuberculosis
Background: The diagnosis of tuberculosis (TB) continues to be a challenge in clinical practice. Traditional diagnostic methods are very useful but don't provide enough sensitivity and specificity. Adenosine deaminase (ADA) has been developed and widely used for the diagnosis of TB. This article reviews the characteristics, metabolism and clinical uses of ADA for the diagnosis of TB in clinical practices.
Methods: This study was carried out in the department of chest and TB, GMC, Amritsar, Punjab, India. In this study total 50 who attended outpatient department (OPD) and indoor patients of adult age and either sex were taken. Patients with pleural effusion as determined by clinical and or radiological means, thoracocentesis on who yield a minimum amount of fluid enough to carry out routine test were included in the study.
Results: Most of the patients were between the age group of 15-34 years, of those 72% were males and 28% female. Most of the patients of tuberculous effusion were from younger age group between 25-34 years. Most common symptom was breathlessness (90%) followed by fever (75%), cough (75%) then chest pain (72%). The diagnosis of TB was made in 40 patients (80%), while in 10 patients (20%) TB were excluded (malignancy and miscellaneous disease) based on history, clinical and laboratory findings. Sensitivity of ADA in diagnosing TB pleural effusion was 95% and specificity 80%.
Conclusions: ADA level of the pleural fluid is a non-invasive test. Pleural fluid ADA is useful in early diagnosing of tuberculosis pleural effusion. So the analysis of ADA levels can be done simply, quickly and cheaply.
World Health Organization. World Health Organization Global tuberculosis report. Gevena: World Health Organization. 2013.
Jay SJ. Diagnostic procedures for pleural disease. Clin Chest Med. 1985;6(1):33.
Porcel JM. Tuberculous pleural effusion. Lung. 2009;187(5):263.
Greco S, Girardi E, Masciangelo R, Capoccetta GB, Saltini C. Adenosine deaminase and interferon gamma measurements for the diagnosis of tuberculous pleurisy: a meta-analysis. Int J Tuberculosis Lung Dis. 2003;7(8):777-86.
Gakis C. Adenosine deaminase (ADA) isoenzymes ADA1 and ADA2: diagnostic and biological role. Eur Respir J. 1996;9(4):632-3.
World Health Organization. Global tuberculosis report 2013. World Health Organization. 2013.
Krenke R, Korczynski P. Use of pleural fluid levels of adenosine deaminase and interferon gamma in the diagnosis of tuberculous pleuritis. Curr Opinion Pulmonary Med. 2010;16(4):367-75.
Light RW. Pleural diseases. Baltimore: Lippincot, Williams and Wilkins. 2001;151-81.
Bothamley GH. Tuberculous pleurisy and adenosine deaminase. Thorax. 1995;50(6):593.
Hirsch AP, Ruffie P, Nebut M, Bignon J, Chretien J. Pleural effusion: laboratory tests in 300 cases. Thorax. 1979;34(1):106-12.
Kataria YP, Khurshid I. Adenosine deaminase in the diagnosis of tuberculous pleural effusion. Chest. 2001;120(2):334-6.
Berger HW, Mejia E. Tuberculous pleurisy. Chest. 1973;63(1):88-92.
Seibert AF, Haynes J, Middleton R, Bass JB. Tuberculous pleural effusion: twenty-year experience. Chest. 1991;99(4):883-6.
Wang Z, Xu LL, Wu YB, Wang XJ, Yang Y, Zhang J, Tong ZH, Shi HZ. Diagnostic value and safety of medical thoracoscopy in tuberculous pleural effusion. Respir Med. 2015;109(9):1188-92.
Aljohaney A, Amjadi K, Alvarez GG. A systematic review of the epidemiology, immunopathogenesis, diagnosis, and treatment of pleural TB in HIV- infected patients. Clin Develop Immunol. 2012.
Porcel JM, Palma R, Valdes L, Bielsa S, San-Jose E, Esquerda A. Xpert® MTB/RIF in pleural fluid for the diagnosis of tuberculosis. Int J Tuberculosis Lung Dis. 2013;17(9):1217-9.
Pefura Yone EW, Kengne AP, Moifo B, Kuaban C. Prevalence and determinants of extrapulmonary involvement in patients with pulmonary tuberculosis in a Sub-Saharan African country: a cross-sectional study. Scand J Infectious Dis. 2013;45(2):104-11.
Valdés L, Alvarez D, San José E, Penela P, Valle JM, García-Pazos JM, Suárez J, Pose A. Tuberculous pleurisy: a study of 254 patients. Arch Int Med. 1998;158(18):2017-21.
Levine H, Szanto PB, Cugell DW. Tuberculous pleurisy: an acute illness. Arch Int Med. 1968;122(4):329-32.
Antony VB, Repine JE, Harada RN. Inflammatory responses in experimental tuberculosis pleurisy. Acta Cytol. 1985;27:355.
Light RW. Pleural diseases. Lippincott Williams & Wilkins. 2007.
Burgess LJ, Maritz FJ, Le Roux I, Taljaard JJ. Use of adenosine deaminase as a diagnostic tool for tuberculous pleurisy. Thorax. 1995;50(6):672-4.
Shibagaki T, Hasegawa Y, Saito H, Yamori S, Shimokata KJ. Adenosine deaminase isozymes in tuberculous pleural effusion. J Lab Clin Med. 1996;127(4):348-52.
Chen ML, Yu WC, Lam CW, Au KM, Kong FY, Chan AY. Diagnostic value of pleural fluid adenosine deaminase activity in tuberculous pleurisy. Clinica Chimica Acta. 2004;341(1-2):101-7.
Laniado-Laborin R. Adenosine deaminase in the diagnosis of tuberculous pleural effusion; is it really an ideal test? A word of caution. Chest. 2005;127(2):417-9.