Adenosine deaminase diagnosis pleural effusion tuberculosis. Diagnostic value of adenosine deaminase in nontuberculous. Value of adenosine deaminase in the diagnosis of tuberculous pleural effusions in young patients in a region of high prevalence of tuberculosis. This gene provides instructions for producing the enzyme adenosine deaminase. Evaluation of polymerase chain reaction, adenosine deaminase and interferongamma in pleural fluid for the differential diagnosis of pleural tuberculosis. Pcr, adenosine deaminase ada activity and absolute lymphocyte count alc were evaluated in the fluid of 31 tuberculous 20 pleural, 8 ascites and 3 pericardial and 24 nontuberculous 10 transudtative ascites, 8 empyema thoracis, 3 malignant pleural and 3. Pdf adenosine deaminase in tuberculous pleural effusion. Peritoneal tuberculosis tb is a considerable problem in certain developing nations. Adenosine deaminase in the diagnosis of tuberculous pleural. Fortyone patients with a presumptive diagnosis of tb peritonitis. Case report tcell lymphoblastic lymphoma with elevated. One hundred and sixty patients who had pleural fluid ada performed. Tuberculosis pleural effusion, ada, diagnostic test, meta analysis. We initially analyzed 296 patients with unknown pleural effusion from the department of respiratory.
Pleural fluid interferongamma and adenosine deaminase levels. Pdf role of adenosine deaminase in the diagnosis of. Mar 21, 2015 diagnosis of tuberculosis tb is not always easy, thus employing methods with a short duration and acceptable sensitivity and specificity is necessary to diagnose tb. There are only a few case reports in the literature presenting with pleural involvement due to brucellosis. Diagnostic value of adenosine deaminase ada in tuberculous. Introduction numerous studies have assessed the diagnostic ability of pleural adenosine deaminase ada in detecting tuberculous pleural effusions, with good specificity and sensitivity reported. Adenosine deaminase in the diagnosis of tuberculous pleural effusion in some parts of the united states, pleural tuberculosis accounts for, 5% of all cases of tuberculosis. Analysis of the adenosine deaminase in pleural fluid pinpoints many pulmonary and systemic diseases are known to cause pleural effusions.
The adenosine deaminase ada test is not a diagnostic test, but it may be used along with other tests such as pleural fluid analysis, acidfast bacillus afb smear and culture, andor tuberculosis molecular testing to help determine whether a person has a mycobacterium tuberculosis infection tuberculosis or tb of the lining of the lungs pleurae. The negative predictive value of ada for the diagnosis of pleural tuberculosis was 99% 403 of 407 cases in the. Adenosine deaminase for diagnosis of tuberculous pleural. Adenosine deaminase level in pleural fluid and the. In the february 2018 issue of the hong kong medical journal, chang et al1 made an important contribution by defining a lower cutoff value to increase its sensitivity. Adenosine deaminase ada is useful in the diagnosis of tuberculous pleural effusion tpe. Highly elevated adenosine deaminase level in brucellar. Diagnostic value of adenosine deaminase in tuberculous and. Serum and pleural fluid ada levels were also examined in a group of 38 nontuberculous patients with pleural effusion. A cross sectional study of patients presenting with pleural effusion were enrolled in the. Nilai diagnostik adenosine deaminase ada cairan pleura pada. Ada has been extensively used in the diagnosis of tuberculous pleural effusion, two isoenzymes, ada1 and ada2, have been described. Adenosine deaminase 2 ada2, d activity of pleural fluids. We initially analyzed 296 patients with unknown pleural effusion from the department of respiratory medicine at.
An adenosine deaminase level ada level and occult tuberculous pleurisy motoki sakuraba, md, 1,4 kimihiko masuda, md,2 akira hebisawa, md, 3 yuzo sagara, md,1 and hikotaro komatsu, md1 from departments of 1thoracic surgery and 2respiratory medicine, and 3division of pathology, national hospital. This enzyme is found throughout the body but is most active in specialized white blood cells called lymphocytes. Adenosine deaminase ada activity of greater than 43 uml in pleural fluid supports the diagnosis of tuberculous pleuritis. How are pleural fluid levels of adenosine deaminase ada and. Adenosine deaminase in csf and pleural fluid for diagnosis of tubercular meningitis and pulmonary tuberculosis. Adenosine deaminase ada can aid in the diagnosis of tuberculous pleural effusions, but falsepositive. We aimed to evaluate the diagnostic value of pleural effusion mononuclear cells count and its combination with adenosine deaminase ada in tbp patients. Diagnostic accuracy of adenosine deaminase and lymphocyte. Hence ada is a good diagnostic method for the diagnosis of tb pleural. The use of adenosine deaminase and interferongamma as diagnostic tools for tuberculous pericarditis. A prospective study of sensitivity and specificity of adenosine deaminase in the diagnosis of tuberculosis pleural effusion. In a retrospective study adenosine deaminase ada, was assayed in 86 serum samples and 12 pleural fluid samples of patients with pulmonary tuberculosis. Review article diagnosis of tuberculosis pleurisy with adenosine deaminase ada. Pleural fluid levels of interferon ifn and adenosine deaminase ada have been found to be high in patients with tuberculosis tb.
Jul 15, 20 this study suggests that the estimation of adenosine deaminase activity in pleural fluid is a rapid diagnostic tool for differentiation of tubercular and non tuberculareffusions. Brazil belongs to the group of 22 countries that account for 80% of all cases, and it is estimated that there are approximately 100,000 new cases per year in the. Use of adenosine deaminase measurements and quantiferon in. Tuberculous pleural effusion tpe is a common problem for differential diagnosis from malignant effusion mpe in epidemic areas of tuberculosis tb. The diagnostic value of pleural effusion mononuclear cells count for tuberculous pleurisy tbp is unclear. For this purpose, activity of adenosine deaminase ada enzyme in serum and body fluids, such as sputum, pleural effusion, ascites and cerebrospinal fluid has been taken into consideration 1, 6, 7.
The reliability of the early diagnosis of pleural tuberculosis has been greatly improved by the use of biochemical markers such as adenosine deaminase. Pdf diagnostic role of pleural fluid adenosine deaminase in. Diagnosis of tuberculosis pleurisy with adenosine deaminase ada. The diagnosis of pleural tb depends on the demonstration of mycobacteriumtuberculosisin sputum, pleural. To the editortuberculous pleural effusion tbpe is often elusive to diagnostic investigations and clinicians often use adenosine deaminase level ada as a surrogate marker to justify antituberculosis tb treatment. Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions.
Tuberculous pleural effusion is synonymous with the term tuberculous pleurisy. Pleural fluid adenosine deaminase ada is a useful diagnostic test for tuberculous pleural effusion tpe, but its exact threshold and accuracy in clinical decisionmaking is unclear. The diagnostic efficacy of adenosine deaminase in tubercular. Frontiers diagnostic value of pleural effusion mononuclear. Adenosine deaminase level in pleural fluid and the diagnosis. A previous article suggested that adaactivity is increased in pleural fluid in this disease. We report a 47yearold male patient with a severe pleural effusion pe, a small pericardial effusion, and a bulky mediastinal mass, but with a high level of adenosine deaminase ada in the pleural fluid and a positive spottuberculosis test tspot. The aim of this study was to investigate the diagnostic value of serum adenosine deaminase. Usefulness of adenosine deaminase assay in diagnosis of. Pdf diagnostic role of pleural fluid adenosine deaminase. Objective pleural fluid adenosine deaminase ada is a useful diagnostic test for tuberculous pleural effusion tpe, but its exact threshold and accuracy in clinical decisionmaking is unclear.
The diagnosis of pleural tb continues to be a challenge in clinical practice. The diagnostic value of adenosine deaminase activity in. However, in the uk uk ada is not routinely used in the investigation of a patient with a pleural effusion, mainly due to a lack of evidence as to its utility in areas where tuberculosis tb. Pdf adenosine deaminase in csf and pleural fluid for. Evaluation of polymerase chain reaction and adenosine. Pleural fluid interferongamma and adenosine deaminase. Adenosine deaminase as a diagnosic aid to ascertain.
Pleural fluid interferon and adenosine deaminase levels in. Diagnostic value of serum adenosine deaminase ada level. Conventional tests are not always helpful in making a diagnosis of tuberculous pleurisy. Pdf objective pleural fluid adenosine deaminase ada is a useful. Diagnostic value of adenosine deaminase isoenzyme ada2. An adenosine deaminase level ada in tuberculous pleurisy s. S115 pleural fluid adenosine deaminase ada in the diagnosis. Adenosine deaminase ada is an enzyme in purin catabolism process which catalyze. Figure 2 shows the pleural ada2 activities of each studied group. Pdf patients with exudative pleural effusion were taken for the study after relevant. Present study tried to find out the diagnostic significance of adenosine deaminase in pleural tuberculosis using the technique of gel electrophoresis. Adenosine deaminase activity in serum and pleural effusions.
Adenosine deaminase as a diagnostic aid to ascertain tuberculous etiology of pleural effusions muhammad usman anwar1, sarah2, adnan afzal3, muhammad umar kamal4 abstract aim. Prediction based on adenosine deaminase ada is dependent on age as well as the tuberculosis incidence. The world health organization who estimated nearly. To determine the sensitivity and specificity of pleural fluid ada for the diagnosis of tuberculous pleural effusion taking the cut off value of ada as. Diagnostic value of adenosine deaminase isoenzyme ada2 and. Highly elevated adenosine deaminase level in brucellar pleural effusion abstract.
Considering 40 ul as the cut off, the results were positive in 35 out of 39 tuberculosis patients and 9 out of 18 controls. All the tuberculous effusions had pleural ada2 activities of 36 ul or more, whereas. Mean adenosine deaminase in the pleural tuberculosis group was 84. Adenosine deaminase ada is an enzyme in purin catabolism process which catalyze adenosine into inosine and deoksiadenosine into deoksiinosin. The sensitivity and specificity of adenosine deaminase for tubercular effusions in this study was 90% and 50% respectively. Methods we searched pubmed, embase, and cochrane library databases for articles indexed up to. The mean adenosine deaminase activity level in all the 57 patients was 109 ul while the mean adenosine deaminase activity levels in pleural tb patients was 80 u, and 64 ul in the controls p0.
Haque department of clinical biochemistry, indira gandhi institute of medical science patna14. Factors affecting pleural fluid adenosine deaminase level. Diagnostic value of serum adenosine deaminase ada level for. Total adenosine deaminase activity ada of pleural fluids. Adenosine deaminase for diagnosis of tuberculous pleural effusion. Pleural effusion adenosine deaminase annals of thoracic and. Conventional tests are not always helpful in making a diagnosis of. Adenosine deaminase deficiency is caused by mutations in the ada gene. Indian journal of chest diseases and allied sciences 2001.
Adenosine deaminase also known as adenosine aminohydrolase, or ada is an enzyme ec 3. Limited diagnostic methods make tb pleural effusion hard to diagnose. Recently, a relatively noninvasive method, pleural fluid adenosine deaminase ada measurement has been advocated in the diagnosis of tuberculous pleurisy with high sensitivity and specificity 1, 2. Diagnostic accuracy of adenosine deaminase for differential. Pleural fluid interferon and adenosine deaminase levels. When analysis was restricted to 689 patients with pleural fluid adenosine deaminase level of. Pleural fluid adenosine deaminase detection for the diagnosis. Tuberculosis pleural effusion is the most common extrapulmonary tb after lymphadenitis tb. Diagnostic accuracy of adenosine deaminase in tuberculous pleurisy.
Review article diagnosis of tuberculosis pleurisy with. It is needed for the breakdown of adenosine from food and for the turnover of nucleic acids in tissues. We aimed to assess diagnostic performance of ada in tpe and to clarify its optimal diagnostic threshold. Its primary function in humans is the development and maintenance of the immune system. Many studies have investigated the usefulness of adenosine deaminase ada in pleural fluid for the early. Diagnostic accuracy of adenosine deaminase and lymphocyte proportion in pleural fluid for tuberculous pleurisy in different prevalence scenarios, plos one, 2012, volume 7, issue 6, doi. The reliability of the early diagnosis of pleural tuberculosis has been greatly improved by the use of biochemical markers such as adenosine deaminase ada, interferon. Role of adenosine deaminase in the diagnosis of tuberculosis pleural effusion article pdf available in the journal of the association of physicians of india march 2009 with 42 reads. How are pleural fluid levels of adenosine deaminase ada. Adenosine deaminase 2 zenzyme that catalyses the deamination of adenosine and deoxyadenonise 1,3,4 zfound in most cells.
Evaluation of adenosine deaminase ada in tuberculous pleurisy s. Diagnostic role of pleural fluid adenosine deaminase in tuberculous pleural effusion article pdf available in the southeast asian journal of tropical medicine and public health 322. Tuberculosis tb remains a major cause of morbidity and mortality throughout the world. The purpose of this study is to assess the ada levels in nontuberculous lymphocytic pleural effusions lymphocyte countw50% of different aetiologies. Pleural fluid adenosine deaminase detection for the diagnosis of. This study aimed to determine the effectiveness of an adenosine deaminase ada assay and the quantiferongold qftg assay in the rapid diagnosis of tb peritonitis.
Diagnosis of tuberculosis tb is not always easy, thus employing methods with a short duration and acceptable sensitivity and specificity is necessary to diagnose tb. Pleural fluid adenosine deaminase detection for the diagnosis of pleural tuberculosis introduction tuberculosis tb is the leading cause of death from infectious diseases worldwide. Pdf adenosine deaminase for diagnosis of tuberculous pleural. Evaluation of adenosine deaminase ada in tuberculous. Current diagnostic tests for peritoneal tb are difficult and timeconsuming.
Pleural fluid adenosine deaminase detection for the. Adenosine deaminase ada is an enzyme involved in purine catabolism, the enzyme catalyzes the hydrolytic and irreversible deamination of adenosine to inosine and deoxyadenosine to deoxyinosine. Tuberculous pleural effusion is the second most common form of extrapulmonary tuberculosis after lymphatic involvement and is the most common cause of pleural effusion in areas where tuberculosis is endemic. Nilai diagnostik adenosine deaminase ada cairan pleura. The present study was carried out to compare the diagnostic utility of these two markers and to carry out a cost. Diagnostic accuracy of adenosine deaminase in tuberculous.
It is generally linked to the local prevalence of tuberculosis. This was a retrospective study from january 2007 to october 2011. Adenosine deaminase in the diagnosis of tuberculous. This study aims to determine the factors affecting pleural fluid ada levels and to establish the optimal ada levels for diagnosis of tpe for different age groups.
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