Adenosine deaminase activity in pleural effusions: an aid to differential diagnosis.

Piras, Martina; Gakis, C; Budroni, Mario; Andreoni, G

doi:10.1136/bmj.2.6154.1751-a

Cited by 216 publications

(126 citation statements)

References 2 publications

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“…Most interest has been focused on adenosine deaminase activity (ADA), which was ¢rst proposed as a diagnostic test in 1978. 4 Since then, many studies have investigated its usefulness.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of adenosine deaminase in tuberculous pleural effusion: a meta-analysis

et al. 2003

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“…Most interest has been focused on adenosine deaminase activity (ADA), which was ¢rst proposed as a diagnostic test in 1978. 4 Since then, many studies have investigated its usefulness.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of adenosine deaminase in tuberculous pleural effusion: a meta-analysis

et al. 2003

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“…sputum smear microscopy (developed over 100 years ago and the most common method for TB diagnosis worldwide), culture for Mycobacterium tuberculosis (the current reference standard for TB diagnosis), and polymerase chain reaction-based techniques and rapid molecular tests (developed more recently for TB diagnosis and diagnosis of drug-resistant TB). [1] About 35 years ago, Piras et al [5] first observed that adenosine deaminase (ADA), a zinc-containing metalloenzyme expressed in high levels by lymphocytes and monocytes, was elevated in PTB. Since then, several authors have confirmed this finding, supporting the use of high pleural fluid ADA (FADA) as a simple, rapid, sensitive, cost-effective and robust diagnostic tool for PTB.…”

mentioning

confidence: 99%

High pleural fluid adenosine deaminase levels: A valuable tool for rapid diagnosis of pleural TB in a middle-income country with a high TB/HIV burden

2014

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Background. South Africa has the highest burden of tuberculosis (TB) in the World Health Organization (WHO) African region. Using traditional TB diagnostic tools, the diagnosis of pleural TB (PTB) is highly unrewarding. Elevated levels of pleural fluid adenosine deaminase (FADA) have been shown to be useful in the diagnosis of PTB; however, similar levels may be found in some other medical conditions leading to misdiagnosis. Following queries from clinicians concerning the likely high false-positive (FP) rate of FADA from our laboratory, we performed a retrospective audit of all high FADA results generated over a 12-month period. Objectives. To determine the positive predictive value (PPV) of FADA, the frequent causes of FPs in our laboratory and the demographic characteristics of tuberculous pleural effusions (TPEs) and non-tuberculous pleural effusions (NTPEs). Methods. High FADA results generated in the past year were extracted with corresponding TB culture results, fluid cell count, cytology/ histology results, radiology reports and HIV results. Hospital records were reviewed for the final diagnosis in each case. Diagnosis of PTB was based on the WHO case definition of TB. Results. A total of 159 results were reviewed: 133 (83.6%) were TPE, hence FADA had a PPV of 83.6%. Neoplasm was the most common cause of an FP in 13/26 (50%) NTPEs. While TPE was more common than NTPE in younger people, both groups had an equal gender distribution. Conclusion. FADA had a high PPV for PTB in our laboratory. We recommend its continued use as a rapid and reliable diagnostic tool for PTB.

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“…Since 1978, when ADA activity was found to be high in tuberculous pleural exudates [1], ADA has been used in the diagnosis of tuberculous pleural effusions [2][3][4][5]; overall, its sensitivity in this role has been 99% and its specificity 93% [6]. High ADA levels can also be found in pleural effusions secondary to other processes or lesions, especially pneumonia, empyema, lymphoma, neoplasia and systemic lupus erythematosus [6].…”

mentioning

confidence: 99%

Adenosine deaminase (ADA) isoenzyme analysis in pleural effusions: diagnostic role, and relevance to the origin of increased ADA in tuberculous pleurisy

Valdés¹,

José²,

Álvarez³

et al. 1996

Eur Respir J

143

100

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The rise in adenosine deaminase (ADA) activity in the pleural fluid of tuberculous pleurisy patients, though used for diagnosis, is of unknown origin. In this work, we determined ADA activity and the activities of 2'-deoxyadenosine deaminase and ADA-2 in 350 patients. We also considered whether the results throw light on the origin of high pleural fluid ADA in tuberculous pleurisy and estimated the diagnostic efficiency of 2'-deoxyadenosine deaminase, ADA-2 and total ADA activities with and without the inclusion of the 2'-deoxyadenosine deaminase/ADA activity ratio in a combined criterion.The 350 pleural effusions were classified by previously established criteria as transudates (60 males/18 females) or as tuberculous (49 males/27 females), neoplastic (50 males/39 females), parapneumonic (36 males/19 females), empyematous (11 males/ 3 females), or miscellaneous (25 males/13 females) exudates. Total ADA, ADA-2 and 2'-deoxyadenosine deaminase activities were, respectively, 127.5±2.9, 103±29.5 and 42.8±14 U·L -1 in tuberculous exudates. With diagnostic thresholds of 47, 40 and 22 U·L -1 respectively, the sensitivities of ADA, ADA-2 and 2'-deoxyadenosine deaminase for tuberculosis were 100, 100 and 95%; their specificities 91, 96 and 92%; and their efficiencies 93, 97 and 93%, respectively. One hundred and one effusions (all 76 tuberculous, 12 neoplastic, 4 parapneumonic and 9 empyematous exudates) had total ADA levels >47 U·L -1 ; of these, 8 neoplastic, 1 parapneumonic and all the tuberculous exudates had a 2'-deoxyadenosine deaminase/ADA activity ratio <0.49. The criterion of simultaneously having ADA >47 U·L -1 , ADA-2 >40 U·L -1 and a 2'-deoxyadenosine deaminase/ADA activity ratio <0.49 was satisfied by all the tuberculous effusions but only eight others (all neoplastic) (sensitivity 100%, specificity 97%, efficiency 98%).We conclude that: 1) high total ADA activity in tuberculous pleural effusions is due mainly to an increase in ADA-2, and, therefore, originated from the only known source monocytes and macrophages; 2) ADA-2 was a more efficient diagnostic marker of tuberculous pleurisy than total ADA activity, although the difference was not statistically significant; and 3) among effusions with high total ADA the 2'-deoxyadenosine deaminase/ADA activity ratio differentiates tuberculous effusions from empyemas and parapneumonic effusions, but fails to discriminate well between tuberculous and neoplastic effusions.

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Adenosine deaminase activity in pleural effusions: an aid to differential diagnosis.

Cited by 216 publications

References 2 publications

Diagnostic value of adenosine deaminase in tuberculous pleural effusion: a meta-analysis

Diagnostic value of adenosine deaminase in tuberculous pleural effusion: a meta-analysis

High pleural fluid adenosine deaminase levels: A valuable tool for rapid diagnosis of pleural TB in a middle-income country with a high TB/HIV burden

Adenosine deaminase (ADA) isoenzyme analysis in pleural effusions: diagnostic role, and relevance to the origin of increased ADA in tuberculous pleurisy

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