Adenosine Deaminase Activity Is a Sensitive Marker for the Diagnosis of Tuberculous Pleuritis in Patients with Very Low CD4 Counts

Baba, Kamaldeen; Hoosen, Anwar A.; Langeland, Nina; Dyrhol‐Riise, Anne Ma

doi:10.1371/journal.pone.0002788

Cited by 73 publications

(50 citation statements)

References 25 publications

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“…It is known that T-lymphocytes play an important role in the pathogenesis of HIV and that the specific activity of ADA is high in T-lymphocytes [43]. In a study by Baba et al [42], the sensitivity of ADA was not affected by low CD4 counts, nor was there a significant difference in the mean ADA value in patients with lower CD4 counts. Even at CD4 counts of <10 cells/mm high lymphocyte counts, which should be suspected of TB.…”

Section: Adenosine Deaminasementioning

confidence: 94%

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Tuberculous Pleural Effusion

Cohen

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2015

Tur Toraks Der

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When a patient presents with new pleural effusion, the diagnosis of tuberculous (TB) pleuritis should be considered. The patient is at risk for developing pulmonary or extrapulmonary TB if the diagnosis is not made. Between 3% and 25% of patients with TB will have TB pleuritis. The incidence of TB pleuritis is higher in patients who are human immunodeficiency virus (HIV)-positive. Pleural fluid is an exudate that usually has a predominance of lymphocytes. The easiest way to diagnose TB pleuritis in a patient with lymphocytic pleural effusion is to demonstrate a pleural fluid adenosine deaminase level above 40 IU/L. The treatment for TB pleuritis is the same as that for pulmonary TB. Tuberculous empyema is a rare occurrence, and the treatment is difficult. KEY WORDS:Tuberculosis, pleural effusions, adenosine deaminase, gamma interferon, pleural biopsy, empyema INTRODUCTION Tuberculosis (TB) remains a major public health problem in developing countries. Most patients with TB have pulmonary TB; however, 25% of adults can present with extrapulmonary TB, which mainly involves the lymph nodes and pleura but can affect any organ system, including the central nervous system (CNS), cardiovascular system, and gastrointestinal (GI) tract [1]. The most common form of extrapulmonary TB is infection of the pleura. In a patient who presents with undiagnosed pleural effusion, the diagnosis of TB pleuritis should be considered. Pleural effusion, as an isolated manifestation of TB, may be selflimited and of little immediate concern, but untreated, it can lead to serious disease many years later. Pathogenesis and Pathologic FeaturesTuberculous pleural effusion may occur in the absence of radiologically apparent TB [2]. The effusion may result as a sequela to a primary infection from 6-12 weeks earlier, or it may represent the reactivation of TB [2]. In developed countries, TB pleural effusions present more often in older patients. The median age in one North American study was 56, suggesting reactivation of the disease [3]. However, a study from 2004 in San Francisco showed that pleural TB cases were 2 times more likely to be clustered (when assessed by genotyping of the mycobacterial organisms) than pulmonary TB and 3 times more likely to be clustered than nonrespiratory TB cases [4]. The observations made in the San Francisco study suggest that the majority of patients has a postprimary infection [4]. This was not confirmed in studies performed in both Houston [5] and Baltimore [6] or in a study in sub-Saharan Africa, in which the prevalence of pleural TB was 63.2% in patients with a primary TB infection [7].The pathogenesis of TB pleural effusion is thought to be related to the rupture of a subpleural caseous focus in the lung into the pleural space [8]. The basis for this was the observation that a caseous TB focus could be demonstrated in the lung, contiguous with the diseased pleural, in 12 to 15 patients with TB pleuritis [9]. The 3 other patients in this study had parenchymal disease but did not have caseous foci adjacent...

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Section: Adenosine Deaminasementioning

confidence: 94%

“…ADA levels are also elevated in HIV patients, even in those with very low cell counts [42]. It is known that T-lymphocytes play an important role in the pathogenesis of HIV and that the specific activity of ADA is high in T-lymphocytes [43].…”

Section: Adenosine Deaminasementioning

confidence: 99%

Tuberculous Pleural Effusion

Cohen

Light

2015

Tur Toraks Der

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“…[3][4][5][6][7][8][9][10][11][12][13] The merits of using pfADA include its low cost, short turnaround time, and high sensitivity and specificity. 3,12 Notwithstanding possibly better sensitivity and specificity for detecting TBPE by combining ADA1 or ADA2 in pleural fluid (PF) with other PF biomarkers such as tumour necrosis factor-alpha, interleukin 27, interferon-gamma and dipeptidyl peptidase IV, [14][15][16][17] it may not be cost-effective to combine pfADA with other PF biomarkers. 18 Although ADA2 is predominantly increased in TBPE, and ADA1 is more commonly associated with pleural effusion due to pyogenic bacteria, 19 determination of ADA1 and ADA2 may not provide a diagnostic advantage over the use of total pfADA.…”

Section: Introductionmentioning

confidence: 99%

Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of adult tuberculous pleural effusion in Hong Kong

Chan²,

Leung

et al. 2017

Hong Kong Med J

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“…In areas with high TB prevalence, pleural fluid adenosine deaminase (ADA) levels greater than 40 U/l are highly specific for the diagnosis of TB [30]. This test has the advantage of being cheap, easy and valid in patients with very low CD4 T-cell counts secondary to HIV [31]. Parapneumonic effusions may also have raised levels of ADA but these effusions are usually predominantly neutrophilic, whereas 90% of TB effusions are lymphocytic.…”

Section: Biomarkers For Pleural Infectionmentioning

confidence: 99%

Advances in the investigation and treatment of pleural effusions

Mishra¹,

Davies²

2010

Expert Review of Respiratory Medicine

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Pleural effusions present a challenge for both diagnosis and treatment. They are a commonly presenting problem of a wide range of local and systemic potentially life threatening diseases and cause significant breathlessness. Significant advances have been made in the last 5 years in the diagnostic pathway and management options. This article reviews recent developments in the investigation of pleural effusions, particularly in pleural fluid analysis, biomarkers, imaging and pleural biopsy, and in the treatment of pleural infection and both malignant and benign effusions, including the use of indwelling pleural catheters. Although significant recent advances have been made in the management of pleural effusions, there the need still remains for further research if we are to reduce the morbidity and mortality caused by pleural effusions.

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Adenosine Deaminase Activity Is a Sensitive Marker for the Diagnosis of Tuberculous Pleuritis in Patients with Very Low CD4 Counts

Cited by 73 publications

References 25 publications

Tuberculous Pleural Effusion

Tuberculous Pleural Effusion

Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of adult tuberculous pleural effusion in Hong Kong

Advances in the investigation and treatment of pleural effusions

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