Adenosine Deaminase Level as an Indicator for Differentiating Between Active Pulmonary Tuberculosis Infection and Other Pulmonary Infections

Abstract

Background: Developmental dislocation of the hip joint is among joint abnormalities and lack of its early diagnosis leads to irreversible complications and disabilities. Methods: The current cross sectional study was conducted on 210 eighteen -month -old premature infants. Premature infants at term gestational age were examined by a neonatologist and underwent a sonographic scanning by a skilled radiologist. The results of the physical examination and ultrasound reports were collected and analyzed. Results: In the clinical assessment, hip joint examination was diagnosed abnormal in 22 cases (10.4%) and joint dislocation was diagnosed by ultrasonographic examination in 17 patients (8.1%). In one high -risk case, despite normal clinical examination (0.48%), the dislocation was diagnosed by ultrasonographic evaluation. There was a significant relationship between hip dislocation rate, and reduced mean gestational age and birth weight (P < 0.05). The dislocation prevalence in the twins was significantly more than that of other infants (P = 0.001). In the current study, there was no statistically significant relationship between gender, family history, oligohydramnios, presentation, and type of delivery with joint dislocation (P > 0.05). In diagnosis of joint dislocation, clinical examination (the results of the Ortolani and the Barlow tests) had sensitivity of 94% and specificity of 97% compared with sonography; the positive and negative predictive values were 73% and 99%, respectively. Conclusions: Clinical examination has high sensitivity and specificity for early diagnosis of developmental hip dislocation. If there are risk factors, ultrasonographic scanning is recommended despite normal physical examination, and ultrasound is not necessary in case of normal physical examination and the absence of risk factors.

Elevated Adenosine Deaminase in Pleural Effusion - A Case of Non-Hodgkin Lymphoma Misdiagnosis

“…Measurement of ADA has been widely recognized as being a useful tool in the diagnosis of TB due to its high sensitivity and specificity (92% and 90%, respectively) [ 1 ] . However, TB is not the only infection, let alone the only disease, that presents with elevated ADA levels [ 2 , 3 ] .…”

“…ADA is an essential enzyme in the purine pathway of DNA metabolism and is widely distributed in tissues and bodily fluids, but its main reservoir is lymphoid tissue, and particularly, T lymphocytes [ 2 ] . As such, ADA elevation in TB-associated pleural effusions is related to the large number of T cells mediating the inflammatory response to TB infection [ 4 ] .…”

“…Despite its undoubted usefulness, the measurement of ADA levels may be misleading as several studies have shown limitations in differentiating some causes of high ADA levels, such as other infections or malignancies [ 2 , 3 , 6 ] . Interpretation of the levels of this marker should therefore take into consideration the clinical findings and other test results, as well as local prevalence rates of the different causes of elevated ADA.…”

Diagnostic Value of Serum Adenosine Deaminase (ADA) Level for Pulmonary Tuberculosis

“…Agarwal and colleagues in India also showed that serum levels of ADA in patients with sputum smear-negative pulmonary tuberculosis (culture positive) was significantly different from non-tuberculosis patients with other lung diseases such as lung cancer, pneumonia, pulmonary abscess and bronchiectasis ( 15 ). Bolursaz et al believed that although, serum ADA level in pulmonary TB patients is higher than in normal individuals, ADA should not be considered as a suitable marker for differentiating between pulmonary TB and other pulmonary infections ( 12 ).…”

“…Increased serum ADA activity can be seen in diseases associated with cellular system stimulation, such as typhoid fever, infectious mononucleosis, liver disease, sarcoidosis, leukemia, brucellosis, acute pneumonia, rheumatoid arthritis, malignancies and tuberculosis ( 10 , 11 ). Although, serum ADA level in pulmonary TB patients is higher than in normal individuals, ADA should not be considered as a suitable marker for differentiating between pulmonary TB and other pulmonary infections ( 12 ).…”