Diagnostic Accuracy of Adenosine Deaminase and Lymphocyte Proportion in Pleural Fluid for Tuberculous Pleurisy in Different Prevalence Scenarios

Garcia-Zamalloa, Alberto; Taboada-Gómez, Jorge

doi:10.1371/journal.pone.0038729

Cited by 59 publications

(54 citation statements)

References 28 publications

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“…Of the 472 samples, 73 patients were diagnosed with TB pleural effusions (mean prevalence of 15.3%) [41]. They reported that the sensitivity and specificity of ADA in the diagnosis of pleural TB were 89% and 92.7%, respectively [40]. This was similar to the sensitivity and specificity reported in a recent meta-analysis of 63 studies (92% and 90%, respectively) [41].…”

Section: Adenosine Deaminasesupporting

confidence: 70%

“…All patients with a fluid ADA level of greater than 70 U/L had TB, whereas no patient with a fluid ADA level of less than 40 U/L had TB pleuritis [39]. A recent study in Spain retrospectively looked at all consecutive patients with pleural effusion with a diagnostic thoracentesis at Mendaro Hospital from January 1998 to December 2008 [40]. The ADA levels had been determined in all samples.…”

Section: Adenosine Deaminasementioning

confidence: 99%

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Tuberculous Pleural Effusion

Cohen

Light

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 Deaminasesupporting

confidence: 70%

Section: Adenosine Deaminasementioning

confidence: 99%

Tuberculous Pleural Effusion

Cohen

Light

2015

Tur Toraks Der

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“…Many studies have suggested that pleural fluid adenosine deaminase (pfADA) is useful in the diagnosis of tuberculous pleural effusion (TBPE). [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.…”

Section: Introductionmentioning

confidence: 99%

“…The test performance of pfADA has largely been evaluated by including all cases with pleural effusion, and estimating its sensitivity and specificity with reference to an optimal cut-off value. Some studies fine-tuned the test performance by restricting the analysis to subjects with lymphocytic exudates 9,13 or to young adults. 21 In Hong Kong, pfADA has been measured centrally by the Chemical Pathology Laboratory at the Princess Margaret Hospital using the Diazyme commercial kit.…”

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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“…It affects mostly the children (elementary school age), the household and the individuals living in such an environment as a nursing home. It is common in those with personal hygiene deficiency because of self-infection [1,2].…”

Section: Introductionmentioning

confidence: 99%