Diagnostic performance of adenosine deaminase activity in pleural fluid: A single-center experience with over 2100 consecutive patients

Porcel, José M.; Esquerda, Aureli; Bielsa, Silvia

doi:10.1016/j.ejim.2010.03.011

Cited by 143 publications

(145 citation statements)

References 15 publications

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“…This was also observed in the same recent study by Porcel et al [44] in which ADA activity was found to be significantly higher in patients diagnosed with pleural tuberculosis and patients with complicated parapneumonic effusion/empyema. When the parapneumonic effusions were categorized as non-complicated, complicated, and empyemas, the latter group exhibited the highest ADA concentrations, along with the TB group [44]. Notably, none of these patients had an ADA level exceeding 250 U/L [44].…”

Section: Adenosine Deaminasesupporting

confidence: 76%

“…When the parapneumonic effusions were categorized as non-complicated, complicated, and empyemas, the latter group exhibited the highest ADA concentrations, along with the TB group [44]. Notably, none of these patients had an ADA level exceeding 250 U/L [44]. However, parapneumonic effusions may be easily distinguished from TB pleuritis for two reasons.…”

Section: Adenosine Deaminasementioning

confidence: 99%

“…Even at CD4 counts of <10 cells/mm high lymphocyte counts, which should be suspected of TB. From these samples, an ADA level above 35 U/L had a sensitivity of 93%, a specificity of 90%, a positive likelihood ratio of 10.05, and a negative likelihood ratio of 0.07 for identifying TB effusion [44]. Based on these results, the authors concluded that a cut-off level of 35 U/L is sufficient, assuming that the prevalence of the disease is high, and that in areas where the prevalence of TB is low, a level greater than or equal to 35 U/L may represent a false-positive result.…”

Section: Adenosine Deaminasementioning

confidence: 99%

“…Based on these results, the authors concluded that a cut-off level of 35 U/L is sufficient, assuming that the prevalence of the disease is high, and that in areas where the prevalence of TB is low, a level greater than or equal to 35 U/L may represent a false-positive result. However, due to its maintained high negative predictive value, an ADA level of less than 35 U/L confidently excludes TB [44].…”

Section: Adenosine Deaminasementioning

confidence: 99%

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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 Deaminasesupporting

confidence: 76%

Section: Adenosine Deaminasementioning

confidence: 99%

Section: Adenosine Deaminasementioning

confidence: 99%

Section: Adenosine Deaminasementioning

confidence: 99%

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Tuberculous Pleural Effusion

Cohen

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2015

Tur Toraks Der

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“…Excluding patients with an early diagnosis of nontuberculous disease, notably malignancy and nontuberculous infection, may also help improve the utility of pfADA for TBPE. 5,9,[23][24][25][26] Diagnostic test accuracy depends on sensitivity and specificity, which are relatively stable, and pre-test probability that can be enhanced by selecting appropriate patients. In this study, we aimed to optimise its utility by increasing the pretest probability, and establish a local diagnostic pfADA cut-off value for adult TBPE.…”

Section: Introductionmentioning

confidence: 99%