Diagnostic value of adenosine deaminase in tuberculous and malignant pleural effusion

Helmy, Nariman A.; Eissa, Saad; Masoud, Hossam; Elessawy, Assem F.; Ahmed, Randa

doi:10.1016/j.ejcdt.2012.08.004

Cited by 18 publications

(16 citation statements)

References 10 publications

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“…The literature usually reports ADA levels between 30–60 IU/L for PlTB diagnosis [ 25 , 32 ]. Our value was slightly smaller than this range of values, even though other groups had reported values as low as 10 IU/L, 15 IU/L, 26 IU/L, 30 IU/L and 35 IU/L [ 2 , 28 , 35 , 36 ]. There are also other reports suggesting that ADA values can vary according to age, protein, DHL and absolute lymphocyte count on PF, CD4 lymphocyte counts and geographic area [ 37 – 41 ] but these were not our scope.…”

Section: Discussioncontrasting

confidence: 82%

Application of Venn's diagram in the diagnosis of pleural tuberculosis using IFN-γ, IP-10 and adenosine deaminase

Santos¹,

Corrêa²,

Ribeiro-Alves³

et al. 2018

PLoS ONE

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BackgroundPleural tuberculosis (PlTB) is the most common extrapulmonary manifestation of this infectious disease which still presents high mortality rates worldwide. Conventional diagnostic tests for PlTB register multiple limitations, including the lack of sensitivity of microbiological methods on pleural specimens and the need of invasive procedures such as pleural biopsy performance. In this scenario, the search for biological markers on pleural fluid (PF) has been the target of several studies as a strategy to overcome the limitations of PlTB diagnosis. This study aims to evaluate the use either isolated or in combination with adenosine deaminase (ADA), interferon-gamma (IFN-γ), interferon-gamma inducible protein of 10-kD (IP-10) levels on PF in order to guide an accurate anti-TB treatment in microbiologically non-confirmed cases.Methods and findingsEighty patients presenting pleural effusion under investigation were enrolled in a cross-sectional study conducted at Pedro Ernesto University Hospital, Rio de Janeiro, RJ, Brazil. Peripheral blood (PB) and PF samples collected from all patients were applied to the commercial IFN-γ release assay, QuantiFERON-TB Gold In-Tube, and samples were analyzed for IFN-γ and IP-10 by immunoassays. ADA activity was determined on PF by the colorimetric method. Based on microbiological and histological criteria, patients were categorized as follow: confirmed PlTB (n = 16), non-confirmed PlTB (n = 17) and non-PlTB (n = 47). The Mycobacterium tuberculosis antigen-specific production of IFN-γ and IP-10 on PB or PF did not show significant differences. However, the basal levels of these biomarkers, as well as the ADA activity on PF, were significantly increased in confirmed PlTB in comparison to non-PlTB group. Receiver operating characteristics curves were performed and the best cut-off points of these three biomarkers were estimated. Their either isolated or combined performances (sensitivity [Se], specificity [Sp], positive predictive value [PPV], negative predictive value [NPV] and accuracy [Acc]) were determined and applied to Venn's diagrams among the groups. Based on the confirmed PlTB cases, IFN-γ showed the best performance of them at a cut-off point of 2.33 IU/mL (Se = 93.8% and Sp = 97.9%) followed by ADA at a cut-off of 25.80 IU/L (Se = 100% and Sp = 84.8%) and IP-10 (Cut-point = 4,361.90 pg/mL, Se = 75% and Sp = 82.6%). IFN-γ plus ADA (cut-point: 25.80 IU/L) represent the most accurate biomarker combination (98.4%), showing Se = 93.7%, Sp = 100%, PPV = 100% and NPV = 97.9%. When this analysis was applied in non-confirmed PlTB, 15/17 (88.2%) presented at least two positive biomarkers in combination.ConclusionIFN-γ, IP-10, and ADA in PlTB effusions are significantly higher than in non-PlTB cases. IFN-γ is an excellent rule-in and rule-out test compared to IP-10 and ADA. The combination of IFN-γ and ADA, in a reviewed cut-off point, showed to be particularly useful to clinicians as their positive results combined prompts immediate treatment for TB while both negative resu...

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Section: Discussioncontrasting

confidence: 82%

Application of Venn's diagram in the diagnosis of pleural tuberculosis using IFN-γ, IP-10 and adenosine deaminase

Santos¹,

Corrêa²,

Ribeiro-Alves³

et al. 2018

PLoS ONE

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“…More than fifty percent of the patients were in the age group 20-40 years and the mean (SD) age was 31.4 ± 15.2 years and Male and female ratio of the patients was almost equal. In another study similar result was found where the mean (SD) age was 29.2 ± 12.2 years [3]. This result was agreed with other report which was found that the mean age of tuberculous group was 33.9 ± 13.2 years that of malignant group was 45.5 ± 16.8 years [4].…”

Section: Discussionsupporting

confidence: 88%

Socio-Demographic Pattern of Patients Suffering from Extra Pulmonary Tuberculosis

Ahmed¹,

Sabah²,

Sarker³

et al. 2020

SJAMS

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Original Research Article Objective: In this study our main goal is to evaluate the demographic pattern of patients suffering from extra pulmonary tuberculosis. Method: This cross-sectional descriptive type study was carried out at Medicine departments of Sir Salimullah Medical College & Mitford Hospital, Dhaka from 19 th December 2016 to 18 th June 2017. A total 100 patients were included in the study where detailed history was taken then thorough clinical examinations. Results: More than fifty percent (56.0%) of the patients were in the age group 20-40 years and 30.0% of the patients were in age group 20 and below while only 14.0% of the patients were in the age group above 40 years. Also, male and female ratio of the patients was almost equal. Majority of the patient's had the history of contact with TB patients. Majority of the patient's had normal chest x-ray findings (60.0%) while 26.0% of the patient's had homogenous opacity in chest xray findings and 2.0% and 4.0% of the patient's had cavity lesion and fibrosis respectively, in chest x-ray findings. Conclusion: Our study concludes that majority of the tuberculosis patients are within the economically productive age group ranged between 20-40 years. Females are the majority of the patients with extra pulmonary tuberculosis. Based on this results TB control programme might usefully target young and female populations for early diagnosis to decrease tuberculosis morbidity and mortality.

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“…In a study from the USA, the mean age of 14,000 patients reported to the Communicable Disease Center between 1993 and 2003 was 49.9 years [7]. Also Helmy et al [17] who stated mean age of the MPE group was significantly higher than the TPE group (P < 0.0001). Valdes et al [18] also found that the mean age of the tuberculous group was 33.9 ± 13.2 years that of the malignant group was 45.5 ± 16.8 years.…”

Section: Discussionmentioning

confidence: 94%

Role of thoracentesis in the management of tuberculous pleural effusion

Agha

El-Habashy

Helwa

et al. 2015

Egyptian Journal of Chest Diseases and Tuberculosis

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Background: Tuberculous pleural effusion (TPE) is the second most common form of extrapulmonary tuberculosis (EPTB). Up to 50% after treatment complicated with pleural thickening. Pleural biopsy has been considered the gold standard in diagnosis of TPE but it is invasive, so that pleural fluid markers of TPE have been extensively evaluated as an alternative to pleural biopsy. Thoracentesis for measuring these fluid markers is important.Aim: Assessing the value of diagnostic thoracentesis (by measuring pleural adenosine deaminase levels) and role of therapeutic thoracentesis in preventing pleural thickening.Subjects and methods: 10 cases with transudative pleural effusion and 45 cases with already diagnosed exudative effusion (30 cases of TPE, and 15 cases of Malignant PE) were included. 50 ml pleural fluid samples were aspirated and sent for measuring ADA levels. The 30 cases of TPE were classified into 2 equal groups the 1st group started 6 months anti tuberculous therapy plus repeated thoracentesis while the 2nd started anti tuberculous therapy only. Chest CT scan was done after 2 and 6 months for assessment of pleural effusion and pleural thickening.Results: Patients with tuberculous pleural effusion had higher pleural effusion ADA levels (mean ± SD 68.51 ± 24.06) than those with malignant pleural effusion (mean ± SD 25.47 ± 12.09) or transudative pleural effusion (mean ± SD 16.58 ± 2.93) and these levels had highly a significant difference (P-value <0.001). Also, there was a significant difference (P-value <0.05) between levels of ADA in malignant and transudative pleural effusion. Using a cut-off point of the pleural fluid ADA (30.49 IU/L) with AUC of 96.7 (sensitivity 96.7%, specificity 84%, NPV 88%, PPV 95% and accuracy 91%) discrimination between tuberculous and other causes of pleural effusion occurred. Regarding the pleural thickening, after 2 months of ttt, in group I, 3 cases developed pleural thickening, while in group II, 9 cases developed thickening. After 6 months, there was one case of pleural thickening in group I, while in group II, 5 cases developed pleural thickening. And there was a significant difference (P value <0.05) between both groups, after 2 and 6 months of treatment.

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Diagnostic value of adenosine deaminase in tuberculous and malignant pleural effusion

Cited by 18 publications

References 10 publications

Application of Venn's diagram in the diagnosis of pleural tuberculosis using IFN-γ, IP-10 and adenosine deaminase

Application of Venn's diagram in the diagnosis of pleural tuberculosis using IFN-γ, IP-10 and adenosine deaminase

Socio-Demographic Pattern of Patients Suffering from Extra Pulmonary Tuberculosis

Role of thoracentesis in the management of tuberculous pleural effusion

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