Study of Adenosine Deaminase Levels in Patients of Pulmonary Tuberculosis with and Without Pleural Effusion

Abstract

Tuberculosis (TB) is one of the oldest and commonest infectious diseases also known as "master of death" or "Captain of death". Pulmonary TB(PTB) and TB with pleural effusion remains a diagnostic challenge. Adenosine deaminase(ADA) is an enzyme of purine catabolism which is an inexpensive and easy test in early routine evaluation of patients with pleural effusion and helps to avoid invasive test like biopsy. Therefore, this study was aimed to determine the exact role of ADA in TB patients with and without pleural effusion and in non-tuberculosis pleural effusion and to provide a clear picture of ADA for early diagnosis & management of TB. Materials and method: Study comprised of 132 subjects of which 33 are healthy controls and 33 are confirmed cases of pulmonary TB without effusion, 33 are PTB with effusion and 33 are non-TB effusion patients. Age group range was from 20-70 years. Estimation of serum and pleural fluid Adenosine deaminase by Guisti and Galanti method of enzymatic analysis. Results: Serum ADA levels in pulmonary tuberculosis (55.09 + 11.02) patients and pulmonary tuberculosis with pleural effusion (44.01 + 7.82) were significantly higher (p <0.001) when compared with healthy controls (18.11 + 6.13). Pleural fluid ADA levels were significantly higher (p <0.0001) in pulmonary tuberculosis with pleural effusion (82.61+ 12.03) than in non tuberculosis pleural effusion (27.72 +7.80). In the present study, the mean pleural fluid ADA were significantly higher as compared to mean serum ADA in pulmonary tuberculosis with pleural effusion (p <0.0001) and in non tuberculosis pleural effusion (p <0.0008). Conclusion: ADA level in serum as well as in pleural fluid in the diagnosis of pulmonary TB with or without pleural effusion is a very sensitive, specific, inexpensive, rapid, easily available & reliable investigation.

Novel biomarkers for Diagnosis of Pulmonary Tuberculosis and Tuberculous Pleural Effusion

“…in accordance with the study of Sonone et al, to avoid pleural biopsy in as much as 82% of patients as certain diagnosis of TB. [14] Against our study, Alpana et al found that On pleural fluid examination, except for ADA levels none of the variables showed a significant difference. [19] So, pleural fluid ADA level is very helpful test to rule out a tubercular etiology of pleural effusion.…”

“…In pathological conditions, the clearance capacity of lungs is decreased leading to increased numbers of cells in pleural fluid and the recirculation of activated T cells may cause a high serum ADA activity in patients with pulmonary disease. [14] Many studies have suggested that pleural fluid adenosine deaminase (pfADA) is useful in the diagnosis of TB-PLE. [15] The merits of using pfADA include its low cost, short turn around time, and high sensitivity and specificity.…”

Serum Biomarker Profile Including CCL1, CXCL10, VEGF, and Adenosine Deaminase Activity Distinguishes Active From Remotely Acquired Latent Tuberculosis

“…A limitation of our designed prediction model is the lack of samples from patients with different diagnoses, such as pneumonia, lung cancer, sarcoidosis, vasculitis, non-tuberculous mycobacterial infections, and aspergillosis. Others reported ADA (2) activity in populations of ATB, pneumonia, lung cancer, and pleural effusions of any origin with sensitivity and specificity values of ADA(2) ranging from 35% to 94% and 55% to 97%, respectively (19,20,(68)(69)(70). In addition, both CXCL10 and VEGF have been described to be potential biomarkers for various diagnoses such as chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer and for exacerbations of autoimmune diseases.…”

Nilai Diagnostik Adenosine Deaminase (ADA) Cairan Pleura pada Penderita Efusi Pleura Tuberkulosi

“…Tes ADA ini juga membantu dalam penegakan diagnosis dan pengobatan efusi pleura TB lebih cepat. 9 Nilai cut off ADA untuk penderita efusi pleura tuberkulosis dari berbagai penelitian bervariasi antara 30-100 IU/L dengan sensitivitas dan spesifisitas yang berbeda-beda. Perbedaan tersebut kemungkinan disebabkan karena metode analisis ADA yang berbeda, prevalensi TB yang berbeda pada setiap populasi penelitian dan karakteristik populasi penelitian yang juga berbeda.…”