Use of pleural fluid levels of adenosine deaminase and interferon gamma in the diagnosis of tuberculous pleuritis

Krenke, Rafał; Korczyński, Piotr

doi:10.1097/mcp.0b013e32833a7154

Cited by 84 publications

(93 citation statements)

References 61 publications

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“…A variety of pleural conditions lead to an elevated pleural fluid ADA level (4,14,26), with parapneumonic effusion and empyema being probably the most important. In line with this, previous reports (13,14,24) showed that roughly 1/10 to 1/3 of parapneumonic effusions and 1/2 to 2/3 of empyemas have ADA levels above 40 U/liter. In this study, the ADA level (38.1 Ϯ 19.2 U/liter) in patients with parapneumonic effusion was not only significantly higher than in the other two control groups (lung cancer, 13.4 Ϯ 7.8 U/liter, and liver cirrhosis, 11.8 Ϯ 14.1 U/liter) but also even higher than that in patients with TBP (36.1 Ϯ 13.3 U/liter) ( Table 1).…”

Section: Discussionsupporting

confidence: 75%

“…While the pleural fluid ADA activity test has been widely used for diagnosis of TBP with high sensitivity and specificity (16,24), the diagnostic value of this test was limited in our hands, with a sensitivity of only 55.5% and a specificity of 86.3% at a cutoff level for ADA of 35 U/liter. The reason underlying the low sensitivity of ADA testing in our study may be that most of our specimens were collected from TBP patients diagnosed by a positive pleural bi- Another reason underlying the low performance of ADA in our study is most likely the high ADA levels in pleural fluid of patients with parapneumonic effusion.…”

Section: Discussionmentioning

confidence: 88%

See 1 more Smart Citation

Gamma Interferon Immunospot Assay of Pleural Effusion Mononuclear Cells for Diagnosis of Tuberculous Pleurisy

Liao¹,

Yang²,

Zhang³

et al. 2014

Clin. Vaccine Immunol.

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e Diagnosis of tuberculous pleurisy remains a challenge in the clinic. In this study, we evaluated the usefulness of a previously developed Mycobacterium tuberculosis antigen-specific gamma interferon enzyme-linked immunospot (ELISPOT) assay in the diagnosis of tuberculous pleurisy by testing a cohort of 352 patients with pleural effusion. We found that M. tuberculosis antigen-specific gamma interferon-producing cells were enriched four to five times in pleural fluid compared with their levels in peripheral blood from patients with tuberuclous pleurisy assayed in parallel. The sensitivity, specificity, positive predictive value, and negative predictive value of the pleural fluid mononuclear cell ELISPOT assay for the diagnosis of tuberculous pleurisy were 95.7%, 100%, 100%, and 81.0%, respectively. In comparison, the sensitivity and specificity of the ELISPOT assay using peripheral blood mononuclear cells were 78.3% and 86.3%, respectively. The sensitivity and specificity of the pleural fluid adenosine deaminase activity test were 55.5% and 86.3%, respectively. These results demonstrate that the M. tuberculosis antigen-specific ELISPOT assay performed on pleural fluid mononuclear cells provides an accurate, rapid diagnosis of tuberculous pleurisy.T uberculosis (TB) is a leading cause of morbidity and mortality throughout the world, with 95% of cases and 97% of all deaths occurring in high-prevalence countries such as China, where the prevalence of active TB is as high as 367/100,000 population (1). Tuberculous pleurisy (TBP) is a common clinical manifestation of active TB disease and may account for up to 50% of all pleural effusions in areas with a high incidence of TB (2). Standard diagnostic assays for TBP, including microbiological examination, adenosine deaminase (ADA) levels, cell infiltrate profile, and certain other biochemical tests, do not provide satisfactory sensitivity and specificity (3). As an example, ADA determination has been recognized as a relatively sensitive diagnostic test for TBP; increased ADA levels are observed in a number of other diseases, such as parapneumonic effusions and noninfectious inflammatory diseases (4). High pleural fluid ADA levels do not necessarily indicate the presence of TBP, especially when pleural fluid potassium levels exceed 5.0 mEq/liter (5).Infection with Mycobacterium tuberculosis elicits a strong antigen-specific gamma interferon (IFN-␥) response from host T cells, which is used as an indicator to diagnose latent M. tuberculosis infection in clinical practice (6, 7). In addition, we and others have applied the M. tuberculosis antigen-specific IFN-␥ enzymelinked immunosorbent spot (ELISPOT) assay to peripheral blood mononuclear cells (PBMC) to diagnose active TB (8, 9). Although the sensitivity of the peripheral blood ELISPOT assay for the diagnosis of active pulmonary TB is significantly higher than those of routine tests such as sputum M. tuberculosis culture, the specificity is not satisfactory, mostly due to its inability to discriminate active TB disease ...

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 88%

Gamma Interferon Immunospot Assay of Pleural Effusion Mononuclear Cells for Diagnosis of Tuberculous Pleurisy

Liao¹,

Yang²,

Zhang³

et al. 2014

Clin. Vaccine Immunol.

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“…First, QFT-GIT and ADA had equivalent and high diagnostic accuracy for TBPE compared to other tests, as observed by others [7,11]. This is important from a public health viewpoint as the QFT-GIT may not be available or affordable at many healthcare settings in developing countries.…”

mentioning

confidence: 77%

Using a whole-blood interferon- assay to improve diagnosis of tuberculous pleural effusion

Katiyar¹,

Sampath²,

Bihari³

et al. 2010

European Respiratory Journal

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“…ADA'nın tanısal etkinliği; çalışmanın yapıldığı ülkedeki TB prevalansına göre değişkenlik göstermesi tanısal test olarak yaygın kulanımını sınır-layan diğer faktördür. ADA'nın bildirilen cut off değerleri yukarıda bahsedilen nedenlerden dolayı oldukça geniş bir varyasyon göstermekle birlikte çalışmaların büyük çoğunluğu cut off değeri için 40-60 U/L aralığını işaret etmektedir (8). Bizim ünitemizde de cut off değeri olarak 40 U/L değeri kullanılmaktaydı.…”

Section: Sonuçunclassified

Diagnostic Value of Adenosine Deaminase Level for the Differential Diagnosis of Tuberculosis and Malignancy in Exudative Lymphocytic Pleurisy

Altınsoy¹,

Yalçınsoy²,

Ünver³

et al. 2016

Istanbul Med J

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GirişPlörezi plevral boşlukta anormal sıvı birikmesi olarak tanımlanır ve her zaman altta yatan bir hastalığın varlığına işaret eder (1). Sıvının biyokimyası ve oluşum mekanizmasına bağlı olarak transuda ya da eksuda olarak sınıflanır. Eksüdatif sıvılarda, plevral boşluğa inflamatuar hücre-lerin toplanması söz konusudur. İnflamatuar hücre kompozisyonu ise altta yatan hastalığa göre değişkenlik gösterir. Parapnömonik sıvı ve ampiyemde hakim hücre tipi nötrofil iken malignite ve tüberkuloz'a (TB) bağlı olanlarda çoğunlukla lenfosit hakimiyeti görülür (2). Plevra sıvının nötrofil ya da lenfositden zengin olması aslında sıvının plevra boşluğunda kaldığı süre ile ilişkilidir (akutkronik inflamasyon). Klinik pratikde eksudatif plörezinin en sık nedenleri; pnömoni, TB ve malignitedir. Parapnömonik efüzyonu ve ampiyemi klinik ve plevral sıvı bulguları (nötrofil hakim sıvı yada püy) ile ayırmak kolaydır (2, 3). Bununla birlikte TB ve malignite ayrımı klinisyen için zorluk teşkil eder. Konvansiyonel plevral biokimyasal incelemelerin ayırıcı tanıda katkısı sınırlıdır. Kapalı plevra biopsisinin tanısal değeri ise yaklaşık olarak, TBP için %60-80, malign plörezi (MP) için % 50'dir (4). Bununla beraber doku kültürü, sitoloji gibi incelemelerin eklenmesiyle tanı oranları artmaktadır.Adenozin deaminaz (ADA) vücutta yaygın olarak bulunan bir enzimdir. Bu enzim sırasıyla adenozin ve deoksadenozin'in deaminasyonunu katalize eder. Lenfosit farklılaşması ve proliferasyonuyla yakın ilişkilidir. Aktivitesi lenfositlerin antijenik yanıtı süresince artar (5). Mevcut çalışmalar TBP ayırıcı tanısında ADA'nın değerli bir biokimyasal parametre olduğuna işaret etmektedir. Artmış plevral ADA düzeyinin TBP tanısında sensitivitesi %47-100, spesifitesi %50-100 arasında değişmektedir (6). Objective: To evaluate the diagnostic performance of adenosine deaminase (ADA) levels in patients with exudative lymphocytic pleurisy for the differential diagnosis of tuberculous pleurisy (TBP) and malignant pleural effusion (MPE).Methods: Data on patients with exudative lymphocytic pleurisy were retrospectively analyzed. The study population comprised 54 patients. Thirtyseven were diagnosed with TBP and 17 were diagnosed with MPE.Results: Significant differences were determined in terms of age and ADA, total protein, albumin, and LDH levels between the TBP and MPE groups. The optimal cut-off value of ADA levels was 35.1 U/L for diagnosing TBP. Sensitivity and specificity were 92% and 100%, respectively. Logistic regression analysis was performed to assess independent variables associated with TBP. Independent predictive factors in the model were ADA (OR: 1.21, 95% CI: 1.06-1.39, p=0.006)], and (OR: 0.92, 95% CI: 0.84-1.00, p = 0.052)]. The AUC value by the regression equation was 0.979 (p<0.001). When patients were categorized according to age (<50 ve ≥50), two different cut-off values (>13.51 and >35.1) for each age range were found in all, but one, TBP patients. Conclusion:ADA levels are useful for the diagnosis of TBP in cases where pleural biopsy cannot be...

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Use of pleural fluid levels of adenosine deaminase and interferon gamma in the diagnosis of tuberculous pleuritis

Cited by 84 publications

References 61 publications

Gamma Interferon Immunospot Assay of Pleural Effusion Mononuclear Cells for Diagnosis of Tuberculous Pleurisy

Gamma Interferon Immunospot Assay of Pleural Effusion Mononuclear Cells for Diagnosis of Tuberculous Pleurisy

Using a whole-blood interferon- assay to improve diagnosis of tuberculous pleural effusion

Diagnostic Value of Adenosine Deaminase Level for the Differential Diagnosis of Tuberculosis and Malignancy in Exudative Lymphocytic Pleurisy

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