Usefulness of adenosine deaminase dosing in the diagnosis of pleural tuberculosis
First national experience
Keywords:
ADENOSINDESAMINASE, PLEURAL TUBERCULOSISAbstract
Background: bacteriology of pleural liquid (LP) for diagnosis of pleural tuberculosis (TBP) is slow and has low sensitivity; the biopsy of highest performance is expensive and cruel. Although adenosine deaminase (ADA) has been described as a valuable tool for diagnosis of LP, there is a lack of information and experience in our country.
Objective: to validate ADA dosage in LP for diagnosis of TBP.
Methods: ADA dosage using Giusti technique in 113 exudates of LP from 66 suspected carriers of TPB (group gTPB) with bacteriology, and 47 patients with non tuberculosis causes (control group gC). Cut point was 40 U/l.
Results: twelve patients of the gTBP showed ADA higher than 40 U/l; diagnosis TBP was done for 8 patients. For the specific cut point, ADA showed: 100% sensitivity; 93% specificity; PPV: 67%; PNV: 100%. In gC (n = 47), four samples showed ADA higher than 40 U/l (one thymona, one lymphoma, and two empyemas).
Conclusions: ADA in LP is a sensitive and specific technique for diagnosing TBP, with high PNV. It decreases rates of byopsy and reduces time of diagnosis; it is a simple and a cheap technique. Other diseases that increase ADA in LP should be considered in the analysis of the results.
References
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(16) Greco S, Girardi E, Masciangelo R, Capoccetta GB, Saltini C. Adenosine deaminase and interferon gamma measurements for the diagnosis of tuberculous pleurisy: a meta –analysis. Int J Tuberc Lung Dis 2003; 7 (8): 777-86.
(17) Diacon AH, Van De Wal BW, Wyser C, Smedema JP, Bezuidenhout J, Bolliger CT, et al. Diagnostic tools in tubercuous pleurisy: a direct comparative study. Eur Respir J 2003; 22: 589-91.
(18) Pérez Rodríguez E, Jiménez Castro D. The use of adenosine deaminase isoenzymes in the diagnosis of tuberculous pleuritis. Curr Opin Pulm Med 2000; 6(4): 259-66.
(19) Shanga Sk, Banga A. Pleural fluid interferon-gamma and adenosine deaminase levels in tuberculosis pleural effusion: a cost-effectiveness analysis. J Clin Lab Anal 2005; 19(2): 40-6.
(20) Pérez Rodríguez E, Pérez Walton IJ, Sánchez Hernández JJ, Pallares E, Rubi J. Nuevo G. ADA1/ADAp ratio in pleural tuberculosis: an excellent diagnostic parameter in pleural fluid. Respir Med 1999; 93(11): 816-21.
(21) Petterson T, Ojala K, Weber TH. Adenosine deaminase in the diagnosis of pleural effusions. Acta Med Scand 1984; 215(4): 299-304.
(22) Strakinga WF, Nautta JJ, Straub JP, Stam J. Adenosine deaminase activity in tuberculous pleural effusions: a diagnostic test. Tubercle 1987; 68(2): 137-40.
(23) Porcel JM, Vives M. Etiology and pleural fluid characteristics of large and massive effusions. Chest 2003; 124: 978-83.
(24) Villena Garrido V. Mesothelioma and pleural adenosine deaminase. Arch Bronconeumol 2005; 41: 175-6.
(25) Miller Kd, Barnette R, Light R. Stability of adenosine deaminase during transportation. Chest 2004; 126: 1933-7.
(2) Caminero Luna JA. Tuberculosis extrapulmonar. In: unión internacional contra la tuberculosis y enfermedades respiratorias. Guía de la Tuberculosis para Médicos Especialistas. París: UICTER, 2003: 328-69.
(3) Comisión Honoraria para la Lucha Antituberculosa y Enfermedades Prevalentes. Programa Nacional de Tuberculosis. Cifras Oficiales. Años 2002-2004. Montevideo: CHLA EP, 2004.
(4) Comisión Honoraria para la Lucha Antituberculosa y Enfermedades Prevalentes. Cifras Oficiales. Años 2002-2004. Montevideo: CHLA EP, 2005.
(5) Burgess Lj, Maritz Fj, Le Roux I, Taljaraard Jjf. The utility of adenosine deaminase as a diagnostic tool for tuberculous pleurisy. Thorax 1995; 50: 672-4.
(6) Kaisemamann MC, Kritski AL, Pereira MFC, Trajman A. Dosagem da atividade da adenosina deaminase no líquido pleural para o diagnóstico da tuberculose pleural. J Bras Pneumol 2004; 30: 549-56.
(7) Ocana I, Martínez Vázquez JM, Ribera E, Segura RM , Pascual C. Adenosine deaminase activity in the diagnosis of lymphocytic pleural effusions of tuberculous, neoplastic and lymphomatous origin.Tubercle 1986; 67(2): 141-5.
(8) Valdes L, Avarez D, San José E, Penela P, Valle JM, García-Pazos JM, et al. Tuberculous pleurisy: a study of 254 patients. Arch Intern Med 1998; 158(18): 1967-8.
(9) Valdes L, Pose A, San José E, Martínez Vázquez JM. Tuberculous pleural effusions. Eur J Intern Med 2003; 14(2): 77-83.
(10) Ocana I, Martínez Vázquez JM, Segura RM, Fernandez De-Sevilla T, Capdevila JA. Adenosine deaminase in pleural fluids.Tests for diagnosis of tuberculous pleural effusion. Chest 1983; 84(1): 51-3.
(11) Giusti G, Galanti B. Adenosine deaminase. In: Bergmeyer HU, ed. Methods of enzymatic analysis. 2 ed. New York: Academic Press, 1974: 1092-6.
(12) Carstens ME, Burgess LJ, Maritz FJ, Taljaraard JJF. Isoenzymes of adenosine deaminase in pleural effusions: a diagnostic tool? Int J Tuberc Lung Dis 1998; 2(10): 831-5.
(13) Argentina. Ministerio de Salud y Acción Social. Instituto Nacional de Enfermedades Respiratorias. Zerbini E, Imaz MS, Franco R, Togneri A, Kuszniers G, Etchart A, et al. Utilidad de la determinación de adenosin deaminasa en el diagnóstico de la tuberculosis extrapulmonar. Buenos Aires: Ministerio de Salud y Acción Social, 2001.
(14) Chen ML, Yu WC, Lam CW, Au KM, Chan AY. Diagnostic value of pleural fluid adenosine deaminase activity in tuberculous pleurisy. Clin Chim Acta 2004; 341(1-2): 101-7.
(15) Carrion-Valero F, Perpiñá-Tordera M. Screening of tuberculous pleural efusión by discriminant analysis. Int J Tuberc Lung Dis 2001; 5(7): 673-9.
(16) Greco S, Girardi E, Masciangelo R, Capoccetta GB, Saltini C. Adenosine deaminase and interferon gamma measurements for the diagnosis of tuberculous pleurisy: a meta –analysis. Int J Tuberc Lung Dis 2003; 7 (8): 777-86.
(17) Diacon AH, Van De Wal BW, Wyser C, Smedema JP, Bezuidenhout J, Bolliger CT, et al. Diagnostic tools in tubercuous pleurisy: a direct comparative study. Eur Respir J 2003; 22: 589-91.
(18) Pérez Rodríguez E, Jiménez Castro D. The use of adenosine deaminase isoenzymes in the diagnosis of tuberculous pleuritis. Curr Opin Pulm Med 2000; 6(4): 259-66.
(19) Shanga Sk, Banga A. Pleural fluid interferon-gamma and adenosine deaminase levels in tuberculosis pleural effusion: a cost-effectiveness analysis. J Clin Lab Anal 2005; 19(2): 40-6.
(20) Pérez Rodríguez E, Pérez Walton IJ, Sánchez Hernández JJ, Pallares E, Rubi J. Nuevo G. ADA1/ADAp ratio in pleural tuberculosis: an excellent diagnostic parameter in pleural fluid. Respir Med 1999; 93(11): 816-21.
(21) Petterson T, Ojala K, Weber TH. Adenosine deaminase in the diagnosis of pleural effusions. Acta Med Scand 1984; 215(4): 299-304.
(22) Strakinga WF, Nautta JJ, Straub JP, Stam J. Adenosine deaminase activity in tuberculous pleural effusions: a diagnostic test. Tubercle 1987; 68(2): 137-40.
(23) Porcel JM, Vives M. Etiology and pleural fluid characteristics of large and massive effusions. Chest 2003; 124: 978-83.
(24) Villena Garrido V. Mesothelioma and pleural adenosine deaminase. Arch Bronconeumol 2005; 41: 175-6.
(25) Miller Kd, Barnette R, Light R. Stability of adenosine deaminase during transportation. Chest 2004; 126: 1933-7.
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Published
2007-03-31
How to Cite
1.
Coitinho C, San Martín R, Mier C, Rodríguez R, Zunino Torres S, Rivas C. Usefulness of adenosine deaminase dosing in the diagnosis of pleural tuberculosis: First national experience. Rev. Méd. Urug. [Internet]. 2007 Mar. 31 [cited 2024 Nov. 21];23(1):19-24. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/631
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