DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20162914

Adenosine deaminase and interferon-gamma in diagnosis of tubercular pleural effusion

Varuna Jethani, Girish Sindhwani, Vinit Mehrotra, Aarti Kotwal, Rakhee Khanduri

Abstract


Background: Pleural effusion is a common extrapulmonary manifestation of tuberculosis (TB). The conventional culture suffers from lack of sensitivity. Many pleural fluid markers have been evaluated to diagnose tubercular pleural fluid but none has proved to be an ideal. We have studied Adenosine deaminase (ADA), Interferon gamma (IFN) and their combination for diagnosis of tubercular pleural effusion.

Methods: All consecutive patients with pleural effusion were subjected to thoracentesis and segregated into transudative and exudative using Light`s criteria. Patients with exudative pleural effusion were enrolled and divided into two groups. Group-I comprised of patients with tubercular etiology, Group-II- non-tubercular etiology. 45 patients were selected for each group. ADA and IFN in pleural fluid of these patients were measured. The sensitivity, specificity and predictive values were calculated.

Results: The  sensitivity, specificity, positive predictive value, negative predictive value of ADA and IFN were 88.89%, 99.85%, 86.96%, 99.87%; 97.78%, 97.78%, 97.78%, 97.78% respectively. Combination of ADA and IFN didn’t improve the sensitivity or specificity compared to IFN alone.

Conclusions: Pleural fluid ADA, IFN were found to be useful in differentiating tubercular from non-tubercular patients. Combination of ADA and IFN doesn’t give additional benefit over IFN alone.


Keywords


Extrapulmonary tuberculosis, Pleural disease, Exudate

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References


Light RW. Useful tests on the pleural fluid in the management of patients with pleural effusions. Curr Opin Pulm Med. 1999;5:245-9.

Scharer L, McClement JH. Isolation of tubercle bacilli from needle biopsy specimens of parietal pleura. Am Rev Respir Dis. 1968;97(3):466-8.

Crompton GK, McHardy GF. Diseases of the respiratory system. In: Edwards CR, Boucher IA. Davidson's Principles and Practice of Medicine. 16th edition. Edinburgh: ELBS. 1992;410-2.

Trajman A, Pai M, Dheda K, vanZylSmit R, Zwerling AA, Joshi R, et al. Novel tests for diagnosing tuberculous pleural effusion: what works and what does not? Eur Respir J. 2008;31:1098-106.

Barnes PF, Mistry SD, Cooper CL, Pirmez C, Rea TH, Modlin RL. Compartmentalization of a CD4+ T lymphocyte subpopulation in tuberculous pleuritis. J Immunol. 1989;142:1114-9.

Kim HJ, Lee HJ, Kwon SY, Yoon HI, Chung HS, Lee CT, et al. The prevalence of pulmonary parenchymal tuberculosis in patients with tuberculous pleuritis. Chest. 2006;129:1253-8.

Haque SS. Evaluation of Adenosine Deaminase (ADA) in Tuberculous Pleurisy American Journal of Medicine and Medical Sciences. 2012:2(1):1-4.

Lingam J, Kandi S. Evaluation of pleural fluid interferon gamma as a diagnostic marker of tuberculous pleural effusion. J NTR Univ Health Sci. 2013;2:92-5.

Krenke R, Safianowska A, Paplinska M, Nasilowski J, Dmowska-Sobstyl B, Bogacka-Zatorska E, et al. Pleural fluid adenosine deaminase and interferon gamma as diagnostic tools in tuberculosis pleurisy. J Physiol Pharmacol. 2008.59(Suppl 6):349-60.

Sharma SK, Mohan A. Eptuberculosis. Indian J Med Res. 2004;120:316-53.

Villegas MV, Labrada LA, Saravia NG. Evaluation of polymerase chain reaction, adenosine deaminase, and interferon-gamma in pleural fluid for the differential diagnosis of pleural tuberculosis. Chest. 2000;118:1355-64.

Burgess LJ, Maritz FJ, Le Roux I, Taljaard JJ. Combined use of pleural adenosine deaminase with lymphocyte/neutrophil ratio. Increased specificity for the diagnosis of tuberculous pleuritis. Chest. 1996;109(2):414-9.

Ribera E, Ocaña I, Martinez-Vazquez JM, Rossell M, Español T, Ruibal A. High level of interferon gamma in tuberculous pleural effusion. Chest. 1988;93:308-11.

Wongtim S, Silachamroon U, Ruxrungtham K, Udompanich V, Limthongkul S, Charoenlap P, et al. Interferon gamma for diagnosing tuberculous pleural effusions. Thorax. 1999;54:921-4.

Krenke R, Safianowska A, Paplinska M, Korczynski P, Dmowska-Sobstyl B, Bogacka-Zatorska E, et al. Pleural fluid interferon-gamma measurement as a diagnostic tool in tuberculous pleurisy. Pneumonol Alergol Pol. 2008;76(4):237-45.