Evaluation of adenosine deaminase activity in serum and pleural fluid of pulmonary tuberculosis patients with pleural effusion
DOI:
https://doi.org/10.18203/2320-6012.ijrms20184046Keywords:
Adenosine deaminase, Pulmonary tuberculosis, Pleuritis, Tuberculous pleural effusionAbstract
Background: In endemic regions, a high adenosine deaminase (ADA) activity in lymphocyte predominant exudate is a valuable adjunct in diagnostic evaluation and treatment initiation in tuberculous pleural effusion. Tuberculosis is highly endemic in India, requiring prompt diagnosis, effective treatment and control of the disease. The present study was aimed to evaluate the serum and pleural fluid ADA activities in pulmonary tuberculosis patients with pleural effusion.
Methods: This study includes a total of 240 subjects; 40 pulmonary tuberculosis patients (PTB), 40 PTB with pleural effusion (PE), 40 PTB treated for one month, 40 healthy controls, 40 transudative PE patients and 40 nontuberculous exudative PE patients, between 20-70 years of age. ADA activity was estimated by the Guisti-Galanti method along with routine parameters in all study subjects.
Results: Serum ADA activity was significantly higher (p<0.001) in PTB with PE (37.68±12.42U/L) than healthy controls (12.15±5.38U/L), transudative PE (22.43±9.12U/L), nontuberculous exudative PE (16.92±4.98U/L) and treated PTB (19.39±4.54U/L). Pleural fluid ADA activity was significantly higher (p<0.0001) in PTB with PE (78.94±36.75U/L) than in transudative PE (11.25±3.12U/L) and nontuberculous exudative PE (17.56±10.42U/L). ADA activity was significantly higher (p<0.001) in pleural fluid than serum in PTB with PE. Lymphocyte percentage was significantly higher (p<0.001) in pleural fluid (86.57±9.64) than peripheral blood (37.48±8.49) in PTB with PE.
Conclusions: The pleural fluid ADA activities were elevated in lymphocyte predominant exudates of PTB patients with PE from endemic regions, prompting treatment initiation in high suspicion cases with elevated ADA activity.
References
World Health Organization. Global Tuberculosis Control 2016, Geneva, 2016. Available at: http://apps.who.int/medicinedocs/en/d/Js23098en/. Accessed on 8th July 2016.
World Health Organization. Global Tuberculosis Control 2017, Geneva, 2017. Available at: http://www.who.int/tb/publications/global_report/en/. Accessed on 30 June 2017.
Porcel JM. Tuberculous pleural effusion. Lung. 2009;187(5):263.
Light RW. Pleural diseases. 5th ed. Lippincott Williams & Wilkins; 2007.
Moudgil H, Sridhar G, Leitch AG. Reactivation disease: the commonest form of tuberculous pleural effusion in Edinburgh, 1980-1991. Resp Med. 1994 Apr 1;88(4):301-4.
Allen JC, Apicella MA. Experimental pleural effusion as a manifestation of delayed hypersensitivity to tuberculin PPD. J. Immunol. 1968;101:481-7.
Leibowitz S, Kennedy L, Lessof MH. The tuberculin reaction in the pleural cavity and its suppression by antilymphocyte serum. Br J Exp Pathol. 1973;54:152-62.
Epstein DM, Kline LR, Albelda SM, Miller WT. Tuberculous pleural effusions. Chest. 1987;91(1):106-9.
Sahn SA. State of the art. The pleura. Am Rev Respir Dis. 1988;138(1):184-234.
Valdes L, Alvarez D, San Jose E, Penela P, Valle JM, García-Pazos JM, et al. Tuberculous pleurisy: a study of 254 patients. Arch Internal Med. 1998 Oct 12;158(18):2017-21.
Zhai K, Lu Y, Shi HZ. Tuberculous pleural effusion. J Thorac Dis. 2016;8(7):E486-94.
Ferrer JS, Muñoz XG, Orriols RM, Light RW, Morell FB. Evolution of idiopathic pleural effusion: a prospective, long-term follow-up study. Chest. 1996 Jun 1;109(6):1508-13.
Alison MB, David JP. Tuberculous pleural effusion. Respir Care. 2012 Oct;57(10):1682-84.
Raj B, Chopra RK, Lal HA, Saini AS, Singh VE, Kumar PA, et al. Adenosine deaminase activity in pleural fluids-a diagnostic aid in tuberculous pleural effusion. Indian J Chest Dis Allied Sci. 1985;27(2):76.
Peterson T, Ozala K, and Weber TH. ADA in the diagnosis of pleural effusions-an aid to differential diagnosis. Br Med J. 1978;2:1751-2.
Ocana I, Martinez-Vazquez JM, Segura RM, Fernandez-De-Sevilla T, Capdevila JA. Adenosine deaminase in pleural fluids: test for diagnosis of tuberculous pleural effusion. Chest. 1983 Jul 1;84(1):51-3.
Ida T, Taniai S, Nitta M, Shimase J, Makiguchi K, Miyasato I, et al. Serum adenosine deaminase (ADA) activity in patients with active pulmonary tuberculosis. Tuberculosis. 1990 Jul 15;65(7):477-81.
King J. A routine method for the estimation of lactic dehydrogenase activity. J Med Lab Tech. 1959 Oct;16:265.
Trinder P. Determination of glucose in blood using glucose oxidase with an alternative oxygen acceptor. Ann Clin Biochem. 1969 Jan;6(1):24-7.
Gornall AG, Bardawill CJ, David MM. Determination of serum proteins by means of the biuret reaction. J Biol Chem. 1949 Feb 1;177(2):751-66.
Light RW, Macgregor MI, Luchsinger PC, Ball WC. Pleural effusions: the diagnostic separation of transudates and exudates. Annl Internal Med. 1972 Oct 1;77(4):507-13.
Guisti G, Galanti B. Colorimetric method. In: Bergmeyer HU, editor. Method of Enzymatic analysis. 3rd Ed. Berlin: Germany Verlag Chemie, Weinheim;1984:315-23.
Gopi A, Madhavan SM, Sharma SK, Sahn SA. Diagnosis and treatment of tuberculous pleural effusion in 2006. Chest. 2007 Mar 1;131(3):880-9.
Lin MT, Wang JY, Yu CJ, Lee LN, Yang PC, On behalf of the TAMI Group. Mycobacterium tuberculosis and polymorphonuclear pleural effusion: incidence and clinical pointers. Respir Med. 2009;103(6):820-6.
Rao KS, An H, Rudresh BM, Srinivas T, Bhat KH. Evaluation of Serum adenosine deaminase activity during the course of pulmonary tuberculosis treatment. Biomed Res. 2012;23(1).
Aminiafshar S, Aalimagham M, Keshtkar JM, Gachkar L, Haghighat B, Keshtkar JM, et al. Serum Adenosine deaminase level as an Indicator of Pulmonary Tuberculosis activity versus other infectious diseases. Iran Tanaffos. 2004;3(12):19-23.
Verma M, Narang S, Moonat A and Verma A. Study of Adenosine deaminase activity in pulmonary tuberculosis. Indian J Clin Biochem. 2004;19(1):129-31.
Lakshmi V, Rao RR, Joshi N, Rao PN. Serum Adenosine deaminase activity in Bacillary or Paucibacillary pulmonary tuberculosis. Indian J Pathol Microbiol. 1992;35(1):48-52.
Castro DJ, Nuevo GD, Perez-Rodriguez E, Light RW. Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions. Eur Resp J. 2003 Feb 1;21(2):220-4.
Sonone KK, Varma SG, Sawale VM, Abhichandani LG, Nilaanjana GN, Abhijeet J. Study of adenosine deaminase levels in patients of pulmonary tuberculosis with or without pleural effusion. J Dental Med Sci. 2014 Feb;13(1):30-7.
Devkota KC, Shyam BK, Sherpa K, Ghimire P, Sherpa MT, Shrestha R, et al. Significance of adenosine deaminase in diagnosing tuberculous pleural effusion. Nepal Med Coll J. 2012 Jun;14(2):149-52.
Gupta BK, Bharat V, Bandyopadhyay D. Sensitivity, specificity, negative and positive predictive values of adenosine deaminase in patients of tubercular and non-tubercular serosal effusion in India. J Clin Med Res. 2010 Jun;2(3):121.
Lee YG, Rogers JT, Rodriguez RM, Miller KD, Light RW. Adenosine deaminase levels in nontuberculous lymphocytic pleural effusions. Chest. 2001 Aug 1;120(2):356-61.
Sachin Kate, Mutha BK, Kulkarni G, Mahajan C, Dugad S. Study of diagnostic importance of adenosine deaminase (ADA) level in pleural effusions. MVP J Med Sci. 2015;2(2):104-9.
Sharma SK, Suresh V, Mohan A, Kaur P, Saha P, Kumar A, et al. A prospective study of sensitivity and specificity of adenosine deaminase estimation in the diagnosis of tuberculosis pleural effusion. Indian J Chest Dis Allied Sci. 2001;43(3):149-55.
Piras M, Gakis C, Budroni M, Andreoni G. Adenosine deaminase activity in pleural effusions: an aid to differential diagnosis. Br Med J. 1978 Dec 23;2(6154):1751.
Shibagaki T, Hasegawa Y, Saito H, Yamori S, Shimokata K. Adenosine deaminase isozymes in tuberculous pleural effusion. Translational Res. 1996 Apr 1;127(4):348-52.