Chest
Clinical InvestigationsAdenosine Deaminase in the Diagnosis of Tuberculous Pleural Effusions: A Report of 218 Patients and Review of the Literature
Section snippets
PATIENTS AND METHODS
Two hundred and eighteen patients with the diagnosis of exudative pleural effusion (protein content greater than 30 g/L) were admitted to our Institute in a period of four years. There were 154 men and 64 women with a total mean age of 52 years (SD, 22.6). All patients were subjected to a pleural fluid aspirated and pleural biopsies, with the exception of those having parapneumonic effusions who had a diagnosis based on a history consistent with pneumonia and appropriate response to a course of
RESULTS
Two or more ADA measurements were performed for each sample with a difference of less than 5 percent between them. The ADA levels obtained in the different studied groups are shown in Figure 1. The ADA mean for the total population was 67.5 IU/L (SD 56). Tuberculous effusions presented a mean of 123.25 IU/L (SD 39.4), whereas nontuberculous fluids showed a mean of 30.36 IU/L (SD 26.4) (p<0.0001; Student's t test). Using 70 IU/L as a cut-off value, the ADA test exhibited a sensitivity of 98
DISCUSSION
Pleural effusions are common in clinical practice and they often constitute difficult diagnostic problems.
In spite of careful evaulation, the etiology of the effusions cannot be established in about 20 percent of patients.1,17,18 Pleural fluid cultures to detect the presence of Mycobacterium tuberculosis are positive in only 20 to 30 percent of patients with tuberculous pleurisy,17 and biopsy of the parietal pleura shows typical epithelioid granulomas in 50 to 80 percent of patients with this
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Adenosine deaminase is a useful biomarker to diagnose pleural tuberculosis in low to medium prevalence settings
2016, Diagnostic Microbiology and Infectious DiseaseCitation Excerpt :It is likely that this scenario could avoid unnecessary costs. ADA activity is known to be also increased in empyema (Banales et al., 1991; Chen et al., 2004; Porcel et al., 2010; Valdes et al., 1996; Zaric et al., 2008). Patients with empyema had clear distinct clinical features with presence of frank pus in the pleural cavity, and may be easily distinguished from pTB, so ADA test should not be used in this situation.
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This study was supported in part by the Canadian International Development Agency.