Adenosine Deaminase in the Diagnosis of Pleural Effusions

Pettersson, Tom; Ojala, Kaarina; Weber, T.

doi:10.1111/j.0954-6820.1984.tb05011.x

Cited by 114 publications

(25 citation statements)

References 17 publications

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“…However, high levels of ADA in pleural TB are due largely to high ADA-2 activity 22,23. The ADA values in the HIV-positive patients did not differ significantly from those in the HIV- negative patients 24. Pleural fluid ADA now forms part of the routine diagnostic workup for tuberculous effusions in many countries where TB is endemic.…”

Section: Discussionmentioning

confidence: 78%

Diagnostic value of pleural fluid interferon-gamma and adenosine deaminase in patients with pleural tuberculosis in Qatar

Khan

M²,

Omran³

et al. 2013

IJGM

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ObjectiveTo investigate the diagnostic utility of interferon-gamma (IFN-γ) and adenosine deaminase (ADA) in tuberculous pleural effusions by determining the best cutoff levels of these two markers for pleural tuberculosis, in the context of the local epidemiological settings in Qatar.MethodsWe prospectively studied IFN-γ and ADA levels in the pleural fluid of patients presenting to Hamad General Hospital between June 1, 2009 and May 31, 2010.ResultsWe studied 103 patients with pleural effusions, 72 (69.9%) with pleural tuberculosis, and 31 (30.1%) with nontuberculous etiologies. The mean IFN-γ concentration for the group with tuberculous effusions was significantly higher than that in the group with nontuberculous effusions (1.98 ± 81 vs 0.26 ± 10 pg/mL [P < 0.0001]). The mean ADA activity for the tuberculous effusions group was significantly higher than that in group with nontuberculous effusions (41.30 ± 20.09 vs 14.93 ± 14.87 U/L [P < 0.0001]). By analysis of receiver operating characteristic (ROC) curves, the best cutoff values for IFN-γ and ADA were 0.5 pg/mL and 16.65 U/L, respectively. The results for IFN-γ vs ADA were: for sensitivity, 100% vs 86%, respectively; for specificity, 100% vs 74%, respectively; for positive predictive value, 100% vs 88.5%, respectively; and for negative predictive value, 100% vs 69.7%, respectively.ConclusionIFN-γ and ADA could be used as valuable parameters for the differentiation of tuberculous from nontuberculous effusion, and IFN-γ was more sensitive and specific for tuberculous effusion than ADA.

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Section: Discussionmentioning

confidence: 78%

Diagnostic value of pleural fluid interferon-gamma and adenosine deaminase in patients with pleural tuberculosis in Qatar

Khan

M²,

Omran³

et al. 2013

IJGM

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“…Bronchoalveolar lavage ADA activity is higher in patients with lungfield accumulation on scintigrams and in those who are under corticosteroid treatment [75]. Even though scientific publications are controversial about its clinical benefits [77], measurement of serum ADA activity might be a useful additional method in sarcoidosis for differential diagnosis, to assess disease activity and follow therapy.…”

Section: Sarcoidosismentioning

confidence: 99%

Adenosine and Adenosine Receptors in the Pathomechanism and Treatment of Respiratory Diseases

Vass¹,

Horváth²

2008

CMC

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It has been known for a long time that inhaled adenosine-monophosphate (AMP) induces airway obstruction in asthmatic patients, but not in healthy subjects. The mechanism of AMP is indirect and occurs via its decay product, adenosine. It stimulates mast cells through its low-affinity receptor A2B to release histamine, which ultimately leads to smooth muscle contraction. This feature of adenosine reveals its pro-inflammatory function, which may play important role in asthma. Indeed, mice lacking adenosine deaminase (ADA), an enzyme which decomposes adenosine, develop asthma-like disorder with elevated IgE, eosinophilia and airway hyperresponsiveness. Human studies showed elevated adenosine levels in bronchoalveolar lavage and exhaled breath condensate of asthmatics as compared to healthy people. Furthermore, certain human ADA phenotypes are associated with prevalence of asthma. These data suggest a protective role for ADA and a pro-inflammatory function for adenosine in asthma. The role of adenosine in inflammatory processes, however, is not unequivocal. Some in vitro studies showed that adenosine binding to its high-affinity receptor A2A results in inhibition of leukotriene synthesis or function of adhesion molecules. It is possible that the concentration of adenosine in lung tissues determines whether it promotes or reduces inflammation. Adenosine has also been associated with other respiratory diseases such as fibrosis, sarcoidosis, cystic fibrosis or tuberculosis. Identification of adenosine receptor subtypes and their role in the pathomechanism of respiratory diseases may provide new therapeutical targets. This review aims to summarize the role of adenosine and adenosine receptors in asthma and other pulmonary disorders.

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“…ADA levels in body fluids can be measured rapidly, and they might provide an alternative for the diagnosis of TB (Giusti, 1974). ADA activity is increased in effusions resulting from infection, several other bacterial infections, rheumatological disease and lymphoproliferative disorders (Pettersson et al, 1984). Nowadays, the use of the automated method of determining ADA activity in pleural and cerebrospinal fluid samples has been validated as an alternative to the conventional modified Giusti method (Feres et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Use of adenosine deaminase measurements and QuantiFERON in the rapid diagnosis of tuberculous peritonitis

Saleh¹,

Hammad

Ramadan

et al. 2012

Journal of Medical Microbiology

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Peritoneal tuberculosis (TB) is a considerable problem in certain developing nations. Current diagnostic tests for peritoneal TB are difficult and time-consuming. This study aimed to determine the effectiveness of an adenosine deaminase (ADA) assay and the QuantiFERON-Gold (QFT-G) assay in the rapid diagnosis of TB peritonitis. Forty-one patients with a presumptive diagnosis of TB peritonitis with ascites were admitted to Mansoura University Hospital and included in the study. Ascitic fluid and blood samples were collected from each patient. Fluid samples were examined biochemically (protein concentration), cytologically (white blood cell count) and microbiologically (Ziehl-Neelsen stain and TB culture in Lö wenstein-Jensen media), and ADA levels were determined using colorimetry. Interferon-c levels in whole-blood samples were measured using the QFT-G assay. Fourteen (34 %) patients received a final clinical diagnosis of TB peritonitis; these patients were subclassified as definite (positive culture for Mycobacterium tuberculosis; eight patients), highly probable (four patients) and probable (two patients) for TB peritonitis. Of the 14 patients with a final clinical diagnosis of TB peritonitis, 3 (21 %) tested positive using an acid-fast bacilli smear, which showed a sensitivity of 21 % and a specificity of 100 %. A receiver operating characteristic curve showed that a cut-off value of 35 IU l "1 for the ADA level produced the best results as a diagnostic test for TB peritonitis, yielding the following parameter values: sensitivity 100 %, specificity 92.6 %, positive predictive value (PPV) 87.5 % and negative predictive value (NPV) 100 %. The QFT-G assay yielded the following values: sensitivity 92.9 %, specificity 100 %, PPV 100 % and NPV 96.4 %. The ADA and QFT-G assays might be used to rapidly diagnose TB peritonitis and initiate prompt treatment while waiting for a final diagnosis using the standard culture approach.

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Adenosine Deaminase in the Diagnosis of Pleural Effusions

Cited by 114 publications

References 17 publications

Diagnostic value of pleural fluid interferon-gamma and adenosine deaminase in patients with pleural tuberculosis in Qatar

Diagnostic value of pleural fluid interferon-gamma and adenosine deaminase in patients with pleural tuberculosis in Qatar

Adenosine and Adenosine Receptors in the Pathomechanism and Treatment of Respiratory Diseases

Use of adenosine deaminase measurements and QuantiFERON in the rapid diagnosis of tuberculous peritonitis

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