Ascitic fluid gamma interferon concentrations and adenosine deaminase activity in tuberculous peritonitis.

Abstract

The y interferon (,y-IFN) concentration and the adenosine deaminase (ADA) activity were evaluated in 30 patients with tuberculous peritonitis, 21 patients with ascites due to a malignant disorder, and 41 patients with cirrhosis. The y-IFN concentrations were significantly higher (p<0.0001) in tuberculous peritonitis patients (mean: 6-70 U/ml) than in the malignant (mean: 3.10 U/ml) and cirrhotic (mean: 3.08 U/ml) groups. Use of a cut off value of ¢3.2 U/mli gave the assay a sensitivity of93% (25 of 27), a specificity of 98% (54 of 55), positive (P+) and negative (P-) (Gut 1995; 36: 419-421)

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

“…In the present work, AFB smears were positive for only 3 of 14 (21.4 %) patients with a final clinical diagnosis of TB peritonitis, thus underpinning the insufficiency of this diagnostic technique. Further, Sathar et al (1995) found that ZN-stained AFB smears yielded negative results in all patients in their study. In contrast, Portillo-Gó mez et al (2000) found that ZN-stained AFB smears were positive for six of seven (85.7 %) patients tested.…”

“…The development of techniques that are rapid and less invasive and that have high sensitivities, specificities, PPVs and NPVs would aid in the diagnosis of TB peritonitis and the swift initiation of treatment (Shawar et al, 1993;Sathar et al, 1995).…”

A prospective audit of the use of diagnostic laparoscopy to establish the diagnosis of abdominal tuberculosis

“…36 Gamma (γ) interferon, secreted by antigen-triggered CD4+ lymphocytes, is a key lymphokine that activates macrophages, increasing their bactericidal activity against Mycobacterium tuberculosis. 34 Although the sensitivity and specificity of ascitic fluid ADA and γ-interferon activity are high in tuberculous peritonitis, their activities have been reported to be significantly lower in patients with low ascitic fluid protein concentration and in patients with AIDS, explained by a low lymphocyte activity due to the CD4+ lymphocyte depletion in HIV infection. 13,34 Serum CA-125 level may be raised in tuberculous peritonitis, but the test is not specific because other conditions can give rise to the level e.g.…”

“…34 Although the sensitivity and specificity of ascitic fluid ADA and γ-interferon activity are high in tuberculous peritonitis, their activities have been reported to be significantly lower in patients with low ascitic fluid protein concentration and in patients with AIDS, explained by a low lymphocyte activity due to the CD4+ lymphocyte depletion in HIV infection. 13,34 Serum CA-125 level may be raised in tuberculous peritonitis, but the test is not specific because other conditions can give rise to the level e.g. carcinoma of the ovaries, though the decreasing CA-125 level is useful to evaluate the efficacy of therapy in TB peritonitis.…”

“…24 The frequency of a positive culture for mycobacterium from small volumes of ascitic fluid has been less than 20% and it takes considerable time before results are available, although the positive rate can be improved by obtaining one litre of ascitic fluid concentrated by centrifugation. 34 The role of ascitic fluid adenosine deaminase activity (ADA) has been studied to differentiate tuberculosis from other causes of ascites. ADA is an enzyme widely distributed in tissues and body fluids and the most important biologic activity is related to lymphoid tissues, because ADA is necessary for proliferation and differentiation of T-Lymphocytes.…”