Determination and Validation of a Lower Cut Off Value of Cerebrospinal Fluid Adenosine Deaminase (CSF-ADA) Activity in Diagnosis of Tuberculous Meningitis

Raviraj,; Henry, Renoy A; Rao, G Ganapathi

doi:10.7860/jcdr/2017/25823.9625

Cited by 8 publications

(5 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These studies were published between 1986 and 2022, and performed in South Africa, Spain, Finland, Malaysia, India, South Korea, Thailand, Nepal, Iran, Turkey, China, Peru, Pakistan, and Vietnam. Twenty studies included patients of all age groups [15, 16, 18, 20, 31, 35, 37–39, 41, 46, 47, 49, 51, 53, 54, 56, 59, 60, 63], 18 studies included adults [17, 19, 21–24, 32–34, 42–44, 48, 50, 55, 57, 58, 61], and 5 studies included children with TBM [36, 40, 45, 52, 62]. In all included studies, bacteriology and clinical diagnosis were used as the reference standard for the confirmation of TBM.…”

Section: Resultsmentioning

confidence: 99%

“…Of the remaining 64 studies, 21 were excluded after reading the full texts for the reasons listed in Figure 1. Finally, 43 studies [15–24, 31–63] were available for the meta‐analysis.…”

Section: Resultsmentioning

confidence: 99%

“…In most of the included studies, ADA of the CSF was measured using the methods of Giusti et al [19, 20, 31–38, 40–43, 45, 46, 48, 51–53, 55, 58, 60, 63], although other methods, such as spectrophotometric, commercial kit, modified Berthlot, colorimetry, Trinder enzyme‐coupled method, and the enzyme‐linked immunosorbent assay, and so forth were also applied. The ADSA cutoff was <10 U/L in 18 studies [15–17, 21, 22, 31, 32, 35, 36, 39, 43, 44, 51, 53, 54, 57, 60, 63], =10 U/L in 18 studies [18–20, 23, 24, 34, 38, 40, 45–49, 52, 55, 56, 58, 59], and >10 U/L in 7 studies [33, 37, 41, 42, 50, 61, 62]. Details of the quality evaluation of the included studies via the QUADAS‐2 criteria are shown in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Details of the quality evaluation of the included studies via the QUADAS‐2 criteria are shown in Table 2. For 34 of the included studies, the risk of bias for patient selection was deemed to be unclear since the patients were not consecutively or randomly selected [17–20, 23, 24, 31–46, 49–51, 53, 56–61, 63]. For the other domains, all included studies were judged as having a low risk of bias.…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, the influence of different cutoffs of ADA in CSF on its diagnostic efficacy of TBM remains to be determined. Due to the extensive number of studies published after the previous meta‐analyses [15–24], we conducted an updated meta‐analysis to comprehensively summarise the diagnostic performance of ADA in CSF for TBM. The influences of patient age and cutoffs of ADA on the diagnostic performance were also explored.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Adenosine deaminase from the cerebrospinal fluid for the diagnosis of tuberculous meningitis: A meta‐analysis

Wang

2023

Tropical Med Int Health

View full text Add to dashboard Cite

Objective: To comprehensively evaluate the diagnostic efficacy of adenosine deaminase in cerebrospinal fluid (CSF) for tuberculous meningitis (TBM), and the potential influence of patients' age groups and cutoffs of measured adenosine deaminase. Methods: Systematic review and meta-analysis of relevant studies retrieved from PubMed, Embase, and Web of Science databases. Pooled sensitivity and specificity were calculated with a random-effect model. Results: Overall, 43 studies with 1653 patients with TBM and 3417 controls without were included. Pooled results showed that adenosine deaminase in CSF is associated with satisfactory diagnostic efficacy for TBM, with a pooled sensitivity of 0.86 (95% confidence interval [CI]: 0.82-0.90), specificity of 0.89 (95% CI: 0.86-0.91), positive likelihood ratio of 7.70 (95% CI: 6.16-9.63), and negative likelihood ratio of 0.15 (95% CI: 0.12-0.20). The pooled receiver operating characteristic (AUC) was 0.94 (95% CI: 0.91-0.96), suggesting good performance. Subgroup analyses showed good diagnostic efficacies of adenosine deaminase in CSF for both adults (AUC 0.95) and children (AUC 0.96) with TBM. AUCs indicating the diagnostic accuracies of adenosine deaminase in CSF for TBM were 0.93 for studies with cutoffs <10 U/L and and 0.94 for a cutoff =10 U/L, but only 0.90 for studies with cutoffs >10 U/L. Conclusions: Measuring adenosine deaminase of CSF shows satisfactory diagnostic efficacy for TBM in children and adults, particularly if using a cutoff ≤10 U/L.

show abstract

Section: Resultsmentioning

confidence: 99%

“…Of the remaining 64 studies, 21 were excluded after reading the full texts for the reasons listed in Figure 1. Finally, 43 studies [15–24, 31–63] were available for the meta‐analysis.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Adenosine deaminase from the cerebrospinal fluid for the diagnosis of tuberculous meningitis: A meta‐analysis

Wang

2023

Tropical Med Int Health

View full text Add to dashboard Cite

show abstract

Miliary Tuberculosis Presenting With Meningitis in a Patient Treated With Mycophenolate for Lupus Nephritis: Challenges in Diagnosis and Review of the Literature

Macauley

Rapp

Park

et al. 2018

Journal of Investigative Medicine High Impact Case Reports

View full text Add to dashboard Cite

Tuberculosis is one of the top 10 causes of death worldwide according to the World Health Organization. Central nervous system involvement is usually the least common presentation of tuberculosis occurring in about 1% of all cases but yet can have very devastating outcomes. Lupus nephritis is one of the most common complications of systemic lupus erythematosus with up to two thirds of patients presenting with some degree of renal dysfunction. The mainstay of treatment is glucocorticoids; however, to sustain remission, steroid sparing agents such as cyclophosphamide, azathioprine and mycophenolate mofetil are used. Such patients, in addition to their baseline dysfunctional immune system, have a heightened risk of infections due to these drugs. In this article, we present a young woman who had recently been started on mycophenolate mofetil for control of class V lupus nephritis who presented with headaches, sinus pressure, and fevers. She had a protracted course of hospitalization as she failed to improve clinically and to respond to conventional therapy for acute bacterial sinusitis and meningitis. She was empirically started on antitubercular therapy 9 days after hospitalization. The diagnosis was not confirmed until day 18, the day results of cerebrospinal fluid acid-fast bacillus culture was reported. This case is reported to highlight the challenges in diagnosing Mycobacterium tuberculosis infection in an immunocompromised state and to demonstrate that its presentation can mimic numerous other conditions. Clinicians must maintain a high index of suspicion of Mycobacterium tuberculosis infection in such patients who present with nonspecific or unexplainable symptoms.

show abstract

Varicella-zoster virus meningitis after spinal anesthesia: A case report

Lee¹,

Yoo²,

Lim³

2022

WJCC

View full text Add to dashboard Cite

BACKGROUND Headache is a common complication of regional anesthesia. The treatment of post spinal anesthesia headache varies depending on the cause. Although meningitis is rare, it can cause significant harm to the patient. Post dural puncture headache and septic meningitis are the most commonly suspected causes of post spinal anesthesia headache; however, other causes should also be considered. CASE SUMMARY A 69-year-old woman was scheduled for varicose vein stripping surgery under spinal anesthesia. The procedure was performed aseptically, and surgery was completed without any complications. After 4 d, the patient visited the emergency room with complaints of headache, nausea, and anorexia. Clinical examination revealed that the patient was afebrile. Considering the history of spinal anesthesia, post dural puncture headache and septic meningitis was initially suspected, and the patient was treated with empirical antibiotics. Subsequently, varicella-zoster virus PCR test result was positive, and all other test results were negative. The patient was diagnosed with meningitis caused by varicella-zoster virus and was treated with acyclovir for 5 d. The headache improved, and the patient was discharged without any problems. CONCLUSION Viral meningitis due to virus reactivation may cause headache after regional anesthesia. Therefore, clinicians should consider multiple etiologies of headache.

show abstract

Determination and Validation of a Lower Cut Off Value of Cerebrospinal Fluid Adenosine Deaminase (CSF-ADA) Activity in Diagnosis of Tuberculous Meningitis

Abstract: This study has demonstrated that CSF-ADA can be used as an important diagnostic tool in early diagnosis of TBM using a cut off value of 6.65. This cut off value gave a good sensitivity and specificity in differentiating it from non-TBM.

Cited by 8 publications

References 7 publications

Adenosine deaminase from the cerebrospinal fluid for the diagnosis of tuberculous meningitis: A meta‐analysis

Adenosine deaminase from the cerebrospinal fluid for the diagnosis of tuberculous meningitis: A meta‐analysis

Miliary Tuberculosis Presenting With Meningitis in a Patient Treated With Mycophenolate for Lupus Nephritis: Challenges in Diagnosis and Review of the Literature

Varicella-zoster virus meningitis after spinal anesthesia: A case report

Contact Info

Product

Resources

About