Diagnostic utility of serum and pleural levels of adenosine deaminase 1–2, and interferon-γ in the diagnosis of pleural tuberculosis

Yurt, Sibel; Küçükergin, Canan; Yiğitbaş, Burcu Arpınar; Seçkin, Şule; Tigin, Hüseyin Cem; Koşar, Filiz

doi:10.1186/2049-6958-9-12

Cited by 20 publications

(25 citation statements)

References 20 publications

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“…Importantly, the diagnostic accuracy of ADA is unaffected by the presence of HIV infection . Use of the ADA‐2 isoenzyme assay increases the test's specificity for TB, which may be useful where there is the potential for a false positive result such as in bacterial pleural infection, chronic rheumatoid effusions, mesothelioma, lung cancer and haematological malignancies . One‐third of parapneumonic effusions and two‐thirds of empyemas have ADA levels exceeding 40 IU/L .…”

Section: Diagnosismentioning

confidence: 99%

“…Assays that directly quantify the amount of IFN‐γ in pleural fluid (so‐called ‘unstimulated’ IFN‐γ) have a high sensitivity (89%) and specificity (97%) for tuberculous effusions, and may be superior to ADA . An IFN‐γ concentration above 140 pg/mL has a sensitivity of 94% for TB effusion and a concentration above 240 pg/mL has a sensitivity of 95% . Recently, the combination of high ADA and IFN‐γ was reported to have a specificity and PPV of 100% .…”

Section: Diagnosismentioning

confidence: 99%

“…53 Use of the ADA-2 isoenzyme assay increases the test's specificity for TB, which may be useful where there is the potential for a false positive result such as in bacterial pleural infection, chronic rheumatoid effusions, mesothelioma, lung cancer and haematological malignancies. [54][55][56][57][58] One-third of parapneumonic effusions and two-thirds of empyemas have ADA levels exceeding 40 IU/L. 8 These conditions are usually distinguishable from TB effusions by the neutrophil predominance in the pleural fluid, highlighting the fact that the ADA should not be interpreted in isolation.…”

Section: Tb Effusionmentioning

confidence: 99%

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Tuberculous pleural effusion

2019

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Tuberculous effusion is a common disease entity with a spectrum of presentations from a largely benign effusion, which resolves completely, to a complicated effusion with loculations, pleural thickening and even frank empyema, all of which may have a lasting effect on lung function. The pathogenesis is a combination of true pleural infection and an effusive hypersensitivity reaction, compartmentalized within the pleural space. Diagnostic thoracentesis with thorough pleural fluid analysis including biomarkers such as adenosine deaminase and gamma interferon achieves high accuracy in the correct clinical context. Definitive diagnosis may require invasive procedures to demonstrate histological evidence of caseating granulomas or microbiological evidence of the organism on smear or culture. Drug resistance is an emerging problem that requires vigilance and extra effort to acquire a complete drug sensitivity profile for each tuberculous effusion treated. Nucleic acid amplification tests such as Xpert MTB/RIF can be invaluable in this instance; however, the yield is low in pleural fluid. Treatment consists of standard anti‐tuberculous therapy or a guideline‐based individualized regimen in the case of drug resistance. There is low‐quality evidence that suggests possible benefit from corticosteroids; however, they are not currently recommended due to concomitant increased risk of adverse effects. Small studies report some short‐ and long‐term benefit from interventions such as therapeutic thoracentesis, intrapleural fibrinolytics and surgery but many questions remain to be answered.

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Tb Effusionmentioning

confidence: 99%

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Tuberculous pleural effusion

2019

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“…The presence of unstimulated IFN‐γ in pleural fluid at a concentration of greater than 140 pg/mL has a sensitivity and specificity of 94% and 92% for TB pleural effusion. These values increased to 95% and 96% when the cut‐off value of 240 pg/mL was used . In a meta‐analysis, the sensitivity of the IFN‐γ assay for TB pleural effusion was 89%, and the specificity 97% .…”

Section: Pleural Fluid Characteristicsmentioning

confidence: 99%

Pleural tuberculosis: A concise clinical review

Shaw

Irusen

Diacon

et al. 2018

Clinical Respiratory J

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Tuberculosis (TB) is the leading infectious cause of death worldwide, and the commonest cause of death in people living with HIV. Globally, pleural TB remains one of the most frequent causes of pleural exudates, particularly in TB-endemic areas and in the HIV positive population. Most TB pleural effusions are exudates with high adenosine deaminase (ADA), lymphocyte-rich, straw-coloured and free flowing, with a low yield on mycobacterial culture. TB pleurisy can also present as loculated neutrophil-predominant effusions which mimic parapneumonic effusions. Rarely, they can present as frank TB empyema, containing an abundance of mycobacteria. Up to 80% of patients have parenchymal involvement on chest imaging. The diagnosis is simple if M. tuberculosis is detected in sputum, pleural fluid or biopsy specimens, and the recent advent of liquid medium culture techniques has increased the microbiological yield dramatically. Where the prevalence of TB is high the presence of a lymphocyte-predominant exudate with a high ADA has a positive predictive value of 98%. In low prevalence areas, the absence of an elevated ADA and lymphocyte predominance makes TB very unlikely, and pleural biopsy should be performed to confirm the diagnosis. Pleural biopsy for liquid culture and susceptibility testing must also be considered where the prevalence of drug resistant TB is high. Treatment regimens are identical to those administered for pulmonary TB. Initial pleural drainage may have a role in symptom relief and in hastening the resolution of the effusion. Surgical intervention may be required in loculated effusions and empyemas.

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“…Its chief role concerns the proliferation and differentiation of lymphocytes and activation of macrophages [11]. Hence it is considered as a good marker for cell immunity [12]. It is also considered to be an important enzyme for modulating the bioactivity of insulin [13] and some studies have reported it to be a predictive marker of insulin resistance [14].…”

Section: Introductionmentioning

confidence: 99%