Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions

Abstract

Adenosine deaminase (ADA) can aid in the diagnosis of tuberculous pleural effusions, but false-positive findings from lymphocytic effusions have been reported. The purpose of this study is to assess the ADA levels in nontuberculous lymphocytic pleural effusions (lymphocyte count w50%) of different aetiologies.Altogether, 410 nontuberculous lymphocytic pleural fluid samples were consecutively selected. These included malignant effusions (n=221), idiopathic effusions (n=76), parapneumonic effusions (n=35), postcoronary artery bypass graft surgery effusions (n=6), miscellaneous exudative effusions (n=21) and transudative effusions (n=51).The ADA level reached the diagnostic cut-off for tuberculosis (40 U?L -1 ) in seven of the 410 cases (1.71%). The negative predictive value of ADA for the diagnosis of pleural tuberculosis was 99% (403 of 407 cases) in the group of lymphocytic pleural effusions. In five of these seven patients ADA 1 and ADA 2 were measured, and in all these cases (100%) ADA 1 /ADA p correctly classified these lymphocytic effusions as nontuberculous (ratio v0.42).This prospective study provides additional evidence that adenosine deaminase levels in nontuberculous lymphocytic pleural effusions seldom exceed the cut-off set for tuberculous effusions. The pleural fluid adenosine deaminase levels were significantly higher in different types of exudative effusions than in transudates. An adenosine deaminase level v40 IU?L -1 virtually excluded a diagnosis of tuberculosis in lymphocytic pleural effusions. Adenosine deaminase 1 /adenosine deaminase p correctly classified all nontuberculous lymphocytic pleural effusions with high adenosine deaminase levels. Eur Respir J 2003; 21: 220-224.

A Case of Pleural Paragonimiasis Confused with Tuberculous Pleurisy

“…The measurement of adenosine deaminase (ADA) levels can facilitate the diagnosis of tuberculous effusions, but false-positive findings from lymphocytic effusions have been reported5,6,7. Here, we report clinical, radiologic, and laboratory features of a case that mimicked tuberculous pleurisy, but was ultimately diagnosed as pleural paragonimiasis after surgical biopsy.…”

C-Reactive Protein in Lymphocytic Pleural Effusions: A Diagnostic Aid in Tuberculous Pleuritis

“…Several biochemical parameters are of interest in diagnosing tuberculous pleural effusion, especially adenosine deaminase (ADA) [3,4,5]. Since almost all patients with tuberculosis pleural fluid have more than 50% lymphocytes in the pleural white blood cell count [2,6,7,8], the use of ADA has been evaluated in the subgroup of patients with lymphocytic pleural effusions, showing higher diagnostic value [9,10,11,12]. …”

Superior vena caval syndrome and ipsilateral pleural effusion: A rare presentation of anterior mediastinal thymoma

“…Lymphocyte predominant, exudative pleural effusion with high ADA value (>60 IU/L) is seen in tuberculosis, complicated para-pneumonic effusion, empyema thoracis, rheumatoid arthritis, chronic lymphatic leukemia, mesothelioma and lymphoma. [910] After extensive search of the literature, we found that very few cases of malignant pleural deposits in thymomas are reported,[1112] the pleural fluid was exudative and lymphocytic in all these cases, but they have remained silent regarding pleural ADA values. This may be due to the fact that unlike in a tuberculosis-prevalent country like India where ADA value is routinely advised in the evaluation of exudative pleural effusion to confirm or exclude tuberculosis, this may not be the routine practice in the developed countries.…”