Evaluation of Adenosine Deaminase Activity for the Diagnosis of Pleural TB in Lymphocytic Pleural Effusions

Silva, Cyro Teixeira da; Behrsin, Rodolfo Fred; Cardoso, Gilberto Perez; Araújo, Elizabeth Giestal de

doi:10.2217/bmm.12.89

Cited by 5 publications

(8 citation statements)

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“…ADA is a major T-lymphocyte enzyme that catalyzes the conversion of adenosine and deoxyadenosine to inosine and deoxyinosine [6]. Many studies have described ADA level as sensitive and specific biomarker for diagnosing TPE [7, 8]. However, high pleural effusions ADA level are also associated with the other etiologies, such as empyemas and parapneumonia [9].…”

Section: Introductionmentioning

confidence: 99%

Pleural IFN-γ release assay combined with biomarkers distinguished effectively tuberculosis from malignant pleural effusion

et al. 2019

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BackgroundTuberculosis (TB) remains a major public health concern on a global scale, especially in developing nations. So far, no formal guidelines are available for the diagnosis and treatment of tuberculosis pleurisy. The diagnosis of TB is worsened by the immense difficulty in differential determination of tuberculosis pleural effusion (TPE) and malignant pleural effusion (MPE). The purpose of this investigation is to assess the differential diagnostic efficiencies of the pleural IFN-γ release assay (IGRA) and widely-used biochemical parameters in the distinction analysis of TPE and MPE.MethodsA cohort of 222 patients with pleural effusion was examined, comprising of 143 TPE and 58 MPE patients. The patients were examined with IGRA, and the widely-used biomarkers in the pleural effusion and peripheral blood.ResultsOur results show that the TPE patients have significantly higher M. tuberculosis (Mtb) antigen-specific IFN-γ responses to ESAT-6 protein and peptide pool in the blood compared to MPE patients. TPE patients were also shown to have enriched Mtb antigen-specific IFN-γ responses in pleural effusion than in peripheral blood. Among the widely-used biomarkers, the adenosine deaminase (ADA) and carcinoembryonic antigen (CEA) in pleural effusion were better biomarkers with high sensitivity and specificity to discriminate TPE and MPE. In addition, pleural IGRA could not be affected by the pleural adhesion, and the applications of the pleural IGRA together with ADA and CEA provide a promising approach for the TPE and MPE differential identification.ConclusionsOur study proposes that the integration of pleural IGRA and ADA, CEA detection could add to more effective diagnosis stratagems in the discernment between TPE and MPE.

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Section: Introductionmentioning

confidence: 99%

Pleural IFN-γ release assay combined with biomarkers distinguished effectively tuberculosis from malignant pleural effusion

et al. 2019

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“…Dozens of biochemical markers in the pleural fluid are currently being investigated and/or are utilized in the clinic, such as carcinoembryonic antigen (CEA), adenosine deaminase (ADA), interferon-γ (IFN-γ), C-reactive protein (CRP), and lactate dehydrogenase (LDH) for identifying the nature of pleural effusions 2 9 11 13 14 15 16 17 18 19 20 21 22 . For pleural fluid ADA levels >40 U/mL, the sensitivity and specificity for the diagnosis of tuberculous pleurisy were 80.3–100% and 60–100%, respectively 17 . In the study by Porcel and colleagues, of 2104 cases with pleural effusion, the sensitivity and specificity of ADA levels >35 U/mL for the diagnosis of TPE were 93% and 90%, respectively 23 .…”

Section: Discussionmentioning

confidence: 99%

Potential diagnostic value of serum/pleural fluid IL-31 levels for tuberculous pleural effusion

Gao

et al. 2016

Sci Rep

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The aim of this study was to explore the diagnostic value of IL-31 levels in the pleural fluid and plasma to differentially diagnose tuberculous and malignant pleural effusion. We enrolled 91 cases, including tuberculous pleural effusion (TPE, n = 50), malignant pleural effusion (MPE, n = 41), other cases including pneumonia with pleural fluid, pulmonary tuberculosis and healthy people as controls. Whole blood was stimulated with the M. tuberculosis–specific antigens and plasma was collected. The multiplex bead-based cytokine immunoassay was employed to measure the levels of various cytokines. IL-31 was found to be the most prominent cytokine (P < 0.0001), and with an optimal cut-off value of 67.5 pg/mL, the sensitivity and specificity for the diagnosis of TPE were 86% and 100%, respectively. Furthermore, the tuberculosis-specific IL-31 levels in the plasma of TPE patients were higher than that of MPE patients (P = 0.0002). At an optimal cut-off value of 23.9 pg/mL, the sensitivity and specificity for the diagnosis of TPE were 92.9% and 85.7%, respectively. Ultimately, the combination of pleural fluid with the plasma tuberculosis-specific IL-31 levels improved the sensitivity and specificity to 94.0% and 95.1%, respectively. Thus, we identified a novel biomarker for the diagnosis of TPE for clinical application.

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“…However, a negative result cannot exclude a diagnosis. Currently, it is desirable to refer a patient with PES without a causal diagnosis for video-assisted thoracoscopic surgery (VATS) after one or two inconclusive thoracentesis attempts with laboratory analysis of pleural fluid [7]. Total adenosine deaminase enzyme (ADA, E.C.…”

Section: Introductionmentioning

confidence: 99%

“…3.5.4.4) is an accurate biomarker for TB in pleural fluids obtained by thoracentesis. The test does not depend on a human immunodeficiency virus (HIV)-positive serostatus of the patient and tissue from CNPB [7,8]. In recent years in Brazil, 29% of the total notified cases and relapses of pulmonary TB involved female patients [6].…”

Section: Introductionmentioning

confidence: 99%

The Impact Profile and Adenosine Deaminase of Age and Female Sex on Its Level in Patients with Pleural Effusion Syndrome

Islam

2024

Glob Acad J Med Sci

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Background: Pleural fluid analysis and closed pleural biopsy are integral parts in the investigative work up of an exudative pleural effusion. For diagnosis of tuberculous pleural effusion (TPE), the yield of pleural fluid culture for mycobacteria is low at about 36%. Objective: To evaluate the levels of adenosine deaminase (ADA) in the pleural fluids (P-ADA) of untreated and non-surgically manipulated female and male adult patients with several confirmed causes of PES. Methods: This was an observational study conducted at dept. of Internal Medicine, 250 Bedded Mohammad Ali Hospital, Bogura, Bangladesh from January to June 2023. 100 pleural fluid samples from 100 patients with proven causes of PES. The sample size was appropriate according to the study design. Written consent was obtained from all patients. It was precise enough to calculate descriptive and inferential statistics on type I and II errors, effect size, standard deviation, and was not influenced by administrative issues and costs. Results: 100 patients summarize the prevalence of the causes of PES and the demographic characteristics. TB was the most prevalent cause of PES (28/100, 28%). Most prevalent male sex was in the lymphoma group (4/0, 100%). None of the five patients with lymphoma were female. When the frequencies were compared for males and females, only adenocarcinoma and lymphoma were significant (chi- square tests, p=0.0021 and p=0.0003, respectively). The causes, prevalence, and median P-ADA (n/%/U/L) were tuberculosis (28/28.0/42.0), adenocarcinoma (24/24.0/9.75), transudate (21/21.0/6.85), simple parapneumonic pleural effusions (PPE; 10/10.0/9.38), complicated PPE/empyema (5/5.0/32.9), lymphoma (4/4.0/401.2), squamous cell carcinoma (4/4.0/13.11), and others (4/4/15.2). For P-ADA, Dunn's post hoc test revealed significance for tuberculosis vs. transudates, vs. simple PPE, and vs. adenocarcinoma (all P<0.05), and not significant for CPPE/empyema, lymphoma, SCC, and others (all P>0.05). For age, Dunn’s post hoc test revealed significance for tuberculosis vs. transudates, vs. simple PPE, and vs. adenocarcinomas (all P<0.05). Sex was not significant in the overall PES group (Chi=0.062, P=0.8028). Kendall's correlation of the relationship between P-ADA and age for pleural tuberculosis (n=26) was significant after 1000 iterations with bootstrap for 95% CI (Tau=-0.213, 95% CI - 0.449-0.0833, P=0.0490). A negative LOESS regression was evident between P-ADA and age >40 years. Conclusions: Evaluation of pleural ADA levels is useful for diagnosing pleural tuberculosis, while sex is not. A negative and significant relationship between P- ADA level and age >40 years was evident.

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Evaluation of Adenosine Deaminase Activity for the Diagnosis of Pleural TB in Lymphocytic Pleural Effusions

Abstract: P-ADA activity is recommended for the diagnosis of TB in lymphocytic pleural effusions.

Cited by 5 publications

References 17 publications

Pleural IFN-γ release assay combined with biomarkers distinguished effectively tuberculosis from malignant pleural effusion

Pleural IFN-γ release assay combined with biomarkers distinguished effectively tuberculosis from malignant pleural effusion

Potential diagnostic value of serum/pleural fluid IL-31 levels for tuberculous pleural effusion

The Impact Profile and Adenosine Deaminase of Age and Female Sex on Its Level in Patients with Pleural Effusion Syndrome

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