Increased Pleural Fluid Adenosine Deaminase in Brucellosis Is Difficult to Differentiate from Tuberculosis

Dikensoy, Öner; Namıduru, Mustafa; Hocaoglu, Sibel; Ikidag, Belgin; Filiz, Ayten

doi:10.1159/000066465

Cited by 27 publications

(29 citation statements)

References 3 publications

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“…ADA levels may also be high in some cases of adenocarcinomas, lymphomas, complicated parapneumonic effusions and, as recently reported, in brucellosis [38]but the value of ADA in the diagnosis of tuberculous effusion remains high especially in areas with high tuberculous prevalence. IFN-γ has also been examined as a potential marker of tuberculous effusion and its sensitivity and specificity are comparable to those of ADA [6, 39]but the cost and slowness in obtaining results have limited its routine use [40].…”

Section: Discussionmentioning

confidence: 99%

Tuberculous Effusion: ADA Activity Correlates with CD4+ Cell Numbers in the Fluid and the Pleura

Gaga

Papamichalis²,

Bakakos

et al. 2005

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Background: Adenosine deaminase (ADA) is a commonly used marker in the diagnosis of tuberculous effusion and there is evidence that its production is linked to T cells and monocytes. Data on the correlation between ADA and T cells or macrophages in tuberculous effusions are conflicting. Furthermore, no studies have examined a possible correlation between pleural tissue infiltration and ADA. Objectives: We undertook this study to examine cell subsets in the fluid and the pleura in tuberculous effusion and their correlation to ADA. The use of cell subsets as a marker in the differential diagnosis was also examined. Methods: Pleural fluid from 36 patients with tuberculous and 34 patients with malignant effusion as well as pleural tissue biopsies from 16 patients with tuberculous pleurisy were examined. The APAAP and the avidin-biotin complex immunocytochemical methods were used to examine CD4+ T cells and macrophages (CD68+), while ADA activity was measured by the Giusti colorimetric method. Results: Our results showed that, in pleural fluid, CD4+ cells and ADA were significantly higher in tuberculous compared to malignant effusion (p < 0.001 for all measurements). In pleural tissue biopsies, macrophages were the predominant cells but CD4+ T cells were also abundant. A significant correlation was found between ADA and CD4+ numbers in pleural fluid and tissue (r = 0.45, p < 0.01; r = 0.75, p < 0.001, respectively). ADA had high sensitivity and specificity for differential diagnosis while cell subsets did not. Conclusions: These results indicate that ADA activity correlates to CD4+ T cell infiltration in the pleura and the fluid. Moreover, ADA but no cell subsets may be used as markers of tuberculous effusion.

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Section: Discussionmentioning

confidence: 99%

Tuberculous Effusion: ADA Activity Correlates with CD4+ Cell Numbers in the Fluid and the Pleura

Gaga

Papamichalis²,

Bakakos

et al. 2005

Respiration

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“…Pure pneumonic infiltration seldom occurs in brucellosis 13 . Brucella could be seen in Gram preparation of sputum or cultivated from sputum culture rarely 19,20 . In our study, it was not isolated from sputums of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…It was isolated from blood cultures of three patients in our study. The pleural fluid, a common feature of pulmonary brucellosis, is characterised as lymphocytic pleocytosis, high protein concentration, increased adenosin deaminase level, and cultivation of B. melitensis 17,19 . It was isolated from pleural effusion in studies conducted in Balkan peninsula 12,20 .…”

Section: Discussionmentioning

confidence: 99%

Pulmonary involvement of Brucellosis: a report of six cases

Şimşek

Yildirmak²,

Gedık³

et al. 2011

Af Hlth Sci

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“…In a study about tuberculous and nontuberculous pleuritis, evaluation of pleural ADA levels correlates with a CD4+ T lymphocyte population which is related to cellular immunity [20]. Other reported infectious diseases with high pleural ADA levels (other than tubercuosis) include legionellosis, brucellosis, coxiellosis and cryptococcosis [15,21,22,23]. These are intracellular microbial agents, and their pathogenicity is related to cellular immunity [24,25,26,27,28].…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal Pleuritis Containing a High Level of Adenosine Deaminase in a Patient with AIDS: A Case Report

Kitazawa¹,

Tatsuno²,

Ota³

et al. 2009

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Cryptococcal infection is the 4th most common opportunistic infection in patients with acquired immune deficiency syndrome (AIDS). Although pleural effusion alone is an unusual presentation, we present a case of cryptococcal pleuritis in an AIDS patient which was initially difficult to discriminate from tuberculous pleuritis because of the high level of pleural adenosine deaminase (ADA). Cryptococcus neoformans was detected in the culture of the pleural effusion after the initiation of antituberculous treatment. High levels of ADA in the pleural fluid can be observed in patients with cryptococcal pleuritis, and longer incubation of pleural fluid should be performed in all patients who present with pleuritis associated with a high ADA level as the only significant finding.

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Increased Pleural Fluid Adenosine Deaminase in Brucellosis Is Difficult to Differentiate from Tuberculosis

Cited by 27 publications

References 3 publications

Tuberculous Effusion: ADA Activity Correlates with CD4+ Cell Numbers in the Fluid and the Pleura

Tuberculous Effusion: ADA Activity Correlates with CD4+ Cell Numbers in the Fluid and the Pleura

Pulmonary involvement of Brucellosis: a report of six cases

Cryptococcal Pleuritis Containing a High Level of Adenosine Deaminase in a Patient with AIDS: A Case Report

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