The diagnostic and prognostic value of adenosine deaminase in tuberculous pericarditis

Abstract

Because of the difficulty in isolating the causative organism, pericardial tuberculosis is rarely diagnosed. Adenosine deaminase activity measured in the pericardial fluid of 108 patients was initially of undetermined origin. Subsequently, we classified five sources: (1) tuberculosis (20 cases); (2) idiopathy (82 cases); (3) neoplasia (three cases); (4) purulent bacterial infection (two cases); and (5) radiotherapy (one case). The highest mean adenosine deaminase value (126 +/- 16.68 U.l(-1) was found in group 1; other values were 29.4 +/- 8.9, 27 +/- 7.21, 29.5 +/- 13.4, 26 U.l(-1) in the idiopathy, neoplasia, purulent bacterial infection and radiotherapy groups, respectively. there was a statistically significant difference between group 1 and the other groups (P less than 0.001), indicating that the adenosine deaminase value has 100% sensitivity and 91% specificity. In addition, there was a positive correlation between high adenosine deaminase values and the development of constrictive pericarditis. In this study, two patients required pericardectomy. Therefore, the adenosine deaminase value is a significant prognostic indicator for the development of constrictive pericarditis in tuberculous pericarditis.

Dosagem sérica de adenosina deaminase em lúpus eritematoso sistêmico: ausência de associação com atividade de doença

“…Os estudos publicados sobre ADA e pericardite relacionam-se principalmente ao valor da ADA para predizer a etiologia tuberculosa do derrame pericárdico e os resultados são controversos: um estudo envolvendo 108 pacientes com pericardite de etiologias diversas, dos quais 20 eram secundários a TB, a ADA do líquido pericárdico foi capaz de discriminar o derrame de etiologia tuberculosa dos demais com sensibilidade de 100% e especificidade de 91%. Foi ainda observado valor prognóstico da ADA em predizer evolução para tamponamento (10) . Ao contrário, em outro estudo (11) , envolvendo 40 pacientes com derrame pericárdico, encontrou-se alta sensibilidade (97%) na dosagem de ADA no líquido pericárdico para excluir o diagnóstico etiológico de TB, mas não para confirmá-lo.…”

The usefulness of adenosine deaminase in the diagnosis of tuberculous pericarditis

“…This suggests that a high ADA activity is indirectly related to the subsets of T cell lymphocytes involved in the inflammatory response 18 .…”

Tuberculous pericarditis: An exceptional STEMI association: Case report

“…Anatomopathology of the pericardial biopsy specimen make certitude diagnosis of TB, but thoracotomy and all its complications with increased morbidity and marked prolongation of the hospital stay may limit the procedure [16]. However the sensitivity diagnostic of pericardial biopsy for TP ranges only from 10% to 64% [17,18]. In other more valuable diagnosis tool, we find the polymerase chain reaction (PCR) for detecting Mycobacterium tuberculosis DNA in pericardial effusion fluid [19].…”