The relation of the pleural thickening in tuberculosis pleurisy with the activity of adenosine deaminase

Abstract

Selvi, A. Kant, S. Arslan, M. Ozgel. Background: Residual pleural thickening (RPT) still occurs in most patients with tuberculosis pleurisy despite advances in the treatment of tuberculosis. The aim of this study was to evaluate the significance of RPT in tuberculosis pleurisy with the patients clinical findings, biochemical and microbiological properties of pleural effusion and with the total adenosine deaminase (ADA) and isoenzymes levels. Methods: 121 tuberculosis pleurisy patients were evaluated retrospectively. According to posteroanterior chest x-rays, the 63 (52%) cases with the thickness 2 mm or more in lower lateral hemithorax were grouped as I and the 58 (48%) cases without pleural thickness were grouped as II. The amount of pleural effusion was classified into small, medium or massive according to their chest x-rays. In both groups; sex, age, symptoms score, bacteriological and biochemical tests and ADA levels were recorded. Results: 81 (67%) male and 40 (33%) female, overall 121 patients were enrolled into the study. RPT was found higher in males (p=0.014) and the increase ran parallel with the amount of cigarette smoking (p=0.014). RPT was found to be lower in small effusions (p=0.001). The group with RPT, the serum albumin was found lower (p=0.002), pleural fluid total protein (p=0.047) and the ratio of pleural fluid protein to serum protein (p=0.002) were found higher. In group I, total ADA: 69.5±38.9 IU/L and ADA2: 41.3±31.6 IU/L were higher than the cases without RPT (p=0.032, p=0.017, respectively). Conclusions: We suggest that the immunological mechanisms are effective in the development of pleural thickening.

Factors Influencing Residual Pleural Opacity in Tuberculous Pleural Effusion

“…The prevalence of RPO in the present study was higher compared with previous studies (2-4, 7, 17, 18). We cannot explain this appropriately although there was a possibility that it originated from selection bias.…”

“…Loculation on CT also implies the chronicity of the pleural effusion. Furthermore, longer symptom duration was a marginal but significant predictor on the formation of TPE, which supports the results of the study by Barbas et al (3, 17). …”

Expression of fibroblast specific protein-1 in pleural tuberculosis and its clinical biological significance

“…In recent years, the mechanism of pleural thickening and adhesion has been controversial. Some researchers present that the pleural thickening degree is associated with elevated protein and adenosine deaminase (ADA) in pleural effusion [7]. While some researchers oppose this view, and instead present that the decrease of PH and glucose in the thoracic liquid is associated with pleural thickening [8].…”

Improved diagnosis of tuberculous pleural effusion by combining medical thoracoscopy with Interferon-Gamma Release Assay and adenosine deaminase activity

“…In addition, its diagnostic utility varies considerably across different geographical regions, clinical settings and test result thresholds (Salmanzadeh et al, 2015). Even though the most widely accepted threshold ADA value is 35-40 U/L, some studies suggested lower cutoffs should be considered in elderly population since ADA decreases with age (Uskul et al, 2005).…”