Tumour necrosis factor, interleukin-1 and adenosine deaminase in tuberculous pleural effusion

Abstract

Tumour necrosis factor (TNF) and interleukin-1 (IL-1) are powerful mediators with a key role in inflammation. This study was undertaken to study the presence of TNF and IL-1 in tuberculous effusion where there is marked inflammation and where examination of the pleural fluid may give information about the local inflammatory reaction. Adenosine deaminase activity (ADA, a marker of TB pleurisy) was also tested. Tumour necrosis factor, IL-1 and ADA levels were measured in the pleural fluid and serum of 97 patients; 33 with tuberculous effusion, 33 with malignant effusion, and 31 patients with benign non-tuberculous effusion. Pleural fluid TNF and ADA levels were higher in tuberculous (TB) patients than in patients with benign disorders or cancer (P < 0.01). Serum TNF levels were also higher in TB patients than other benign (P < 0.01) or malignant (P < 0.05) effusions. There was a positive correlation between serum and pleural fluid values (r = 0.998-0.999, P < 0.001) although pleural fluid concentration was higher (P < 0.001), possibly suggesting local production in the pleural cavity. Pleural fluid IL-1 levels were not raised in any patient group but there was a positive correlation between TNF and IL-1. In addition, a positive correlation was found between TNF and ADA levels, probably indicating some common production mechanism. Furthermore, ADA sensitivity in the diagnosis of tuberculous effusion was augmented by the combined use of TNF and ADA. The use of both these markers may prove useful in the differential diagnosis of TBC pleurisy.

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

“…When considering ADA and cell subsets as an aid to differential diagnosis, ADA showed very high sensitivity and specificity and this finding further confirms data already reported [3, 8, 9, 36, 37]and applied in clinical practice. 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.…”

“…Both types of cells characterize tuberculous reactions and their presence has been shown in the lung parenchyma [11, 12], the tuberculin skin reaction [13]and in pleural fluid [14, 15, 16]. However, similar cell counts are also reported in malignant effusions where no significantly high ADA activity is usually detected [3, 14, 15, 17]. Furthermore, while some studies show a positive correlation between T cells and ADA in tuberculous effusion, other studies fail to demonstrate such a correlation [18, 19, 20].…”

“…Adenosine deaminase (ADA) is a commonly used marker in the diagnosis of tuberculous pleural effusions and its value has been reported in a number of studies [1, 2, 3, 4, 5, 6, 7, 8, 9]. Enzyme activity is found in all cells with the highest activity in lymphocytes and monocytes [10].…”

Evaluation of adenosine deaminase seric activity in the diagnosis of bovine tuberculosis

“…Indeed, clinical signs of enzootic bovine leukosis, confirmed by histopathology, were detected in some animals from Herd E. According to Yasuda et al (1996), animals with clinical signs of enzootic bovine leukosis have high levels of ADA seric activity. Although elevated ADA seric levels were reported from human TB patients (Lakshimi et al 1992, Rodrigues et al 1993, Orphanidou et al 1996, measurement of this enzymatic activity had medium to low sensitivity compared to ADA determination in pleural fluid (Lakshmi et al 1992, Orphanidou et al 1996. Furthermore, Orphanidou et al (1996) could not find any correlation between ADA activity in serum and in pleura.…”

“…Although elevated ADA seric levels were reported from human TB patients (Lakshimi et al 1992, Rodrigues et al 1993, Orphanidou et al 1996, measurement of this enzymatic activity had medium to low sensitivity compared to ADA determination in pleural fluid (Lakshmi et al 1992, Orphanidou et al 1996. Furthermore, Orphanidou et al (1996) could not find any correlation between ADA activity in serum and in pleura. In the present study, the lack of a significant difference in ADA seric values between TBpositive and TB-negative cattle could be due to the difference between the production of ADA isoenzymes during immune responses in unlike species to diverse stimulus and to the clinical status of TB-positive animals.…”