Value of adenosine deaminase in the diagnosis of tuberculous pleural effusions in young patients in a region of high prevalence of tuberculosis.

Valdés, Luís; Álvarez, David; José, Esther San; Juanatey, José Ramón González; Pose, Antonio; Valle, José M. González del; Salgueiro, Marcelino; Suárez, J. L.

doi:10.1136/thx.50.6.600

Cited by 129 publications

(106 citation statements)

References 15 publications

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“…Examination of those studies reveals that pleural fluids of any cell type predominance were included. As in this study, previous reports [17,18] have found increased ADA levels in patients with complicated parapneumonic effusions, wherein the immune response involves polymorphonuclear cells and macrophages rather than lymphocytes.…”

Section: Discussionsupporting

confidence: 69%

Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions

Castro¹,

Nuevo²,

Pérez-Rodríguez³

et al. 2003

Eur Respir J

128

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Adenosine deaminase (ADA) can aid in the diagnosis of tuberculous pleural effusions, but false-positive findings from lymphocytic effusions have been reported. The purpose of this study is to assess the ADA levels in nontuberculous lymphocytic pleural effusions (lymphocyte count w50%) of different aetiologies.Altogether, 410 nontuberculous lymphocytic pleural fluid samples were consecutively selected. These included malignant effusions (n=221), idiopathic effusions (n=76), parapneumonic effusions (n=35), postcoronary artery bypass graft surgery effusions (n=6), miscellaneous exudative effusions (n=21) and transudative effusions (n=51).The ADA level reached the diagnostic cut-off for tuberculosis (40 U?L -1 ) in seven of the 410 cases (1.71%). The negative predictive value of ADA for the diagnosis of pleural tuberculosis was 99% (403 of 407 cases) in the group of lymphocytic pleural effusions. In five of these seven patients ADA 1 and ADA 2 were measured, and in all these cases (100%) ADA 1 /ADA p correctly classified these lymphocytic effusions as nontuberculous (ratio v0.42).This prospective study provides additional evidence that adenosine deaminase levels in nontuberculous lymphocytic pleural effusions seldom exceed the cut-off set for tuberculous effusions. The pleural fluid adenosine deaminase levels were significantly higher in different types of exudative effusions than in transudates. An adenosine deaminase level v40 IU?L -1 virtually excluded a diagnosis of tuberculosis in lymphocytic pleural effusions. Adenosine deaminase 1 /adenosine deaminase p correctly classified all nontuberculous lymphocytic pleural effusions with high adenosine deaminase levels. Eur Respir J 2003; 21: 220-224.

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Section: Discussionsupporting

confidence: 69%

Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions

Castro¹,

Nuevo²,

Pérez-Rodríguez³

et al. 2003

Eur Respir J

128

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“…[19][20][21][22][23][24][25] Despite the high diagnostic sensitivity of ADA, its specificity is influenced by other clinical conditions and by the regional prevalence of tuberculosis. 26,27 In the present study, 13 (9%) patients with cancer presented an ADA activity higher than 40 U/L. Five of these patients had lymphomas (diagnosed by immunophenotypying) and eight had solid tumors.…”

Section: Discussionmentioning

confidence: 91%

Clinical and Laboratory Parameters in the Differential Diagnosis of Pleural Effusion Secondary to Tuberculosis or Cancer

Antonângelo

Vargas

Seiscento

et al. 2007

Clinics

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62(5):585-90. PURPOSE:To evaluate the clinical and laboratory characteristics of pleural effusions secondary to tuberculosis (TB) or cancer (CA). METHODS: A total of 326 patients with pleural effusion due to TB (n=182) or CA (n=144) were studied. The following parameters were analyzed: patient gender, age and pleural effusion characteristics (size, location, macroscopic fluid aspect, protein concentration, lactate dehydrogenase (DHL) and adenosine deaminase activity (ADA) and nucleated cell counts). RESULTS: Young male patients predominated in the tuberculosis group. The effusions were generally moderate in size and unilateral in both groups. Yellow-citrine fluid with higher protein (p < 0.001) levels predominated in effusions from the tuberculosis group (5.3 + 0.8 g/dL) when compared to the CA group (4.2 ± 1.0 g/dL), whereas DHL levels were more elevated in CA (1,177 ± 675 x 1,030 ± 788 IU; p = 0.003) than in TB. As expected, ADA activity was higher in the TB group (107.6 ± 44.2 x 30.6 ± 57.5 U/L; p < 0.001). Both types of effusions presented with high nucleated cell counts, which were more pronounced in the malignant group (p < 0.001). TB effusion was characterized by a larger percentage of leukocytes and lymphocytes (p < 0.001) and a smaller number of mesothelial cells (p = 0.005). Lymphocytes and macrophages were the predominant nucleated cell in neoplastic effusions. CONCLUSION: Our results demonstrate that in lymphocytic pleural exudate obtained from patients with clinical and radiological evidence of tuberculosis, protein and ADA were the parameters that better characterize these effusions. In the same way, when the clinical suspicion is malignancy, serous-hemorrhagic lymphocytic fluid should be submitted to oncotic cytology once this easy and inexpensive exam reaches a high diagnostic performance (≅ 80%). In this context, we suggest thoracocentesis with fluid biochemical and cytological examination as the first diagnostic approach for these patients.

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“…Equal gender distribution seen in the TPE and NTPE groups differs from that of previous studies where there were generally slightly more males than females. [10,15] This may be due to changing patterns in access to healthcare, gender issues and changing epidemiological profiles, such as the rise of HIV infection particularly among women, which may contribute to the development of more TB cases in females. [16] We observed that more patients who were HIVpositive had TPEs than patients who were HIV-negative.…”

Section: Discussionmentioning

confidence: 99%

High pleural fluid adenosine deaminase levels: A valuable tool for rapid diagnosis of pleural TB in a middle-income country with a high TB/HIV burden

2014

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Background. South Africa has the highest burden of tuberculosis (TB) in the World Health Organization (WHO) African region. Using traditional TB diagnostic tools, the diagnosis of pleural TB (PTB) is highly unrewarding. Elevated levels of pleural fluid adenosine deaminase (FADA) have been shown to be useful in the diagnosis of PTB; however, similar levels may be found in some other medical conditions leading to misdiagnosis. Following queries from clinicians concerning the likely high false-positive (FP) rate of FADA from our laboratory, we performed a retrospective audit of all high FADA results generated over a 12-month period. Objectives. To determine the positive predictive value (PPV) of FADA, the frequent causes of FPs in our laboratory and the demographic characteristics of tuberculous pleural effusions (TPEs) and non-tuberculous pleural effusions (NTPEs). Methods. High FADA results generated in the past year were extracted with corresponding TB culture results, fluid cell count, cytology/ histology results, radiology reports and HIV results. Hospital records were reviewed for the final diagnosis in each case. Diagnosis of PTB was based on the WHO case definition of TB. Results. A total of 159 results were reviewed: 133 (83.6%) were TPE, hence FADA had a PPV of 83.6%. Neoplasm was the most common cause of an FP in 13/26 (50%) NTPEs. While TPE was more common than NTPE in younger people, both groups had an equal gender distribution. Conclusion. FADA had a high PPV for PTB in our laboratory. We recommend its continued use as a rapid and reliable diagnostic tool for PTB.

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Value of adenosine deaminase in the diagnosis of tuberculous pleural effusions in young patients in a region of high prevalence of tuberculosis.

Cited by 129 publications

References 15 publications

Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions

Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions

Clinical and Laboratory Parameters in the Differential Diagnosis of Pleural Effusion Secondary to Tuberculosis or Cancer

High pleural fluid adenosine deaminase levels: A valuable tool for rapid diagnosis of pleural TB in a middle-income country with a high TB/HIV burden

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