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

BackgroundAccurate differentiating diagnosis is essential for choosing treatment for exudative pleural effusions.ObjectiveTo establish the diagnostic accuracy of interleukin 27 for tuberculous pleural effusion (TPE).MethodsFirst, the concentrations of pleural interleukin 27, interferon-gamma and adenosine deaminase were compared between 51 patients with TPE and 103 with non-TPEs (Beijing cohort), and their diagnostic values were evaluated. These were further verified in another independent population (Wuhan cohort, n=120). In the second part of the study, we performed a meta-analysis.ResultsWith a cut-off value of 591.4 ng/L in the Beijing cohort, the area under the curve, sensitivity, specificity, positive predictive value and negative predictive value of interleukin 27 to diagnose TPE were 0.983 (95% CI 0.947 to 0.997), 96.1% (86.5% to 99.5%), 99.0% (94.7% to 100%), 98.0 (89.4 to 99.9) and 98.1 (93.3 to 99.8), respectively. Excellent diagnostic accuracy of interleukin 27 was also found in the Wuhan cohort and was further confirmed in the meta-analysis. The diagnostic performance of interleukin 27 was comparable to that of interferon-gamma and was more accurate than that of adenosine deaminase. Since the post-test probability of a negative result was always <0.1%, a negative test was considered to exclude TPE in all tuberculosis prevalence settings.ConclusionsInterleukin 27 can be used to diagnose TPE in a high prevalence setting, and a negative result can also be reliably used to rule out TPE in all prevalence settings.

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Diagnostic significance of pleural fluid adenosine deaminase activity in tuberculous pleurisy

Ibrahim Medical College Journal ◽

10.3329/imcj.v5i1.9852 ◽

1970 ◽

Vol 5 (1) ◽

pp. 1-5

Author(s):

Sharmeen Ahmed ◽

Reaz Fatema ◽

Ahmed Abu Saleh ◽

Mumayun Sattar ◽

Md Ruhul Amin Miah

Keyword(s):

Pleural Effusion ◽

Adenosine Deaminase ◽

Pleural Fluid ◽

Colorimetric Method ◽

Diagnostic Methods ◽

Test Accuracy ◽

Diagnostic Significance ◽

Tuberculous Pleural Effusion ◽

Adenosine Deaminase Activity ◽

Significant Difference

Diagnosis of tuberculous pleural effusion (TPE) is difficult because of its non-specific clinical presentation and insufficient efficiency of conventional diagnostic methods. The study was carried out to evaluate the utility of adenosine deaminase (ADA) activity in pleural fluid for the diagnosis of TPE. ADA activity was measured in pleural fluid of 103 pleural effusion patients by colorimetric method using a commercial ADA assay kit. The diagnosis of TPE was made from pleural fluid examinations (including cytology, biochemistry, and bacteriology) and pleural biopsy. Patient with negative result of this methods were diagnosed by response of empirical treatment. Out of 130 cases, 62 (61.1%) had TPE and the remaining 41 (39.8%) had pleural effusion due to non tuberculous diseases. There was statistically significant difference (p < 0.001) between the mean of pleural fluid ADA levels (70.82±22.54 U/L) in TPE group and (30.07±22.93 U/L) in non-TPE group. Of 62 TPE cases, microscopy for AFB and culture for M.tuberculosis in pleural fluid revealed positivity in 9.6% and 22.5% cases respectively, and biopsy of pleura showed typical epithelioid granuloma in only 43.5% cases. The cut-off value of ADA for diagnosing TPE was 40 U/L using a ROC curve, with a sensitivity of 94% and specificity of 88%. Positive and negative predictive value of ADA assay were 92% and 90% respectively. The overall test accuracy was 90%. Pleural fluid ADA assay is therefore a simple, rapid, highly sensitive and specific adjunct test for diagnosis of TPE. DOI: http://dx.doi.org/10.3329/imcj.v5i1.9852 Ibrahim Med. Coll. J. 2011; 5(1): 1-5 Keywords: Pleural fluid; adenosine deaminase; tuberculous pleural effusion

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Evaluation of adenosine deaminase activity for diagnosis of tuberculous pleural effusion

Journal of Pathology of Nepal ◽

10.3126/jpn.v3i5.7860 ◽

2013 ◽

Vol 3 (5) ◽

pp. 367-373

Author(s):

SK Bhoumik ◽

MM Rahman ◽

M Ibrahim ◽

MM Hiron ◽

M Ahamad

Keyword(s):

Pleural Effusion ◽

Adenosine Deaminase ◽

Infectious Agent ◽

Activity Level ◽

Diagnostic Tools ◽

P Value ◽

Tuberculous Pleural Effusion ◽

Diffi Cult ◽

Adenosine Deaminase Activity ◽

Low Sensitivity

Background: Tuberculosis is a leading cause of worldwide preventable morbidity and mortality from an infectious agent. A defi nite diagnosis of tubercular pleural effusion can be diffi cult to make because of low sensitivity and/or specifi city of noninvasive traditional diagnostic tools. This study is done to fi nd out a sensitive and specifi c marker for early diagnosis of tuberculous pleural effusion. Materials and Methods: One hundred and three pleural effusion cases were enrolled in the study, out of which 62 were tuberculous pleural effusion cases and 49 were non-tuberculous cases. Results: Considering 40 U/L as a cut off value for Adenosine deaminase assay level, the test result was positive in 58 out of 62 patients of tuberculosis indicating sensitivity of the test as 94%; however, among 41 non-tuberculous patients, 5 presented ADA activity level more than 40U/L, which lowers the specifi city of the test to 88%. ADA levels were signifi cantly higher in tuberculous than in non tuberculous cases (P value <0.001). Conclusion: It may be concluded that ADA levels are signifi cantly high in patients with tuberculous pleural effusion compared to that in non tuberculous group. Sensitivity (94%) and specifi city (88%) of the test in tuberculous pleural effusions are very high, when cut off value set at 40U/L. The result indicated that the analysis of ADA levels in pleural effusion constitute a very useful marker for the diagnosis of TPE which, in addition, can be made quickly in a non- invasive way. Journal of Pathology of Nepal (2013) Vol. 3, No.1, Issue 5, 367-373 DOI: http://dx.doi.org/10.3126/jpn.v3i5.7860

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Immunologic Characteristics of Tuberculous Pleural Effusion -Diagnostic Value and Mechanism of Increased Adenosine Deaminase Activity-

Tuberculosis and Respiratory Diseases ◽

10.4046/trd.1987.34.3.223 ◽

1987 ◽

Vol 34 (3) ◽

pp. 223-232

Author(s):

K. S. Jung ◽

H. S. Chung ◽

S. K. Han ◽

Y. S. Shim ◽

K. Y. Kim ◽

...

Keyword(s):

Pleural Effusion ◽

Adenosine Deaminase ◽

Diagnostic Value ◽

Tuberculous Pleural Effusion ◽

Adenosine Deaminase Activity

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Comparison of diagnostic utility of pleural fluid ADA and interferon-gamma release assay (IGRA) in differentiating tubercular and non-tubercular exudative pleural effusion

10.1183/13993003.congress-2015.pa1534 ◽

2015 ◽

Author(s):

Varuna Jethani ◽

Girish Sindhwani ◽

Aarti Raghuvanshi ◽

Vinit Mehrotra ◽

Rakhee Khanduri

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Interferon Gamma ◽

Interferon Gamma Release Assay ◽

Diagnostic Utility ◽

Release Assay ◽

Exudative Pleural Effusion

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Study of Adenosine Deaminase Activity As A Biochemical Marker of Cell Mediated Immunity in Tuberculous Meningitis, Tuberculous Pleural Effusion and Tuberculous Ascites

Journal of Medicine ◽

10.3329/jom.v13i1.9065 ◽

2012 ◽

Vol 13 (1) ◽

pp. 32-37 ◽

Cited By ~ 2

Author(s):

Shashikant Agrawal

Keyword(s):

Pleural Effusion ◽

Adenosine Deaminase ◽

Tuberculous Meningitis ◽

Biochemical Marker ◽

Cell Mediated Immunity ◽

Supportive Evidence ◽

Tuberculous Pleural Effusion ◽

Medical College ◽

Adenosine Deaminase Activity ◽

Gandhi Medical College

The present study conducted with the aim that ADA estimation is a simple cheaper and quicker biochemical test and could provide additional supportive evidence for the diagnosis of tuberculous meningitis, tuberculous pleural effusion, tuberculous ascites in clinically suspected cases and will therefore help in early institution of therapy to these patients. The data was collected and interpreted at department of Physiology and Department of Medicine Gandhi Medical College, Bhopal.DOI: http://dx.doi.org/10.3329/jom.v13i1.9065JOM 2012; 13(1): 32-38

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