ROLE OF CEREBROSPINAL FLUID ADENOSINE DEAMINASE IN DIAGNOSIS OF TUBERCULAR MENINGITIS IN ADULTS

Background: Meningitis can be caused by bacteria, viruses, parasites, and fungi as well as by non-infectious conditions including inflammatory disorders (e.g., systemic lupus erythematosis or Kawasaki disease) and neoplasia (e.g., leukemic meningitis). The objective of this study were to study cerebrospinal fluid (CSF) adenosine deaminase (ADA) levels in infective meningitis of different aetiologies. And to assess the role of cerebrospinal fluids (CSF) adenosine deaminase (ADA) levels in differentiating tubercular from non-tubercular meningitis.Methods: The study was conducted on 70 patients of meningitis at Postgraduate Department of Paediatrics, in G. B. Pant Hospital, an associated hospital of Government Medical College Srinagar. Out of 70 patients included in the study 27 cases were Aseptic Meningitis (AM), 14 cases partially treated pyogenic -meningitis (PTM), 19 cases pyogenic meningitis (PM), and 10 cases were tubercular meningitis (TBM). ADA activity of CSF was quantified by colorimetry.Results: In our study we observed a significant high level of ADA 30.0±3.2U/L (20.0, 54.0) among the tubercular meningitis (TBM) patients and its respective level among Aseptic Meningitis (AM), was 8.1±0.3U/L (4.0, 11.5), partially treated pyo -meningitis (PTM) was 7.6±0.4U/L (5.0, 11.0), pyogenic meningitis (PM) was 11.6±0.5U/L (8.0, 14.5). In total Non-TBM ADA level was 9.1±0.3U/L (4.0, 14.5) units/liter. At cut off of > or equal to 10U/L sensitivity was 100% specificity66.67% positive predictive value33.33% negative predictive value of 100% diagnostic accuracy 71.43%. At a higher cut off of > or equal to 12U/L sensitivity was 100% and specificity increased to 81.67% positive predictive value 47.62% negative predictive value100% diagnostic accuracy was 84.29%.Conclusions: The sensitivity and specificity of CSF ADA activity is markedly high in differentiating TBM from non-TBM. Hence CSF ADA activity may be used as a simple, cost-effective and reliable test for early diagnosis of TBM.

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Role of Cartridge Based Nucleic Acid Amplification Test of Cerebrospinal Fluid in the Diagnosis of Tubercular Meningitis

International Journal of Current Research and Review ◽

10.31782/ijcrr.2019.11113 ◽

2019 ◽

Vol 11 (11) ◽

pp. 11-17

Author(s):

Lavanya S.R. ◽

Mahesh Dave ◽

Archana Gokhroo

Keyword(s):

Cerebrospinal Fluid ◽

Nucleic Acid ◽

Nucleic Acid Amplification Test ◽

Nucleic Acid Amplification ◽

Tubercular Meningitis

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Analysis of Cerebrospinal Fluid (CSF) – Adenosine Deaminase (ADA) in Meningitis

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/236 ◽

2021 ◽

Vol 10 (16) ◽

pp. 1102-1105

Author(s):

Akkamahadevi V. Nipanal ◽

Madhukumar M.H ◽

Nagappa H

Keyword(s):

Cerebrospinal Fluid ◽

Early Diagnosis ◽

Adenosine Deaminase ◽

Viral Meningitis ◽

Tubercular Meningitis ◽

Acid Fast Bacilli ◽

Group I ◽

Adenosine Deaminase Activity ◽

Function Test ◽

The Mean

BACKGROUND Acute infections of the nervous system are generally widespread and cause significant problems in the field medicine and therefore early detection, right decision making, and early initiation of therapy can be lifesaving. Meningitis is the inflammation of the membranes that cover the brain and spinal cord. It is a general clinical problem during infancy and childhood. Delay in differentiating between bacterial, tubercular & viral meningitis and institution of its treatment may have irreparable consequences that lead to significant morbidity & mortality. The present study was conducted to find out the utility of cerebrospinal fluid-adenosine deaminase (CSF-ADA) for the early diagnosis & differentiation of tubercular & viral meningitis in adults. METHODS 50 meningitis patients who met the inclusion criteria were selected. Investigations including complete haemogram, liver function test (LFT), renal function test (RFT), random blood sugar (RBS), serum electrolytes, human immunodeficiency virus (HIV) test, chest x-ray and computed tomography (CT) brain (plain) were done. CSF cytology, biochemistry, gram stain, acid-fast bacteria (AFB) stain & culture were done. These cases were further divided in to two groups based on clinical and CSF laboratory findings as group I: tubercular meningitis, group II: viral meningitis. An estimation of CSF-ADA was done in all patients. RESULTS The mean age of the 50 patients studied was 37.76 + 15.58 years, with the maximum number of patients suffering from tubercular meningitis. The incidence of meningitis was more in males. CSF-adenosine deaminase activity was found to be higher in tubercular meningitis, the mean value was 17.67 ± 8.13 IU / L. CONCLUSIONS Assessment of CSF-ADA will be helpful for early diagnosis and differentiation of tubercular and viral meningitis. This is needed when gold standard investigations for meningitis like smear and / or culture for acid fast bacilli are not available or negative or are time consuming. KEY WORDS CSF-Cerebrospinal Fluid, ADA-Adenosine Deaminase, AFB-Acid Fast Bacilli.

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Role of Cerebrospinal Fluid - Adenosine Deaminase Level in Early diagnosis of Various Etiologies of Meningitis in children

Nepal Journal of Medical Sciences ◽

10.3126/njms.v1i2.6608 ◽

2012 ◽

Vol 1 (2) ◽

pp. 97-102 ◽

Cited By ~ 1

Author(s):

K Malla ◽

KS Rao ◽

T Malla ◽

J Vedamony ◽

P Ghimire

Keyword(s):

Cerebrospinal Fluid ◽

Early Diagnosis ◽

Adenosine Deaminase ◽

Predictive Value ◽

Viral Meningitis ◽

Clinical Findings ◽

Medical Sciences ◽

Tubercular Meningitis ◽

Meningitis In Children ◽

A Prospective Study

Background: Determination of cerebrospinal fluid-adenosine deaminase (CSF-ADA) activity is a reliable means to differentiate tubercular from non- tubercular meningitis. This study was carried out to see the range with mean CSF-ADA levels in meningitis of various etiologies and to see if early diagnosis is possible based on these levels. Methods: A prospective study of 140 children admitted in Manipal Teaching Hospital, from July 2009 – June 2011. Diagnosis was established by clinical findings and relevant investigations and patients were divided in different groups as pyogenic meningitis (PM), partially treated meningitis (PPM), tubercular meningitis (TBM), viral meningitis (VM) and controls. CSF-ADA estimation was done by using spectrophotometer. Results: Out of total 140 patients, 103 were cases of meningitis and 37 were controls. There were 32 cases of PM, 27 cases of PPM, 34 cases of VM and 10 cases of TBM. The mean±SD with range of CSF-ADA was respectively 48±20.37 IU/L (20-70 IU/L), 14.57±6.48 IU/L (2-28 IU/L), 6.40±2.17 IU/L (3-9 IU/L), 8.29±10 IU/L (3-11 IU/L) and 5.27±2.69 IU/L (2-7 IU/L) in TBM, PM, PPM, VM and controls and the value was highest in TBM. The specificity, sensitivity, positive predictive value and negative predictive value of CSF-ADA for TBM were 94.6%, 100 %, 83.3% and 100%. Conclusion: Estimation of ADA activity in CSF can be of great value in early diagnosis of tubercular meningitis. Furthermore it is a simple, reliable, relatively inexpensive test with easy procedure. DOI: http://dx.doi.org/10.3126/njms.v1i2.6608 Nepal Journal of Medical Sciences. 2012;1(2): 97-102

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Clinical study of meningitis in children and role of adenosine deaminase in differentiating tubercular from non-tubercular meningitis

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20192779 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1695

Author(s):

Deepmala Pandey ◽

Ankur Yadav

Keyword(s):

Adenosine Deaminase ◽

Cross Sectional Study ◽

Cell Mediated Immunity ◽

Age Group ◽

Sectional Study ◽

Tubercular Meningitis ◽

Cross Sectional ◽

Group 5 ◽

Meningitis In Children

Background: In diseases where cell mediated immunity plays an important role like in tuberculosis, CSF (Cerebrospinal fluid) adenosine deaminase (ADA) activity is increased. Hence, this testing is done especially among children with suspected tubercular meningitis. The objective of this was to study role of Adenosine Deaminase in differentiating tubercular from non-tubercular meningitis.Methods: This was a hospital based cross sectional study was carried out among 50 children of proven meningitis for a period of two years. CSF ADA levels were done for all cases. They were divided into tubercular meningitis and non-tubercular meningitis group and compared.Results: Incidence of tuberculous meningitis (TBM) was found high in the age group 5-8 years. Male:female ratio was 2.3:1. Fever was present in all cases followed by vomiting and neck rigidity. CSF AFB was positive in 3 cases (6%). Neuroimaging was done in all cases in which 3 patients had basal exudate in which 2 patients had TBM and 1 patient was Non-TBM. 3 patients had hydrocephalus in MRI in which 2 had TBM diagnosed and 1 had non-TBM. As per ADA levels, 10 were diagnosed as TBM out of which 8 patients had ADA level ≥10 IU/L and 2 had ADA level <10 IU/L which was missed by ADA and later confirmed by other modalities.Conclusions: It was concluded that if ADA level in CSF is ≥10IU/l the diagnosis of TBM should be considered.

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