January-March 2018

Pleural Fluid Adenosine Deaminase for Diagnosis of Tuberculous Pleural Effusion

Vinayak Dave1, Swati Jayantilal Patel2, Amrish Shah3

1Resident Doctor, 2Assistant Professor, 3Additional Professor, Medical College Baroda


BACKGROUND AND OBJECTIVES: Diagnosis of tuberculous pleural effusion (TPE) is a common clinical problem with multiple pitfalls. Adenosine deaminase (ADA) analysis is a simple and inexpensive test that can be performed on body fluids.The isoenzyme ADA-2 is elevated significantly in pleural fluid with activated lymphocytes. To evaluate the diagnostic value of ADA in tuberculous pleural effusion present study was conducted. METHODS: Total 80 patients with age >12 yrs of either sex with pleural effusion were enrolled for study. CBC, sputum examination, chest X-ray and thoracocentesis were performed. Cell count, cyto-pathological examination, glucose-proteins levels, Gram's and Z-N staining were performed. Pleural fluid ADA levels were done. Patients were divided in to tuberculous or non-tuberculous(NTB) group according to their finding. RESULTS: Total 52 patients were diagnosed as having TPE and 28 patients as NTB effusion. The mean age in the study population was 39 ± 17.13 years. Dyspnea was the most common presenting complaint. In TPE group, the other presenting complaints were anorexia, cough, weight loss, expectoration, and chest pain. NTB group also showed the same trends in presenting complaints except fever. The mean pleural fluid ADA level was 54.97±23.51 U/L in TB group were higher in comparison with NTB group. It was statistically significant with ‘p’ value of <0.05. CONCLUSION: The level of ADA in TPE is much higher than the levels in effusion of other etiology. Pleural fluid ADA is adequately sensitive and specific test and at the same time, inexpensive and easy to perform.

Keywords: Tuberculosis, Tuberculous Pleural Effusion, Non-Tuberculous Pleural Effusion, ADA analysis.

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