Critical Cerebrospinal Fluid Adenosine Deaminase Activity In Tubercular Meningitis

Background:Tuberculosis of the central nervous system accounts for ~5% of extrapulmonary cases in the United States. It is seen most often in young children but also develops in adults, especially those infected with HIV. If unrecognized, tuberculous meningitis is uniformly fatal. This disease responds to chemotherapy.Cerebrospinal fluid (CSF) evaluation is the single most important aspect of laboratory diagnosis of meningitis. Basic studies of CSF that should be performed in meningitis include measurement of pressure, cell count and differential count, estimation of glucose and protein levels, Gram's stain and culture.Objectives:To evaluate the diagnostic significance of CSF adenosine deaminase (ADA) activity in tuberculous meningitis.Material & Methods:70 Tubercular Meningitis patients who were admitted in Department of Medicine, Victoria hospital were included. The study was approved by the Ethical Committee of Bangalore Medical College and Research Institute, Bangalore. Patients were selected after fulfilling the following inclusion and exclusion criteria.Results:The mean age of the 70 patients studied was 39.82+16.48 years. The youngest patient was 18 years old and oldestpatient was 70 years.The mean value of ADA activity in tubercular meningitis was 18.07±8.03IU/L. Cut-off value of ADA in our study was 10 IU/. The result was statistically significant with a p value<0.001. Conclusion: The test for ADA in CSF is simple and can be carried out in a central laboratory with a rapid diagnosis, thus reducing unwarranted or harmful therapy for patients.Elevated CSF-ADA level helpsin differentiating tubercular from non-tubercular meningitis.

Comparision of Adenosine Deaminase [ADA] Levels with Cyto-Chemical Analysis of Pleural Fluids to Differentiate Tubercular and Non – Tubercular Effusions..

This study is intended to utilize biochemical parameters like ADA and protein levels in comparison with cell count and cell type in pleural fluid to differentiate tubercular and non-tubercular effusions. We have analyzed a total of 208 cases and among them 59.61% cases were ADA positive and 40.39% cases were ADA negative, and 156 cases were exudates and 52 cases were transudates. Categorized these effusions into 4 groups taking consideration of ADA, cell count, lymphocyte and protein levels as exudate with ADA positive, exudate with ADA negative, transudate with ADA positive and transudate with ADA negative. This study has shown promising results to diagnose tuberculosis with immediate and cost effectiveness that can be undertaken by any basic laboratory, in a endemic areas and developing countries like India.