Diagnostic Significance Of Adenosine Deaminase And Lymphocytes In Suspected Tuberculous Pleural Effusion

CONTEXT: Tuberculosis is a major public health problem in India. Tuberculous pleural effusion is a paucibacillary manifestation of the Tuberculosis, so isolation of Mycobacterium tuberculosis is difficult, biomarkers being an alternative for diagnosis. Pleural fluid Adenosine deaminase (ADA) level is being used in diagnosis of Tubercular pleural effusion. The combination of ADA and pleural fluid lymphocyte count is being recognized as a better method for increasing the specificity of ADA test. The present study was conducted to analyze the diagnostic usefulness ofAIM: ADA alone (? 40U/L) compared with the combination of ADA and pleural fluid lymphocyte count ( ? 50% ). SETTINGS AND DESIGN: METHODS AND MATERIAL:Retrospective study. Study was conducted for a period of one year from May 2017 to April 2018. A total of 110 pleural fluid samples data was analysed. SPSS 20STATISTICAL ANALYSIS USED: statistical software. ADA level in Tuberculous pleural effusion ranged from 40U/L to 112U/L with mean value ofRESULTS: 69.4U/L. Sensitivity, Specificity, Positive predictive valve (PPV) and Negative predictive values (NPV) for ADA alone were 93.2%, 76.4%, 82% and 90.6% respectively. For ADA and lymphocyte count the Specificity and PPV increased (98% and 98.1% respectively) with hardly any decrease in sensitivity or NPV (89.8% and 89.5% respectively). CONCLUSION: Combined use of ADA and pleural fluid lymphocyte count increases the specificity and PPV when compared to the specificity of ADA test alone in diagnosing Tubercular pleural effusion

Research progress in the characteristics and differential diagnosis of tuberculous pleural effusion and malignant pleural effusion / 国际生物医学工程杂志

Pleural effusion is a common clinical pleural disease, and it is also an accompanying manifestation of many diseases. The characteristics and etiological diagnosis of pleural effusion have always been the focus of clinical attention. Pleural effusion is divided into exudate and exudative effusion, and tuberculous pleural effusion and malignant pleural effusion are more common in exudative pleural effusion. Its characteristics and the selection of appropriate diagnostic methods are crucial to the treatment and prognosis of patients. With the rapid development of experimental technology and molecular biology, some new experimental techniques and experimental indicators have emerged. In this review, the characteristics of tuberculous pleural effusion and malignant pleural effusion and the research progress of its differential diagnosis methods were reviewed.

Diagnostic performance of adenosine deaminase for tuberculous pleural effusion / 临床检验杂志

Objective@#To verify the diagnostic value of adenosine deaminase (ADA) for tuberculous pleural effusion. @*Methods@#Forty-three cases with tuberculous pleural effusion and 163 cases with non-tuberculous pleural effusion were consecutively collected. The concentration of ADA in pleural effusion was determined by enzyme kinetics. The receiver operating characteristic (ROC) analysis curve was used to calculate the optimal cut-off value of ADA for diagnosing tuberculous pleural effusion based on the control groups with non-tuberculous pleural effusion. Meanwhile, the specificity and sensitivity of ADA level for diagnosis of tuberculous pleural effusion were compared with previous reports. @*Results@#The concentration of ADA in tuberculous pleural effusion (median 52.5 U/L) was significantly higher than that in non-tuberculous pleural effusion (median 9.8 and 10.6 U/L) (P＜0.05). With a cut-off level for ADA of 25 U/L, the diagnostic sensitivity and specificity was 88.0% and 91.0%, respectively. A system review analyzed data from 17 studies with QUADAS score ≥10 points and revealed the cut-off value of ADA to be （28.1±12.8） U/L (range 10.2 to 55.8 U/L) with a sensitivity of 89% (95%CI: 87% to 91%) and a specificity of 89% (95%CI: 88% to 91%). @*Conclusion@#The specificity and sensitivity of ADA for diagnosis of tuberculous pleural effusions should be up to over 85%, while the cut-off value of ADA from different literature reports were diverse.

Estimation of Amylase in Serum and Pleural Fluid among HIV Known Seronegative Patients with Tuberculous Pleural Effusion.

Background: Myocardial Pleural TB is one of the most frequent extra-pulmonary manifestations of tuberculosis. Extra Pulmonary tuberculosis is the area of concern for the diagnosis of tuberculosis. Aim of this study is to estimate enzyme Amylase levels in serum and pleural fluids of HIV seronegative exudative tuberculous pleural fluids and their possible role in the diagnosis of tubercular pleural effusion. Methods: A total number of 100 patients were selected to do this study. Selected individuals were randomly included in this study as cases and controls, 50 members each. The samples of blood and pleural fluid were tested for amylase within the stipulated time, on the same day, to prevent the loss of analyte by CNPG method. Results: Among Group I or Cases, the mean value of serum amylase and pleural fluid amylase was 53.044 and 77.122 respectively. Among Group II or controls, the mean value of serum and pleural fluid amylase was 49.508 and 63.238 respectively. Conclusion: Serum and pleural fluid Amylase levels indicate a coexisting pathology of pancreas, gastrointestinal tract and malignancies. According to our study, diagnosing Tuberculous pleural effusion by assessing amylase levels has less sensitivity and specificity.

Application of IL-10 and IL-12 detection in differential diagnosis of tuberculous and malignant pleural effusion / 吉林大学学报(医学版)

Objective:To investigate the role of interleukin-10 (IL-10) and IL-12 in the differential diagnosis of tuberculous and malignant pleural effusion through measuring the serum and pleural effusion IL-10 and IL-12 levels of tuberculous and malignant pleural effusion patients.Methods: Forty-eight inpatients with exudative pleural effusion who didn''t receive any treatment before were selected.According to the pathogeny, the patients were divided into tuberculous pleural effusion group (n=25) and malignant pleural effusion group (n=23).The levels of IL-10 and IL-12 in peripheral blood and pleural effusion of the patients in two groups were detected by Cytometric Bead Array (CBA).The differences in IL-10, IL-12 levels and IL-12/IL-10 ratio were compared between two groups.The ROC curves of the above indexes, cast-off and adenosine deaminase (ADA) were used to compare the effects in differential diagnosis of tuberculous and malignant pleural effusion.Results: There were no statistical differences in the levels of serum IL-10, IL-12 and IL-12/IL-10 ratios of the patients between tuberculous and malignant pleural effusion groups (P>0.05),and the IL-12 level in pleural effusion and the IL-12/IL-10 ratio of the patients in malignant pleural effusion group were lower than those in tuberculous pleural effusion group (P<0.005).The area under the ROC curve for the levels of IL-12 in pleural effusion (0.984) was higher than those for the ratio of IL-12/IL-10, cast-off and ADA (0.744, 0.804 and 0.911, respectively) in the differential diagnosis of tuberculous and malignant pleural effusion.Conclusion: The detection of IL-12 levels in pleural effusion is helpful for the differential diagnosis of tuberculous and malignant pleural effusion, and the pleural effusion is easy to obtain, therefore the detection of IL-12 in pleural effusion is worth to be widely applied in clinic.

Study on the diagnostic value of the ratio of ADA and CysC in the Pleural effusion and serum for Tuberculous pleural effusion / 国际检验医学杂志

Objective To investigate the clinical value of the ratio of ADA and CysC in the Pleural effusion and serum for the di-agnosis of Tuberculous pleural effusion .Methods In the first half of 2014 ,50 cases from a random sample of patients with tubercu-lous pleurisy admitted in our hospital were chosen as tuberculosis group ,20 cases of patiente with lung cancer pleural effusion as malignant group and 30 cases of patiente with hepatic hydrothorax as control group .The concentrations of CysC and ADA in the pleural effusion and serum were detected ,and the ratios of these two indexes in the pleural effusion and serum were calculated .Re-sults (1)The results in three groups including PADA and SADA ,SCysC and PCysC ,PCysC/SCysC and PADA/SADA were com-pared ,and the differences were statistically significant (P<0 .05) .(2) According to the ROC curve ,the critical value of PADA/SA-DA and PCysC/SCysC were set as 1 .58 and 2 .30 ,respectively ,and area under the curve of PADA/SADA and PCysC/SCysC were 0 .880 and 0 .786 respectively .Conclusion The diagnostic value of PADA/SADA and PCysC/SCys for tuberculous pleural effusion is higher than that of PADA ,SADA ,PCysC or SCysC alone ,which can be used for the differential diagnosis of tuberculous pleural effusion index for clinical application .

Two-dimensional electrophoresis analysis of tuberculosis pleural effusion / 实用医学杂志

Objective To analyze the different expressed protein of pleural effusion caused by tuberculosis and to identify proteins associated with tuberculous pleural effusion for building an economic , rapid, and accurate diagnostic method. Methods Two-dimensional gel electrophoresis technology was applied to separate protein in pleural effusion of 20 cases of tuberculous pleurisy ,19 cases of lung cancer patients and 6 cases of transudate. Analysis of isoelectric point, the range of molecular weight, matching rate and grey value of the protein was carried out by the PDQuest8.0 software.Then the electrophoregram was compared to get the distinct protein. Results There were 13 differential protein spots between tuberculous pleural effusion and the transudateand 9 protein spots were highly expressed for two folds, but 4 protein spots poorly expressed for 0.5 folds in pleural effusion caused by tuberculous pleurisy. There were 11 differential protein spots between tuberculous and malignant pleural effusion and 5 protein spots were highly expressed , but 4 protein spots poorly expressed in pleural effusion caused by tuberculous pleurisy , while 2 protein spots were expressed only in the pleural effusion caused by lung cancer. Conclusion Two-dimensional electrophoresis technology is available to acquire an electrophoretogram of pleural effusion caused by tuberculosis , lung cancer and transudate with well resolution and high repetition rate.In addition, there are different protein spots.

Diagnostic flex-rigid pleuroscopic biopsy of parietal pleura for exudative pleural effusions in suspected malignant and tuberculosis cases: a retrospective study of 219 cases

Objectives: This study was carried out to ascertain the aetiology of exudative pleural effusions when other diagnostic investigations such as pleural fluid and sputum examination for cytology and acid fast bacilli fail to yield a definitive diagnosis and to differentiate between tuberculosis and malignancy in cases suspicious of malignancy. Methods: Pleuroscopic biopsies were obtained in 219 cases by Chest Physicians in the endoscopy suite using flexi-rigid fiber-optic pleuroscopes. Histological sections were stained with H&E and microscopic examination performed. Ziehl-Nielsen stain for acid fast bacilli was performed in all suspected tuberculosis cases and immunohistochemistry for Thyroid transcription factor 1 and other markers were carried out for all cases suspicious of malignancy. Results: Adequate biopsy material for interpretation was obtained in 210 (95.9%) of 219 cases. Histopathology revealed 79 (37.6%) cases were tuberculosis, 64 (30.5%) were malignant (primary from lung and other sites), 62 (29.5%) were non-specific inflammation and 5 (2.4%) were empyema. A definitive diagnosis of tuberculosis, malignancy and empyema was obtained in 70.5% of cases. Tuberculosis was encountered in a younger age-group than malignancy. Mean age for tuberculosis patient was 49 years while for malignant patients was 63 years. The majority (79.6%) of malignances encountered were metastatic lung adenocarcinoma.

Diagnosis significance of medical thoracoscopy in tuberculous pleural effusion / 重庆医学

Objective To assess the accuracy and safety of medical thoracoscopy(MT)in the diagnosis of tuberculous pleural effusion.Methods We evaluated 52 patients who were suspected tuberculous pleural effusion.The diagnosis rate and complications of medical thoracoscopy was assessed.Results About 33 of 52 patients were tuberculous pleural effusion.Twenty-nine cases were diagnosed by medical thoracoscopy,and the diagnostic rate was 88%.Under the thoracoscope,clinical manifestations of these pa-tients with tuberculous pleuritic were miliary nodules in 23 cases (70%),fiber cord-like adhesions in 12 cases (36%),extensive wrapped with fiber deposition in 7 cases(21%),and white scar in 5 cases (1 5%).All complication was relived or caused,and 1 case of gas embolism was the most serious one.Conclusion Medical thoracoscopy was a method with high diagnostic value and safety in the diagnosis of tuberculous pleural effusion.

Diagnostic significance of combination of secretory leukocyte protease inhibitor (SLPI), interferon-γ(IFN-γ) and adenosine deaminase (ADA) for tuberculous pleural effusion / 实用医学杂志

Objective To compare the diagnostic significance of pleural SLPI,IFN-γ and ADA for differenti-ating TPE from pleural effusions with the other etiologies. Methods Pleural effusion samples were obtained from 93 patients who were divided into the following groups: tuberculous pleural effusion,malignant pleural effusion, bacterial pleural effusion and transudative pleural effusion. The pleural effusion and/or serum levels of SLPI , IFN-γand ADA were determined. Results 1.The concentrations of SLPI, IFN-γand ADA in tuberculous pleural effusion was higher than that in malignant group, bacterial group and transudative group. 2. The diagnostic value of SLPI, IFN-γor ADA for the diagnosis of tuberculous PE is high respectively. The combinations of SLPI, IFN-γand/or ADA gained the more valuable diagnostic performance. Conclusion Pleural SLPI, IFN-γand ADA may be helpful for the differential diagnosis of tuberculous pleural effusion and the other pleural effusion. The combinations of SLPI or/and IFN-γor/and ADA further increased diagnostic value.

Superoxide dismutase 2 as a marker to differentiate tuberculous pleural effusions from malignant pleural effusions

OBJECTIVES: Our previous study demonstrated that superoxide dismutase levels were higher in tuberculous pleural effusions than in malignant pleural effusions, but that this difference could not be used to discriminate between the two. The objective of the present study was to investigate the levels of superoxide dismutase 2 in pleural effusions and to evaluate the diagnostic significance of pleural effusion superoxide dismutase 2. METHODS: Superoxide dismutase 2 concentrations were determined in pleural effusions from 54 patients with tuberculous pleural effusion and 33 with malignant pleural effusion using an enzyme-linked immunosorbent assay (ELISA) kit. Pleural effusion interferon gamma and tumor necrosis factor alpha levels were also analyzed by ELISA. The Mann-Whitney U test was used to evaluate the significance of differences. Associations between superoxide dismutase 2 concentrations and sex, age and smoking habits were assessed using Spearman's or Pearson's correlation coefficient analysis. Receiver operator characteristic analysis was performed to evaluate the value of superoxide dismutase 2 levels in the discrimination of tuberculous pleural effusion from malignant pleural effusion. RESULTS: Superoxide dismutase 2 levels were significantly higher in patients with tuberculous pleural effusion compared with those with malignant pleural effusion ...

Usefulness of Pleural Adenosine Deaminase in Children for the Differentiation Tuberculous Pleural Effusion from Mycoplasma pneumonia with Pleural Effusion / 소아알레르기및호흡기학회지

PURPOSE: Determination of adenosine deaminase (ADA) in pleural fluid has been suggested as another tool to establish early diagnosis of tuberculous pleural effusion. However, there are few studies concerning its usefulness in children. The objective of this study was to evaluate the utility of the determination of ADA level in pleural fluid for the differential diagnosis between tuberculous pleural effusion (TPE) and Mycoplasma pneumonia with pleural effusion (MP) in children. METHODS: We retrospectively reviewed the clinical records of 13 TPE patients and 21 MP patients with pleural effusion. Also, we analyzed ADA levels, and clinical, biochemical, microbiologic and cytologic findings in the pleural fluid. RESULTS: The pleural fluid of all the subjects revealed exudative rather than transudate characteristics. The mean ADA level in the TPE group was significantly higher than that in the MP group (106.27+/-43.71 IU/L vs. 65.28+/-26.27 IU/L, P=0.003). The area under the curve in receiver operating characteristic analysis was 0.810. With a cut-off level for ADA of 60 U/L, the sensitivity, specificity, positive predictive value, and negative predictive value were 92.3%, 61.9%, 60.0%, and 92.9%, respectively. As many as 38.9% of patients with MP were false-positive with this ADA cut-off setting. CONCLUSION: Although the measurement of ADA activity in pleural fluid can help TPE diagnosis, we should consider that some cases of MP with pleural effusion showed high ADA activities. Accordingly, the utility of the ADA level in pleural fluid for the differentiation of TPE from MP declines and additional relevant studies are required.

Diagnostic accuracy of immunological methods in patients with tuberculous pleural effusion from Venezuela / Precisión diagnóstica de métodos inmunológicos en pacientes con tuberculosis pleural de Venezuela

In recent years, better diagnostics for tuberculosis (TB) has received increasing attention, especially the diagnosis of tuberculous pleural effusion, which is difficult and at present the main tool in TPE diagnostic is pleural effusion smear and culture, but unfortunately, sensitivities are low, therefore better TPE diagnostic tools are needed. The aim of this study was to find a diagnostic algorithm to assess the progress in TPE diagnostic at the Hospital Vargas de Caracas, that permits identification of the majority of patients, at a satisfactory cost-benefit ratio, evaluating the levels of IFN-g and IL-12p40 in pleural effusion and serum, as well as the antibody reactivity in order to compare it with microbiological tests. A total of 60 individuals with pleural effusion were studied; 20 patients with tuberculous pleural effusion (TPE) formed the patient group and 40 patients with non-tuberculous pleural effusion (NTPE) formed the control group. The levels of IFN-g and IL-12p40 in effusion and serum and class and subclasses of IgG reactivity to Mycobacterium tuberculosis antigens were measured by ELISA. The utility of these methods for diagnosis of TPE was evaluated using receiver operating characteristic (ROC) curve analysis. The results of the 11 immunological methods evaluated showed that the anti-PPD IgG2 method was able to reach the highest specificity of 95% (CI: 88.3-101.8), positive predictive value (PPV)=75 (at 30% sensitivity); while that the overall sensitivity of methods was between 95% and 30%, of these, two methods reached higher sensitivities; increased levels of pleural IFN-g, with a sensitivity of 95% (CI: 85.5-104.5) with the highest negative predictive value (NPV)=97, (at 82.5% specificity), followed by decreased levels of serum IL-12p40 with a sensitivity of 95% (CI: 85.5-104.5), NPV=95.2 (at 50% specificity). In contrast, microbiological methods showed that smear had a sensitivity of only 20%, while smear plus ...

Recientemente existe un gran interés hacia un mejor y más rápido diagnóstico de tuberculosis (TB), especialmente de tuberculosis pleural, el cual es difícil. Al presente las principales herramientas diagnósticas son la baciloscopia y el cultivo de líquido pleural; desafortunadamente, las sensibilidades de estos métodos son bajas, por lo que el desarrollo de nuevas herramientas diagnósticas es necesario. El objetivo del presente estudio consistió en encontrar un algoritmo que permita la rápida identificación de la mayoría de los pacientes con TB pleural que ingresan en el Hospital Vargas de Caracas a un buen costo-beneficio. Para esto se evaluaron los niveles de las citocinas Interferón-gamma (IFN-g) y la Interleucina 12p40 (IL-12p40) en líquido pleural y suero, así como la reactividad de anticuerpos contra antígenos de Mycobacterium tuberculosis. Se estudiaron 60 individuos con derrame pleural; 20 individuos con líquido pleural tuberculoso (LPT) conformaron el grupo de pacientes y 40 individuos con líquido pleural no tuberculoso (LPNT) el grupo de controles. La técnica de inmunoensayo de ELISA fue utilizada para medir los niveles de IFN-g y IL-12p40; así como las reactividades de los diversos isotipos y subclases de inmunoglobulina G (IgG) frente a antígenos del bacilo. La utilidad de los métodos fue evaluada utilizando el análisis de las curvas ROC (receiver operating characteristic). Los resultados de los 11 métodos inmunológicos evaluados mostraron que el método IgG2 anti-PPD alcanzó la mayor especificidad de 95%, (CI: 88,3-101,8) con un valor predictivo positivo (VPP) de 75. La sensibilidad de los métodos estuvo entre 30% y 95%; dos métodos alcanzaron altas sensibilidades: los altos niveles de IFN-g en líquido pleural, con sensibilidad de 95% (CI: 85,5-104,5), con un valor predictivo negativo (VPN) de 97, seguido de los bajos niveles de IL-12p40 en suero, con una sensibilidad de 95% (CI: 85,5-104,5) con un VPN de 95,2. En contraste, ...

Clinical Value of Vascular Endothelial Growth Factor Combined with Interferon-γ in Diagnosing Malignant Pleural Effusion and Tuberculous Pleural Effusion / 华中科技大学学报（医学）（英德文版）

In order to investigate the clinical value of vascular endothelial growth factor (VEGF) combined with interferon-γ (IFN-γ) in diagnosing malignant pleural effusion and tuberculous plearal effusion, 42 cases of malignant pleurai effusion and 45 cases of tuberculous plcural effusion in Tongji Hospital, from March 2004 to May 2005, were included. The carcinoembryonic antigen (CEA), VEGF and IFN-γ levels of pleural effusion were detected by using ELISA, and adenosine deaminasc (ADA) activity was determined by using enzyme kinetic analytical method. The sensitivity, specific-ity, accuracy and area under the curve (AUCROC) of CEA and VEGF, VEGF/IFN-γ ratio, ADA and IFN-γ were measured by receiver operating characteristic curve (ROC). The results showed that CEA, VEGF levels and VEGF/IFN-γ ratio were significantly higher and the ADA and IFN-γ levels were significantly lower in malignant group than those in tuberculous group (P<0.01). The sensitivity, specificity, accuracy and AUCROC of VEGF/IFN-γ ratio (88.7%, 99.8%, 94.4%, 0.96 respectively) were higher than those of CEA (67.8%, 96.1%, 82.4%, 0.78 respectively) and VEGF (81.5%, 84.3%,82.9%, 0.79 respectively). The sensitivity, specificity, accuracy and AUCROC of IFN-γ (85.7%, 96.4%,90.9%, 0.94 respectively) were higher than those of ADA (80.2%, 87.6%, 83.8%, 0.81 respectively).It was concluded that VEGF/IFN-γ ratio and IFN-γ could be used as valuable parameters for the dif-ferential diagnosis of malignant pleural effusion and tuberculous pleural effusion.

A Case of Tuberculous Pleural Effusion Developed after Percutaneous Needle Biopsy of a Solitary Pulmonary Nodule / 결핵및호흡기질환

A tuberculous pleural effusion may be a sequel to a primary infection or represent the reactivation of pulmonary tuberculosis. It is believed to result from a rupture of a subpleural caseous focus in the lung into the pleural space. It appears that delayed hypersensitivity plays a large role in the pathogenesis of a tuberculous pleural effusion. We encountered a 52 years old man with pleural effusion that developed several days after a CT guided percutaneous needle biopsy of a solitary pulmonary nodule. He was diagnosed with TB pleurisy. It is believed that his pleural effusion probably developed due to exposure of the parenchymal tuberculous focus into the pleural space during the percutaneous needle biopsy. This case might suggest one of the possible pathogeneses of tuberculous pleural effusion.

The Utility of Pleural Adenosine Deaminase for Diagnosis of Differentiating Tuberculous Pleural Effusion in Children / 소아알레르기및호흡기학회지

PURPOSE: The aim of this study is to evaluate the value of pleural adenosine deaminase (ADA) in differentiating tuberculous pleural effusion from non tuberculous pleural effusion of children. METHODS: We measured pleural ADA activity in patients with pleural effusion whose age were from seven months to seventeen years from January 1995 to October 2001. By some criteria the patients were grouped to tuberculous pleural effusion, bacterial effusion, mycoplasma effusion, malignant effusion, and other effusion. RESULTS: The mean pleural ADA activity in tuberculous pleural effusion was 86.2+/-27.3 U/L. Pleural ADA activities in bacterial effusion, mycoplasma effusion, malignant effusion, other effusion were 32.6+/-20.1, 22.1+/-15.4, 23.1+/-10.9, 36.7+/-28.4 U/L, respectively. Pleural ADA activity in tuberculous pleural effusion was significantly higher than in any other group(P<0.001). At a level of 50 U/L, the sensitivity, specificity, positive predictive value (ppv), and and negative predictive value(npv) for the identification of tuberculous pleural effusion from nontuberculous pleural effusion were calculated at 93.8%, 84.8%, 81.1%, 95.1%, respectively. CONCLUSION: Pleural ADA is a useful test in the diagnosis of tuberculous pleural effusion of children from nontuberculous pleural effusion.

Relationship Between Age and Pleural Fluid Adenosine Deaminase Activity in Patients with Tuberculous Pleural Effusion / 결핵

BACKGROUND: ADA is an enzyme found in most cells, and is involved in purine metabolism, but its chief role concerns the proliferation and differentiation of lymphocytes, especially T-lymphocytes. For that reason ADA has been looked on as a marker of cell-mediate immunity, which is th key mechanism of the tuberculous pleural effusion. Thus, the pleural fluid ADA activity is increased in the tuberculous pleural effusion.Age associated immune deline is characterized by decreases in both B and T-lymphocyte function and the former may be largely a result of the latter. Therefore, the epleural fluid ADA activity would be lower in old rather than in young, patients with tuberculous pleural effusion. We studied the relationship between age, and pleural fluid ADA activity, in patients with tuberculous pleural effusion. METHODS: In the 46 patients with tuberculous pleural effusion enroll in this study, the pleural fluid ADA activities were measured by means of an automated kinetic method. RESULTS: The mean age of the patients was 53.0+/-22.0 years, with a male to female ratio of 30 : 16. The patients were divided into two groups, young patients, regarded as or=65 years with 28 and 18 patients, respectively. The pleural fluid ADA activity in both groups show significant differences : 99.4+/- 22.6 IU/L(young patients) Vs. 75.8+/-30.9 IU/L(old patients)(p<0.05), but a negative correlation with age (r=-0.311, p<0.05). CONCLUSION: Although pleural fluid ADA activity was not adequately increase, tuberculous pleural effusion, in older patients, would have to be considered clinically suspicious tuberculous pleural effusion.

Relationship Between Age and Pleural Fluid Adenosine Deaminase Activity in Patients with Tuberculous Pleural Effusion / 결핵

BACKGROUND: ADA is an enzyme found in most cells, and is involved in purine metabolism, but its chief role concerns the proliferation and differentiation of lymphocytes, especially T-lymphocytes. For that reason ADA has been looked on as a marker of cell-mediate immunity, which is th key mechanism of the tuberculous pleural effusion. Thus, the pleural fluid ADA activity is increased in the tuberculous pleural effusion.Age associated immune deline is characterized by decreases in both B and T-lymphocyte function and the former may be largely a result of the latter. Therefore, the epleural fluid ADA activity would be lower in old rather than in young, patients with tuberculous pleural effusion. We studied the relationship between age, and pleural fluid ADA activity, in patients with tuberculous pleural effusion. METHODS: In the 46 patients with tuberculous pleural effusion enroll in this study, the pleural fluid ADA activities were measured by means of an automated kinetic method. RESULTS: The mean age of the patients was 53.0+/-22.0 years, with a male to female ratio of 30 : 16. The patients were divided into two groups, young patients, regarded as or=65 years with 28 and 18 patients, respectively. The pleural fluid ADA activity in both groups show significant differences : 99.4+/- 22.6 IU/L(young patients) Vs. 75.8+/-30.9 IU/L(old patients)(p<0.05), but a negative correlation with age (r=-0.311, p<0.05). CONCLUSION: Although pleural fluid ADA activity was not adequately increase, tuberculous pleural effusion, in older patients, would have to be considered clinically suspicious tuberculous pleural effusion.

Study on the cellular morphism in tuberculous pleural effusion

A study of 284 patients with tuberculous pleural effusions cytologically diagnosed by smears stained with giemsa common method allowed distinguishing two groups: typical and untypical patients. Typical tuberculous pleural effusions were characterized by the presence of lymphocytes, typical characterized by the presence of lymphocytes, typical Langhans and/or epithelioid cells, typical caseum and other products and a few number of neutrophils. Untypical tuberculous pleural effusions were marked by the preponderance of lymphocytes, the complete degeneration of neutrophil, the presence of macrophages, lipophages, untypical Langhans and epithelioid cells, and of minor but clear caseum and other degeneration elements, no common bacteria on smears. With these criteria, the true of cytodiagnosis in comparison with histophatology was 80%.