Diagnostic value of serum adenosine deaminase levels in sputum smear negative pulmonary tuberculosis patients in Nepalese population

Objective: To assess the levels of adenosine deaminase (ADA) in serum in patients with sputum smear negative pulmonary tuberculosis (SNPTB) and to compare it with serum ADA levels in patients with non-tuberculous pulmonary disease - chronic obstructive pulmonary disease (COPD) and with healthy control group and to explore its validity as a diagnostic marker in serum in SNPTB patients.Methods:Three groups of study populations were made. Group I: SNPTB - 142 cases, Group II:non-tubercular pulmonary disease - COPD - 40 cases, Group III: healthy controls - 80 cases. Serum samples were collected and ADA assay was done by the method of Guisti and Galanti. Results: ADA levels (Mean±SD, U/L) in the three groups were as follows: Group I: 42.26±21.22, Group II: 23.31±8.22, Group III: 18.88±6.67. Difference between Group I and Group III was statistically significant (P < 0.0001). The test showed a high specificity 91.25% (95% confidence interval - CI 83.00 - 95.7) and a sensitivity of 83.10% (95% CI 76.08-88.37) in Group I. Positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and accuracy in Group I were 94.00%, 69.52%, 9.49, 0.18 and 82.43% respectively.Conclusions: Overall assessment of the use of serum ADA levels as a diagnostic biochemical marker in smear-negative pulmonary tuberculosis patients showed promising results. Studies with a larger population group are required to validate its use as a routine diagnostic test in these cases.

Evidence for HIV-2 infection in Nepal.

Assessment of the presence and prevalence of HIV-2 antibodies in patients attending the Universal College of Medical Sciences Teaching Hospital, Bhairahawa, western Nepal was done. A total of 1534 patients sera were screened for the presence of HIV-1 and HIV-2 antibodies from March 2000 to May 2003. A total of 3 (0.2%) patients were found to be sero-positive for HIV-2 antibodies. Out of the above three patients, 1 (0.1%) was infected with HIV-2 only and the remaining 2 (0.1%) were infected with HIV-1 and HIV-2 both. This evidence of the presence of HIV-2 presence implicates serious outcomes as HIV-2 has not been reported from hospital patients in Nepal.

Status of infectious disease markers among blood donors in a teaching hospital, Bhairahawa, western Nepal.

A cross-sectional group of 1548 blood donors (voluntary--554 and replacement--994 blood donors) during the period February 2001 to April 2003 at Blood Bank Centre (being run by Nepal Red Cross Society) in our Teaching Hospital in Bhairahawa, were studied and screened for antibodies to Human immunodeficiency virus type 1 and type 2 (HIV- 1 & 2), Hepatitis C virus (HCV) and hepatitis B surface antigen (HBsAg) by enzyme immunoassays and for reagin antibody for syphils by (Rapid Plasma Reagin, RPR) flocculation method. The results revealed that the overall prevalence of anti-HIV-1 was 0.13%, anti-HCV--0.13%, HBsAg positivity--0.45% and RPR reactivity for syphilis was 0.39%. HIV and HCV seropositivity was 0.20% and 0.20% respectively among replacement blood donors. None of the voluntary blood donors were found to be seropositive for HIV and HCV antibodies. HBsAg seropositivity was found to be higher among replacement (0.50%) than voluntary blood donors (0.36%). Voluntary blood donors showed a higher RPR seropositivity (0.72%) than replacement blood donors (0.20%). Males constituted 1418 (91.6%) and females were 130 (8.4%) of the total blood donors studied. The highest numbers of blood donors were in the age group of 15-29 years, both for males 902 (58.27%) and females 96 (6.2%). All the seventeen seropositive cases for all the infectious disease markers studied belonged to the sexually active and productive age group of 15-45 years and all seropositives were males except one female case (i.e HBsAg positive). One blood donor was found to be seropositive for both HIV-1 and HCV infections. None was found to be seropositive for HIV-2. Blood group status was also examined for all the blood donors tested. Maximum numbers of blood donors belonged to blood group O--516 (33.33%), followed by B 497 (32.11%), A 407 (26.29%) and AB 128 (8.27%). None of the seropositive blood donor was found to belonged to blood group AB.