Serum adenosine deaminase [ADA] level in the cases of tuberculous pleural effusion

ABSTRACT

Pleural biopsy is conventionally considered as a sole important procedure for the diagnosis of tuberculous pleural effusion even though pleural fluid contain sensitive biochemical markers like adenosine deaminase [ADA] gamma interferon and tumour necrosis factor. This prospective study was conducted at Nishtar Hospital, Multan. The objective of the study was to assess the value of adenosine deaminase activity for the diagnosis of tuberculous pleural effusion without performing needle pleural biopsy. Sixty patients with history and clinical examination suggestive of tuberculous pleural effusion admitted in four medical units and chest unit of Nishtar Hospital, Multan were included in this study and these were labeled as group-I. In addition as a control of study, the pleural fluid was also aspirated in 20 selected patients having transudative pleural effusion secondary to congestive cardiac failure and cirrhosis of liver, denoted as group-II. The selection criteria for the patients was the history, clinical examination and lymphocytic exudative pleural effusion. Pleural biopsy was performed in all the patients of group-I and ADA activity in the pleural aspirate of all the subjects of group-I and group-II was estimated by Giusti G method1. The ADA activity was compared in both the groups by setting a cut off value 40 U/L. The results were statistically analyzed by applying chi square test. The ADA activity of the group-I was 40.2 + 10.82 U/L while that of group-II was 24 + 11 U/L. Thirty three in group-I and one of group-II had ADA activity above cut off value. The p value was <0.001. The results of this study favor the application of ADA activity in pleural fluid as the diagnostic tool for tuberculous pleural effusion without performing an invasive procedure like the pleural biopsy