Title: Role of Adenosine Deaminase and Lymphocyte/Neutrophil Ratio in the Diagnosis of Tuberculous Pleural Effusion in Patients with Exudative Pleural Effusion
Authors: Dr Avala Tejaswi, Dr K. Sudheer, Dr B. Ashokbabu
DOI: https://dx.doi.org/10.18535/jmscr/v11i3.09
Abstract
Background: Pulmonary tuberculosis is the most common cause of death by an infectious agent worldwide. Failure to diagnose and treat pleural TB can result in progressive disease with the involvement of other organs in as many as 65% of patients.
Objectives: To evaluate the role of ADA and L/N ratio in the diagnosis of tuberculous pleural effusion in patients with exudative pleural effusion.
Materials & Methods: Statistical analysis carried out in hospitalized 60 consecutive patients with exudative effusion admitted in medical wards are taken in this study of age >12 years were included. Patients with immunodeficient states and on chemotherapy excluded.
Results: Out of 60 exudative effusions, males are more effected thanf emales (69.1%, females-30.9%).Out of these 49 were diagnosed to have tuberculousetiology. Most common age group was 21-40yrs with mean 26.6 years.Pleuritic chest pain is most common symptom.Mean ESR as 57mm/hr.Total ADA was >40u/l in tuberculous effusion with mean 153.6u/l.
Conclusion: Increased ADA activity in pleural effusionis classically associated with tuberculosis. When the L/N ratio’s was considered together with ADA activity, the results improved considerably for the diagnosis of tuberculosis pleuritis.
References
- Seaton A, Seaton D, Leitch AG. Crofton and Doughlas’ Respiratory Diseases. 5th edition, 2008.
- Maarteens G, Bateman ED. Tuberculous pleural effusion: increased culture yield with bedside inoculation of pleural fliud and poor diagnostic value of adenosine deaminase. Thorax, 1991; 46(2): 96-99.
- Van Kennpema AR, Slaats EH, Wagenaar JP. Adenosine deaminase activity, not diagnostic for tuberculous pleurisy. Eur J Respire Dis., 1987; 71(1): 15-18.
- Burgess LJ, Maritz FJ, Le roux I, Taljaard JJ. Combined use of pleural adenosine deaminasewithc lymphocyte/neutrophil ratio increased specificity for the diagnosis of tuberculosis pleuritis. Chest, 1996; 109(2): 414-419
- Crofton and Doughlas, Respiratory diseases, Vol 2; 5th edition: 1050-51. Anthoni Seaton, Doughlasseaton, A Gordonleitch.
- Fishman’s Pulmonary diseases and disorders. Vol 1; 3rd edition: 1391-92. Alfred P. Fishman, Jack A, Elide,M.D., Jay A.Fishman,M.D., LawyR.Kaisari.
- Light, Richard W. Pleural Diseases, 5th Edition.
- Noppen M, De Waele M, Li R, et al. Volume and cellular content of normal pleural fluid in humans examined by pleural lavage. Am J Respir Crit Care Med 2000;162:1023-1026.
- Miserocchi G, Agostoni E. Contents of the pleural space. J Appl Physiol1971;30:208-213.
- Rolf LL, Travis DM. Pleural fluid-plasma bicarbonate gradients in oxygentoxic and normal rats. Am J Physiol1973;224:857-861.