Usefulness of adenosine deaminase dosing in the diagnosis of pleural tuberculosis
First national experience
Abstract
Background: bacteriology of pleural liquid (LP) for diagnosis of pleural tuberculosis (TBP) is slow and has low sensitivity; the biopsy of highest performance is expensive and cruel. Although adenosine deaminase (ADA) has been described as a valuable tool for diagnosis of LP, there is a lack of information and experience in our country.
Objective: to validate ADA dosage in LP for diagnosis of TBP.
Methods: ADA dosage using Giusti technique in 113 exudates of LP from 66 suspected carriers of TPB (group gTPB) with bacteriology, and 47 patients with non tuberculosis causes (control group gC). Cut point was 40 U/l.
Results: twelve patients of the gTBP showed ADA higher than 40 U/l; diagnosis TBP was done for 8 patients. For the specific cut point, ADA showed: 100% sensitivity; 93% specificity; PPV: 67%; PNV: 100%. In gC (n = 47), four samples showed ADA higher than 40 U/l (one thymona, one lymphoma, and two empyemas).
Conclusions: ADA in LP is a sensitive and specific technique for diagnosing TBP, with high PNV. It decreases rates of byopsy and reduces time of diagnosis; it is a simple and a cheap technique. Other diseases that increase ADA in LP should be considered in the analysis of the results.
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