SIGNIFICANCE OF ADENOSINE DEAMINASE IN DIAGNOSING TUBERCULOUS PLEURISY
ADENOSINE DEAMINASE IN DIAGNOSIS OF TUBERCULOUS PLEURISY
Abstract
Tuberculous pleurisy (TP) is one of the most common extra-pulmonary tuberculosis forms. Tuberculous pleurisy occurs when Mycobacterium tuberculosis antigen is released from a ruptured caseous focus into the pleural space causing hyperinflammatory response with a rapid influx of lymphocytes.
Acid-fast bacilli (AFB) staining, cultures and pathohistological biopsy finding are positive in most patients only in less than 10% of samples. Culture results take about 6-8 weeks which delays the diagnosis. A problem also occurs in the differentiation of effusions with lymphocytic predominance. Adenosine deaminase (ADA) is a biochemical marker with high sensitivity and specificity and is considered a gold standard within biomarkers when it comes to diagnosing TP. Using an algorithm for the values of ADA above or below 40 U/L we can distinguish this type of effusion from other types.
ADA in pleural punctate is a fast, efficient, and economical way for clarifying the etiology of a pleural effusion such as tuberculous pleurisy and treatment response during the follow up period.
References
1. Shaw JA, Koegelenberg CFN. Pleural Tuberculosis. Clin Chest Med. 2021;42(4):649-66. doi: 10.1016/j.ccm.2021.08.002.
2. World Health Organization. Global Tuberculosis Report 2019. [Internet] Geneva: World Health Organization. 2019. Available from: https://www.who.int/publications/i/item/9789241565714/.
3. Moule MG, Cirillo JD. Mycobacterium tuberculosis Dissemination Plays a Critical Role in Pathogenesis. Front Cell Infect Microbiol. 2020;10:65. doi: 10.3389/fcimb.2020.00065.
4. Shaw JA, Diacon AH, Koegelenberg CFN. Tuberculous pleural effusion. Respirology. 2019;24(10):962-71. doi: 10.1111/resp.13673.
5. Jankovic J, Jandric A, Jordanova E. Vanbolnički stečene pneumonije (community acquired pneumonia - CAP). Halo 194. 2022;28(3):82-7. doi: 10.5937/halo28-40900.
6. Porcel JM. Pleural fluid biomarkers: beyond the Light criteria. Clin Chest Med. 2013 Mar;34(1):27-37. Porcel JM. Pleural fluid biomarkers: beyond the Light criteria. Clin Chest Med. 2013;34(1):27-37. doi: 10.1016/j.ccm.2012.11.002.
7. Xi S, Sun J, Wang H, Qiao Q, He X. Diagnostic Value of Model-Based Iterative Algorithm in Tuberculous Pleural Effusion. J Healthc Eng. 2022;2022:7845767. doi: 10.1155/2022/7845767.
8. Popevic S, Ilic B. Brohoskopija u dijagnostici i lečenju endobronhijalne tuberkuloze. In: Stjepanović M, Popević S, Dimić-Janjić Sanja, editors. Odabrana poglavlja iz pulmologjje. Beograd: Medicinski fakultet Univerziteta u Beogradu; 2023.
9. Petborom P, Dechates B, Muangnoi P. Differentiating tuberculous pleuritis from other exudative lymphocytic pleural effusions. Ann Palliat Med 2020;9(5):2508-15. doi: 10.21037/apm-19-394.
10. Jeon D. Tuberculous pleurisy: an update. Tuberc Respir Dis (Seoul). 2014;76(4):153-9. doi: 10.4046/trd.2014.76.4.
11. Tousheed SZ, Ranganatha R, Kumar H, Sagar C, Manjunath PH, Philip D, et al. Yield of pleural biopsy in different types of tubercular effusions. Indian J Tuberc. 2020;67(4):523-7. doi: 10.1016/j.ijtb.
12. Lo Cascio CM, Kaul V, Dhooria S, Agrawal A, Chaddha U. Diagnosis of tuberculous pleural effusions: A review. Respir Med. 2021;188:106607. doi: 10.1016/j.rmed.2021.106607.
13. Ali MS, Light RW, Maldonado F. Pleuroscopy or video-assisted thoracoscopic surgery for exudative pleural effusion: a comparative overview. J Thorac Dis. 2019;11(7):3207-16. doi: 10.21037/jtd.2019.03.86.
14. Javadi J, Dobra K, Hjerpe A. Multiplex Soluble Biomarker Analysis from Pleural Effusion. Biomolecules 2020; 10(8):1113. doi: 10.3390/biom10081113.
15. Aggarwal AN, Agarwal R, Sehgal IS, Dhooria S. Adenosine deaminase for diagnosis of tuberculous pleural effusion: A systematic review and meta-analysis. PLoS One. 2019;14(3):e0213728. doi: 10.1371/journal.pone.0213728.
16. Jankovic J, Djurdjevic N, Jandric A, Mitic J, Bojic Z. Case Report of Rare Presentation Double Primary Tumor - Colon Carcinoma and Malignant Pleural Mesothelioma. JOJ Case Stud. 2022; 13(5): 555872. doi: 10.19080/JOJCS.2022.13.555872.
17. Lee J, Park JE, Choi SH, Seo H, Lee SY, Lim JK, et al. Laboratory and radiological discrimination between tuberculous and malignant pleural effusions with high adenosine deaminase levels. Korean J Intern Med. 2022;37(1):137-45. doi: 10.3904/kjim.2020.246.
18. Zeng T, Ling B, Hu X, Wang S, Qiao W, Gao L, et al. The Value of Adenosine Deaminase 2 in the Detection of Tuberculous Pleural Effusion: A Meta-Analysis and Systematic Review. Can Respir J. 2022;2022:7078652. doi: 10.1155/2022/7078652.
19. Shaw JA, Irusen EM, Diacon AH, Koegelenberg CF. Pleural tuberculosis: A concise clinical review. Clin Respir J. 2018;12(5):1779-86. doi: 10.1111/crj.12900.
20. Lin L, Li S, Xiong Q, Wang H. A retrospective study on the combined biomarkers and ratios in serum and pleural fluid to distinguish the multiple types of pleural effusion. BMC Pulm Med. 2021;21(1):95. doi: 10.1186/s12890-021-01459-w.
21. Jankovic J. Biomarkeri u dijagnostici pleuralnih izliva. U: Stjepanović M, Popević S, Dimić-Janjić Sanja, urednici. Odabrana poglavlja iz pulmologjje. Beograd: Medicinski fakultet u Beogradu; 2023.
22. Soedarsono S, Prinasetyo KWAI, Tanzilia M, Nugraha J. Changes of serum adenosine deaminase level in new cases of pulmonary tuberculosis before and after intensive phase treatment. Lung India. 2020;37(2):126-9. doi: 10.4103/lungindia.lungindia_395_19.
23. Jovanović D, Antonijević G, Luković B, Ilić B. Multirezistentna tuberkuloza i ekstenzivna multirezistentna tuberkuloza – klinička slika i dijagnostika. In: Jovanović D, editor. Klinički aspekti tuberkuloze. Beograd: Medicinski fakultet Univerziteta u Beogradu; 2020. p. 165-77.
