Title: Utility of serum ADA estimation in the diagnosis of extrapulmonary tuberculosis
Authors: Prashant Chikkahonnaiah, Surabhi Jaggi, Bela Goyal, Kranti Garg, Seema Gupta, Shivani Jaswal, Kamaljeet Kaur
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.52
Abstract
Background: Adenosine deaminase (ADA) has largely been studied in body fluids for the diagnosis of extra pulmonary tuberculosis (EPTB). Serum ADA has been used as non-invasive assay for Pulmonary TB. The aim of the present study was to test the utility of serum ADA for the diagnosis of EPTB.
Methods: A retrospective analysis of serum ADA values from 122 patients was carried out. The patients were divided into three groups based on their diagnosis i.e. Group A: pulmonary TB patients, group B: Extra pulmonary TB patients and Group C: patients with other respiratory illnesses. Nonparametric tests were performed to compare the groups. Receiver operating curve was plotted to determine the cut-off for knowing the sensitivity and specificity of serum ADA.
Results: The mean serum ADA levels in patients of TB showed significantly higher values than disease controls (other respiratory illnesses). Although, the levels of mean ADA were higher in group B as compared to group A, it was not statistically significant. ROC showed sensitivities of 73.7% and 89.5% for group A and group B respectively at the cut-off of 17.5 and a high AUC of 0.814 and 0.945 for group A and group B respectively when compared to disease controls (group C).
Conclusions: Serum ADA has a potential to be used as surrogate marker for the diagnosis of sputum smear negative and extra pulmonary TB.
Keywords- Serum Adenosine deaminase, Pulmonary tuberculosis, Extra pulmonary tuberculosis.
References
1. WHO. Global tuberculosis report 2013. Tuberculosis -epidemiology. WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland. 2013: 1-11.
2. Purohit M, Mustafa T, Laboratory Diagnosis of Extra-Pulmonary Tuberculosis (EPTB) In Resource - Constrained Setting: State of The Art, Challenges And The Need, Journal of Clinical And Diagnostic Research, Apr 2015; 9(4):EE01-EE06.
3. Harries AD, Gausi F, Chimzizi R, Salaniponi FM. Characteristics and outcome of tuberculosis patients whose sputum smears are positive at or after 5 months of treatment. Int J Tuberc Lung Dis. 2004 Mar;8(3):384-7.
4. Greco S, Girardi E, Masciangelo R et al Adenosine Deaminase and interferon gamma measurements for the diagnosis of tuberculous pleurisy: a metaanalysis. Int J Tuberc Lung Dis 2003; 7 (8): 777-86.
5. Piras MA, Gakis C, Budroni M, Andreoni G. Adenosine deaminase activity in pleural effusions: An aid to differential diagnosis. Br Med J. 1978; 2:1751–2.
6. Tuon FF, Silva VI, Almeida GM, Antonangelo L, Ho YL. The usefulness of adenosine deaminase in the diagnosis of tuberculous pericarditis. Rev Inst Med Trop Sao Paulo. 2007;49:165–70.
7. Saleh MA, Hammad E, Ramadan MM, Abd El-Rahman A, Enein AF. Use of adenosine deaminase measurements and QuantiFERON in the rapid diagnosis of tuberculous peritonitis. J Med Microbiol. 2012;61:514–9.
8. Kuyucu N, Karakurt C, Bilaloğlu E, Karacan C, Teziç T. Adenosine deaminase in childhood pulmonary tuberculosis: Diagnostic value in serum. J Trop Pediatr. 1999; 45:245–7.
9. Barua R, Hossain M. Adenosine deaminase in diagnosis of tuberculosis: a review. Anwer Khan Mod Med Coll J. 2014; 5:43–8.
10. Salmanzadeh S, Tavakkol H, Bavieh K, Alavi SM. Diagnostic Value of Serum Adenosine Deaminase (ADA) Level for Pulmonary Tuberculosis. Jundishapur J Microbiol. 2015;8(3):e21760
11. Afrasiabian S,Mohsenpour B, Bagheri KH, Sigari N, Aftabi K. Diagnostic value of serum adenosine deaminase level in pulmonary tuberculosis, J. Res. Med. Sci. 18 (3 (March)) (2013) 252–254.
12. Atta S, Kassem A, Elhadidi A, El Esawy H. The diagnostic value of adenosine deami-nase activity in pulmonary tuberculosis: Comparison between sputum and serum. Egypt J Chest Dis Tuberc.2015;64:103–107.
13. Farazi A, Moharamkhani A, Sofian M. Validity of serum adenosine deaminase in diagnosis of tuberculosis. Pan Afr Med J. 2013; 15:133.
14. Agarwal MKN, Mukerji PK, Srivastava VML. A study of serum adenosine deaminase activity in sputum negative patients of pulmonary tuberculosis. Ind L Tub. 1991; 38:139.
15. Chander A, Shrestha CD. Diagnostic Value of Serum Adenosine Deaminase Levels in Sputum Smear Negative Pulmonary Tuberculosis Patients In Nepalese Population, Asian Pacific Journal of Tropical Biomedicine, 2012: S1896 - S1899.