- Original Article
- Open access
- Published:
Diagnostic utility of serum adenosine deaminase level in the diagnosis of pulmonary tuberculosis
Egyptian Journal of Bronchology volume 10, pages 133–139 (2016)
Abstract
Aim of the work
This study was conducted to evaluate the role of serum adenosine deaminase (ADA) level in the diagnosis of pulmonary tuberculosis (TB) and its relationship with clinical, radiological, and laboratory parameters.
Patients and methods
This study was performed on 70 individuals: 60 patients with tuberculous and nontuberculous pulmonary diseases and 10 apparently healthy individuals as a control group. The participants were divided into four groups: group I included 30 patients with active pulmonary TB who were subdivided into group IA, which included 20 patients with sputum smear-positive pulmonary TB, and group IB, which included 10 patients with sputum smear-negative pulmonary TB (culture positive); group II included 10 patients with tuberculous pleural effusion; group III included 20 patients with nontuberculous lung diseases (five cases with pneumonia, five cases with pyogenic lung abscess, five cases with bronchiectasis, three cases with lung cancer, and two cases with mesothelioma); and group IV included 10 apparently healthy individuals as a control group. Patients were subjected to history taking, clinical examination, plain chest radiography posterior–anterior view, three consecutive sputum smears for acid-fast bacilli (AFB), sputum culture for AFB using BACTEC TB-460 system in group IB, laboratory investigations, tuberculin skin test, serum ADA level evaluation in all participants, and pleural ADA level evaluation in cases of tuberculous pleural effusion.
Results
Serum ADA showed high percentage positivity (90%) in the diagnosis of pulmonary TB, followed by tuberculin skin test (83.3%), chest radiography (73.3%), erythrocyte sedimentation rate (70%), sputum for AFB (66.6%), toxic symptoms (53.3%), and hemoptysis (36.3%). Serum ADA sensitivity and specificity at cut-off point 30.15 μ/l were 95 and 86.7%, respectively, with a positive predictive value of 90.5%, negative predictive value of 92.2%, and accuracy of 91.4%.
Conclusion
Serum ADA level shows higher percentage positivity compared with clinical, radiological, and laboratory parameters in the diagnosis of pulmonary TB.
References
Oxlade O, Schwartzman K, Behr MA. Global tuberculosis trends: a reflection of changes in tuberculosis control or in population health? Int J Tuberc Lung Dis 2009;13:1238–1246.
Kant L. Improving detection of infectious cases. Indian J Tuberc 2001;48:115–116.
Stead WW, Lofgren JP, Warren E, Thomas C. Tuberculosis as an endemic and nosocomial infection among the elderly in nursing homes. N Engl J Med 1985;312(23):1483–1487.
Raj B, Chopra RK, Lal H. Adenosine deaminase activity in pleural fluids – a diagnostic aid in tuberculous pleural effusion. Indian J Chest Dis Allied Sci 1998;27:76–80.
Bhargava DK, Gupta M, Nijhawan S, Dasarathy S, Kushwaha AK. Adenosine deaminase (ADA) in peritoneal tuberculosis: diagnostic value in ascitic fluid and serum. Tubercle 1990;71(2):121–126.
World Health Organization. WHO library cataloguing in publication data. Implementing the WHO stop TB strategy: a handbook for national tuberculosis control programs. Geneva, Switzerland: World Health Organization; 2008:17.
Rao KS, Kumar HA, Rudresh BM, T Srinivas, KH Bhat. A comparative study and evaluation of serum adenosine deaminase activity in the diagnosis of pulmonary tuberculosis. Biomed Res 2010;2:189–194.
Ganeswrie R, Chui CS, Balan S, Puthucheary SD. Comparison of BACTEC MGIT 960 system and BACTEC 460 TB system for growth and detection of Mycobacteria from clinical specimens. Malays J Pathol 2004;26(2):99–103.
Lardizabal AA, Reichman LB. Diagnosis of latent tuberculosis infection. Schlossberg D Tuberculosis. 5th ed. New York, NY: McGraw-Hill Press; 2006: 62–64.
Guisti G, Galanti B. Colorimetric method. Bergmeyer HU. Methods of enzymatic analysis. 3rd ed. Weinheim, Germany: Verlag Chemie; 1984: 315–323.
Mishra OP, Yusaf S, Ali Z, Nath G, Das BK. Adenosine deaminase activity and lysosyme levels in children with tuberculosis. J Tropical Pediatr 2013;46:175–178.
Ioanna Samarai, Petros Bakakos, D Orphanidou, P Latis, S Katsimpoula, Georgios S et al. Adenosine deaminase activity in patients with pulmonary tuberculosis and lung cancer. Adv Clin Exp Med 2007;16:533–535.
Hassanein K, Hosny H, Mohamed R, El-Moneim WA. Adenosine deaminase (ADA) in the diagnosis of pulmonary tuberculosis. EJB 2010;4:11–18.
Verma M, Narang S, Moonat A, Verma A. Study of adenosine deaminase activity in pulmonary tuberculosis and other common respiratory diseases. Indian J Clin Biochem 2004;19(1):129–131.
Chander A, Shrestha CD. Diagnostic value of serum adenosine deaminase levels in sputum smear negative pulmonary tuberculosis patients in Nepalese population. Asian Pac J Trop Biomed 2012;2: s1896–s1899.
Agarwal MK, Nath J, Mukerji PK, VML Srivastava. A study of serum adenosine deaminase activity in sputum negative patients of pulmonary tuberculosis. Indian J Tub 1991;38:139–141.
Conde MB, Marinho SR, Pereira-Mde F, JR Lapae-Silva, MH Saad, CL Sales et al. The usefulness of serum adenosine deaminase 2 (ADA-2) activities in adults for the diagnosis of pulmonary tuberculosis. Respir Med 2002;96:607–610.
Thora S, Rajsekaran P, Chhaparwal BC. Serum adenosine deaminase estimation in relation to BCG vaccination. Indian Pediatr 1995;32 (10):1087–1088.
Alatas F, Uslu S, Moral H, Aiatas O, Metintes M, Ergenil S et al. Serum adenosine deaminase activity in pulmonary tuberculosis. Tuberk Toraks 2003;51:277–281.
Lamsal M, Gautam N, Bhatta N, Majhi S, Baral N, Bhattacharya SK. Diagnostic utility of adenosine deaminase (ADA) activity in pleural fluid and serum of tuberculous and non-tuberculous respiratory disease patients. Southeast Asian J Trop Med Public Health 2007;38(2):363–369.
Jhamaria JP, Jenaw RK, Luh SK, Mathur DK, Parihar HL, Sharma SK. Serum adenosine deaminase (ADA) in differential diagnosis of pulmonary tuberculosis and common non tubercular respiratory diseases. Ind J Tub 1988;35:25–27.
Gupta S, Bhatia R, Datta KR. Serodiagnosis of tuberculosis. J Commun Dis 1995;27:208–214.
Author information
Authors and Affiliations
Corresponding author
Additional information
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Alaarag, A.H., Mohammad, O.I. & Farag, N.M. Diagnostic utility of serum adenosine deaminase level in the diagnosis of pulmonary tuberculosis. Egypt J Bronchol 10, 133–139 (2016). https://doi.org/10.4103/1687-8426.184369
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.4103/1687-8426.184369