Diagnostic significance of ascites adenosine deaminase levels in suspected tuberculous peritonitis in adults

Amaç: Tüberküloz peritonit hastalarında adenozin deaminaz’ın (ADA) tanısal belirteç olarak kullanımı hakkında çelişkili raporlar vardır. Nepal’de erişkinlerde tüberküloz peritonit tanısında ADA aktivitesinin değerini araştıran bir çalışma bulunmamaktadır. Bu nedenle şüpheli tüberküloz peritonit hastalarında asit sıvıda ADA düzeylerini araştırmak ve istatistiksel olarak bu testin tanısal önemini belirlemek için yola çıktık.Yöntemler: Çalışmaya alınan hastalar iki farklı erişkin hasta grubundan oluşmaktaydı. Grup I; 35 şüpheli tüberküloz peritonit olgusu, ve Grup II; transüdatif asitli 35 hastanın oluşturduğu kontrol grubu (transüda olduğu biyokimyasal olarak kanıtlanmış veya hipoproteinemisi olan hastalar) çalışmaya dahil edildi ve periton sıvıları alındı. ADA ölçümü spektrofotometri ile yapıldı.Bulgular: ADA düzeyleri (ortalama ± SS)şüpheli tüberküloz peritonit ve transudatif asit olgularında, sırasıyla, 48,5 ± 17,9 U/L ve 19,8 ± 7,7 U/L idi (P

Anahtar Kelimeler:

adenozin deaminaz, duyarlılık, özgüllük, tanısal değer; peritonit tüberküloz

Diagnostic significance of ascites adenosine deaminase levels in suspected tuberculous peritonitis in adults

Objectives: There are contradictory reports about the use of adenosine deaminase (ADA) as a diagnostic marker in tuberculous peritonitis patients. Reports evaluating significance of ADA activity in the diagnosis of tuberculous peritonitis in adults are lacking in Nepal. We thus set out to investigate the ascitic fluid ADA levels in suspected tuberculous peritonitis patients and to determine the diagnostic significance of the test statistically. Materials and Methods: This study population comprised of two different adult patients groups. Group I - 35 suspected cases of tuberculous peritonitis and Group II - 35 cases of transudative ascites - the control group (patients with biochemically proved transudates or hypoproteinaemia) and peritoneal tap was done. ADA estimation was carried out by spectrophotometry. Results: ADA levels (Mean ± SD) in suspected tuberculous peritonitis and transudative ascites cases were 48.5 ± 17.9 U/L and 19.8 ± 7.7 U/L respectively (P<0.001). In the receiver operating characteristic (ROC) curve for ascites, ADA cut-off level of 41.5 U/L was found to yield the best results of differential diagnosis; sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the test in tuberculous peritonitis cases were 80.0%, 97.2 %, 96.6%, 82.9%, 88.6% respectively. Conclusion: ADA levels are elevated in suspected tuberculous peritonitis cases and it is a simple, rapid, inexpensive and the least invasive test. It is thus a useful biochemical marker for the early diagnosis of tuberculous peritonitis while waiting for the results of mycobacterial cultures or biopsies.

Keywords:

adenosine deaminase sensitivity, specificity, diagnostic significance, tuberculous peritonitis,

PDF

___

Van der Weyden MB, Kelley WN. Human adenosine de- aminase. Distribution and properties. J Biol Chem 1976;251:5448-5456.
Boonyagars L, Kiertiburanakul S. Use of adenosine deami- nase for the diagnosis of tuberculosis: a review. J Infect Dis Antimicrob Agents 2010;27:111-118.
Dinnes J, Deeks J, Kunst H, et al. A systematic review of rapid diagnostic tests for the detection of tuberculous infection. Health Technol Assess 2007;11:1-106.
Segura RM, Pascual C, Ocana I, et al. Adenosine deaminase in body fluid: a useful diagnostic tool in tubercuosis. Clin Bio- chem 1989;22:141-148.5.
Ocana I, Martinez Vazquez JM, Ribera E, et al. Adenosine deaminase activity in the diagnosis of lymphocytic pleural ef- fusions of tuberculous, neoplastic and lymphomatous origin. Tubercle 1986;67:141-145.
Banales JL, Pineda PR, Fitzgerald JM, et al. Adenosine de- aminase in the diagnosis of tuberculous effusions: a report of 218 patients and review of the literature. Chest 1991; 99:355-357.
Ribera E, Martinez-Vazquez JM, Ocana I, et al. Activity of for the diagnosis and follow up of tuberculous meningitis in adults. J Infect Dis 1987;155:603-607.
Pettersson T, Klockars M, Weber TH, Somer H. Diagnostic value of cerebrospinal fluid adenosine deaminase determi- nation. Scand J Infect Dis 1991;23:97-100.
Voigt MD, Kalvaria I, Trey C, et al. Diagnostic value of asci- tes adenosine deaminase in tuberculous peritonitis. Lancet 1989;1:751-754.
Dwivedi M, Misra SP, Misra V, Kumar R. Value of adenosine deaminase estimation in the diagnosis of tuberculous asci- tes. Am J Gastroenterol 1990; 85:1123-1125.
Bhargawa DK, Gupta M, Nijhawan S, et al. Adenosine deami- nase in peritoneal tuberculosis : diagnostic value in ascitic fluid and serum. Tubercle 1990;71:121-126.
Greco S, Girardi E, Masciangelo R, et al. Adenosine deami- nase and interferon gamma measurements for the diagnosis of tuberculous pleurisy: a meta-analysis. Int J Tuberc Lung Dis; 7:777-786.
Kaur A, Basha A, Ranjan M, Oommen A. Poor diagnostic val- ue of adenosine deaminase in pleural, peritoneal and cere- brospinal fluids in tuberculosis. Ind J Med Res 1992;95:270- 277.
Malan C, Donald PR, Golden M, Taljaard JJ. Adenosine de- aminase levels in cerebrospinal fluid in the diagnosis of tu- berculous meningitis. J Trop Med Hyg 1984;87:33-40.
Maartens G, Bateman ED. Tuberculous pleural effusions; in- creased culture yield with bedside inoculation of pleural fluid and poor diagnostic value of adenosine deaminase. Thorax 1991;46:96-99.
http://www.tradingeconomics.com/Nepal/incidence-of-tuber- culosis-per-100-000-people-wb-data.html.
Giusti G, Galanti B. Colorimetric method. In: Bergmeyer HU, editor. Methods of enzymatic analysis, 3rd ed. Wienheim: Verlag Chemie; 1984, p. 315-323.
Kosseifi S, Hoskere G, Roy TM, et al. Peritoneal tubercu- losis: modern peril for an ancient disease. South Med J 2009;102:57-59.
Chow KM, Chow VC, Hung IC, et al. Tuberculous peritonitis- associated mortality is high among patients waiting for the results of mycobacterial cultures of ascitic fluid samples. Clin Infect Dis 2002;35:409-413.
Marshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol 1993;88:989-999.
Sanai FM, Bzeizi KI. Systematic review: tuberculous peritoni- tis - presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther 2005;22:685-700.
Akhan O, Pringot J. Imaging of abdominal tuberculosis. Eur Radiol 2002;12:312-323.
Gupta VK, Mukerji S, Dutta SK. Diagnostic evaluation of ADA in tuberculous peritonitis. JAPI 1992;40:387-389.
Agarwal S. Study of adenosine deaminase activity as a bio- chemical marker of cell mediated immunity in tuberculous meningitis, tuberculous pleural effusions and tuberculous ascites. J Medicine 2012;13:32-38.
Riquelme A, Calvo M, Salech F, et al. Value of adenosine deaminase (ADA) in ascitic fluid for the diagnosis of tubercu- lous peritonitis: A meta-analysis. J Clin Gastroenterol 2006; 40:705-710.