Authors: Zemlin, A.E.¹; Burgess, L.J.²; Carstens, M.E.²

Source: The International Journal of Tuberculosis and Lung Disease, Volume 13, Number 2, February 2009 , pp. 214-220(7)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

SETTING: Pleural adenosine deaminase (ADA) levels have been found to be useful in diagnosing tuberculous pleuritis. Elevated ADA levels have been attributed to ADA₂ isoenzyme, although no comprehensive studies have evaluated ADA₂ as a diagnostic test.

OBJECTIVE: To estimate the diagnostic accuracy of ADA and ADA₂ in diagnosing tuberculous pleurisy.

METHOD: A 3-year retrospective study was carried out. ADA and ADA₂ were determined on patients diagnosed according to predetermined criteria.

RESULTS: A total of 951 samples were received, including 387 patients with tuberculosis (TB). ADA values ≥52.4 U/l yielded a sensitivity, specificity and positive (PPV) and negative predictive value (NPV) respectively of 93.7% (95%CI 90.0-96.0), 88.7% (95%CI 85.7-91.3), 85.5% (95%CI 81.7-88.8) and 95.2% (95%CI 92.9-96.9). ADA₂ values ≥40.6 U/l yielded a sensitivity, specificity and PPV and NPV of respectively 97.2% (95%CI 95.0-98.7), 94.2% (95%CI 91.8-96.0), 92.2% (95%CI 89.1-94.7) and 98.0% (95%CI 96.3-99.0). The χ² and McNemar tests proved the superiority of ADA₂ statistically.

CONCLUSION: ADA₂ is superior to ADA in the diagnosis of tuberculous pleuritis and should be used as a routine test in the diagnostic work-up of patients with pleural effusions in areas with high TB prevalence.

Keywords: tuberculous effusions; adenosine deaminase; isoenzymes

Document Type: Regular paper

Affiliations: 1: Division of Chemical Pathology, National Health Laboratory Service, Tygerberg Hospital, Stellenbosch University, Parow, Tygerberg, South Africa 2: TREAD Research/Cardiology Unit, Department of Internal Medicine, Tygerberg Hospital, Stellenbosch University, Parow, Tygerberg, South Africa

Publication date: 2009-02-01

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• The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

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