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Free Content Adenosine deaminase activity and its isoenzymes in the sputum of patients with pulmonary tuberculosis

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BACKGROUND: Adenosine deaminase (ADA) has been widely used for the diagnosis of tuberculous pleural effusion. Two isoenzymes have been described, ADA1 and ADA2.

OBJECTIVE: To evaluate the diagnostic value of sputum ADA, ADA1 and ADA2 activity in pulmonary tuberculosis (TB).

DESIGN: We measured total ADA, ADA1 and ADA2 activity in the sputum of 27 patients with pulmonary TB (11 had a negative Ziehl-Neelsen stain for acid-fast bacilli [AFB]). Nineteen patients with lung cancer were used as controls.

RESULTS: Sputum total ADA activity was significantly higher in TB than in lung cancer patients (median 18 U/l [range 3–70] vs. 6 U/l [2–16]; P < 0.001). Sputum ADA2 activity was significantly higher in TB compared to lung cancer patients (9 U/l [0–65] vs. 5 U/l [0–12]; P = 0.001). Sputum ADA2 was significantly higher than ADA1 in TB patients (P = 0.001). Sputum ADA and ADA2 were higher in both AFB-positive and AFB-negative TB patients. Using a cut-off level of respectively 16 UI/l and 5UI/l for sputum total ADA and ADA2, sensitivity and specificity were 55.6% and 100% for total ADA and 81.5% and 63.2% for ADA2.

CONCLUSION: Sputum total ADA and ADA2 levels are elevated in patients with pulmonary TB. As they are elevated even in AFB-negative patients, they may assist in the early diagnosis of pulmonary TB.

Keywords: ADA; sputum; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Sixth Department of Respiratory Medicine, Sotiria Chest Hospital, Athens, Greece 2: Department of Respiratory and Critical Care Medicine, Sotiria Chest Hospital, Athens, Greece

Publication date: June 1, 2009

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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.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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