Diagnostic Role of Adenosine Deaminase (ADA) among Tuberculous Meningitis Patients (original) (raw)
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Adenosine Deaminase Levels in CSF of Tuberculous Meningitis Patients
Background: Tuberculosis kills five lakh patients in India every year, out of which 7-12 % are with meningeal involvement. Delay in its diagnosis and in initiation of treatment results in poor prognosis and sequlae in up to 25% of cases. The aim of the present study is to look for a simple, rapid, cost effective, non-invasive and fairly specific test in differentiating tubercular etiology from other causes.
International Journal of Research in Medical Sciences, 2018
Background: Tuberculous meningitis is an important cause of morbidity and mortality in developing countries especially in India. The mortality associated with tuberculous meningitis is very high if not detected early and meticulous treatment is not given. CSF analysis and imaging are the most commonly used tools for diagnosis of meningitis. But these are often inadequate in making a definitive diagnosis. CSF Adenosine Deaminase estimation (ADA) is useful in differentiation of tuberculous meningitis from non-tuberculous meningitis. Though few studies have proved efficacy of Adenosine Deaminase level for the diagnosis, studies to assess the sensitivity and specificity of ADA levels were limited. This study was conducted to assess its usefulness and to validate the sensitivity and specificity of ADA level in tuberculous meningitis (TBM).Methods: This was a prospective study conducted at Academy of Medical Sciences, Pariyaram for a period of 18 months from December 2013 to June 2015, Ad...
Utility of ADA (Adenosine Deaminase) enzyme assay in diagnosis of tuberculous meningitis
IP Innovative Publication Pvt. Ltd., 2017
Introduction: Tuberculous meningitis (TBM) remains one of the leading causes of morbidity and mortality worldwide, including India. Treatment and prevention of TBM is depended on early and quality assured diagnosis. Earlier studies have showed that there is wide delay in diagnosing TBM. ADA is essential for proliferation and differentiation of lymphoid cells, especially T cells. ADA activity increases during activation of the cell, for energy demand to detoxify the toxic metabolites generated. This enzyme increases in TB patients because of delayed hypersensitivity reaction to mycobacterial antigen. Objective: To evaluate the diagnostic utility of the ADA assay for the diagnosis of tuberculous meningitis and to compare ADA results with results of Ziehl Neelsen stain, routine biochemical tests and cytology. Materials and Method: Total 86 Cerebrospinal fluid (17 cases of TBM and 69 cases of non-TBM) were studied for ADA levels, ZN stain, routine biochemical tests and cytological evaluation. Results: Mean level of ADA in TBM is 11.81 U/L and in non-TBM 1.65 U/L. Comparison between different tests for TBM shows: ZN stain is having high specificity of 100% but its sensitivity is 5.88%. Sensitivity of cytological analysis is 88.83% and specificity is 26.87%. Specificity of sugar test is only 34%. Protein estimation is also very less specific, 61%. ADA test is having both sensitivity (64.70%) and specificity (97%) higher than other tests. Conclusion: As an alternative to subjecting CSF of suspected tuberculous meningitis to various tests (cytology, protein and sugar estimation and ZN stain), subjecting sample for single test, ADA test(very easy, sensitive, specific, cheap and less time consuming: one and half hour) is better option with good results.
International Journal of Basic & Clinical Pharmacology
Background: Tubercular meningitis is one of the highly prevalent form of meningitis in the world and is a significant cause of morbidity and mortality in developing countries like India. Lack of early and timely diagnosis and subsequent initiation of treatment makes the fatality rate even higher. Cerebrospinal fluid (CSF) analysis is most important aspect of lab diagnosis in tuberculous meningitis (TBM) worldwide. The objective of this study was to study the cerebrospinal fluid CSF adenosine deaminase (ADA) levels in TBM and non-TBM meningitis cases and to determine its diagnostic significance as a biochemical marker of TBM infection.Methods: The study population comprised three different patient groups. TBM (n=36), pyogenic meningitis (n=17) and aseptic meningitis group (n=12). Total 75 subjects were enrolled consecutively in the study and CSF specimens were collected from them. ADA and other cytological and biochemical estimation were carried out using standard protocol.Results: A...
Iranian Journal of …, 2010
Introduction: Tuberculous meningitis is a medical emergency that low sensitivity of CSF smear staining and mycobacterial culture make its diagnosis difficult, so there is an urgent need for rapid, accurate and reliable laboratory test. The aim of this study was comparing the sensitivity and specificity of CSF adenosine deaminase (ADA) level with Polymerase Chain Reaction (PCR) test in the diagnosis of tuberculous meningitis (TBM). we had 49 patients with primary diagnosis of TBM in Bou-Ali University hospital. After committing and using the definite and probable TB as a golden standard, the final diagnosis for 29 of them was TBM. Results: Our study showed that the sensitivity and specificity of CSF-ADA level in comparison with PCR results in diagnosis of TBM with a 6.5 IU/L cut-off were 100% and 85% respectively. Our study showed that selecting a 6.5 IU/L cut-off with respect to the PCR results of the patients makes a reasonable sensitivity and specificity for CSF-ADA test in TBM diagnosis. Conclusion: Our study emphasized that CSF-ADA level measurement can be used as a good, rapid and reliable laboratory test for diagnosing tuberculous meningitis.
Cerebrospinal Fluid Adenosine Deaminase Activity: A Valid Ancillary Test for Tubercular Meningitis
Innovative publication, 2016
Background: Tuberculosis affects 1.80 million persons every year with 3.70 lakh annual deaths, ~ 10% of which are of meningeal involvement. Diagnosis of Tubercular meningitis is difficult with often under or over diagnosis. Delay in diagnosis and initiation of treatment results in poor prognosis and sequel in up to 25% of cases. Cerebrospinal fluid (CSF) Adenosine deaminase (ADA) is a simple, reliable, cost effective and rapid diagnostic test that can even be done in small clinical laboratory set up. We evaluated CSF-ADA as an ancillary test for tubercular meningitis (TBM). Materials and Methods: Total 118 CSF samples were analyzed in this study under four different groups viz. TBM (n= 30), pyogenic meningitis (PM, n=24), aseptic meningitis (AM, n=20) and Controls (no meningeal involvement, n=44). Diagnosis of meningitis was done by clinicians on the basis of presence of signs of meningeal irritation and cytological and biochemical examination of CSF. CSF-ADA was estimated by method based on Berthelot reaction, which is the formation of a colored indophenol complex from ammonia liberated from adenosine, and quantified colorimetrically. Kruskal-Wallis test with Dunnett's multiple comparison post-test was done to compare CSF-ADA activity in different groups. ROC curve analysis was done for CSF-ADA cutoff value. Result: Mean CSF-ADA (U/L) value in TBM patients were significantly higher (24.37±10.73) than in PM (14.28±5.979), AM (10.32±5.554) and Controls (6.520±4.801), p-value <0.0001 in TBM vs AM and TBM vs Controls. A cutoff value of 13.3 U/L gave a sensitivity of 91% and specificity of 90% when used to diagnose TBM. Conclusion: CSF-ADA is not only simple, cost effective and rapid but also fairly sensitive and specific in diagnosis of TBM, especially in dilemma of differentiating the tuberculous etiology from non-infectious one. For these reasons CSF-ADA is a well performer as an ancillary test of TBM.
Adenosine deaminase, an aid in the diagnosis of tubercular meningitis – hospital based study
IP innovative publication pvt. ltd, 2019
Introduction: Tubercular meningitis (TBM) is the most prevalent and most grave form of extrapulmonary tuberculosis. It is associated with high mortality rate. The confounding factor for this is the delay in diagnosing the disease and initiation of treatment. The present study aims to look for the diagnostic utility of ADA estimations in Tubercular meningitis patients. Materials and Methods: For this study the patients with the signs and symptoms of meningitis and attending our hospital within a st ipulated period of one year approximately, were taken as subjects. As per the accepted criteria, the patients were segregated into two broad groups: tubercular meningitis cases and nontubercular meningitis cases. CSF specimens were collected and ADA levels were estimated on semiautoanalyser in the laboratory. Results: Out of 31 patients of tubercular meningitis, 27 showed ADA levels above 10 U/L while 2 showed lower values. On the other hand 32 cases of non- tubercular meningitis showed ADA levels below 10 U/L and 4 showed higher values, thereby supporting the fact that ADA evaluation in CSF is of substantial value in diagnosing TBM. It also illustrious that if CSF ADA value of 10 U/L is taken as bench mark then the sensitivity for diagnosing TBM is 93.10% and specificity is 88.87% which is fairly good. Conclusion: Therefore, just by evaluating CSF ADA levels we can diagnose the TBM cases with respectably good sensitivity and high specificity and consuming least time and resources. Therefore, ADA estimation is a valuable adjunct to routine investigations in diagnosis of TBM.
Journal of Infection, 2017
Introduction: The measurement of adenosine deaminase (ADA) level in CSF has generated as a suitable test for TBM diagnosis. The main objective in the present metaanalysis focused on analyzing the ADA test accuracy in order to diagnose TBM. Methods: We searched several databases including Medline, Embase and Cochrane databases to identify studies addressing the diagnosis of TBM. The quality of included reports were assessed by RevMan5 software (via QUADS2 checklist). Accuracy measures of ADA test (sensitivity, specificity and others) pooled with random effects models. In addition, the data was elicited by using midas and metan packages in stata (version 12). Result: conceptually twenty studies were eligible for inclusion within the meta-analysis. The pooled sensitivity and specificity for TBM diagnosis hallmarks were 89 % (95% CI: 0.84-0.92) and 91 % (95% CI: 0.87-0.93), respectively. The positive likelihood ratio was 9.4 (95% CI: 7-12.8), negative likelihood ratio was 0.12 (95% CI: 0.09-0.17), and diagnostic odds ratio was 77 (95% CI: 45-132). Indeed, the area under the SROC was 0.96. Conclusion: It was magnificently attained that ADA test hade a relatively high accuracy for TBM diagnosis. .