Evaluation of Diagnostic Value of Adenosine Deaminase in Diagnosis of Tuberculous Pleural Effusion

Abstract
Background: Many studies suggest that adenosine deam-inase is a marker for tuberculous pleurisy, while controversy exists as to its diagnostic value, accurate diagnosis is essential for tuberculous effusion for initiation of treatment. So evalu-ation of diagnostic value of adenosine deaminase in diagnosis of tuberculous pleural effusion is important.
Aim of the Work: To evaluate the diagnostic value of adenosine deaminase in diagnosis of tuberculous pleural effusion from non tuberculous pleural effusion.
Subject and Methods: Forty patients with pleural effusion were admitted to Giza chest hospital, Bab El-Sha’eria and Al-Hussein Al- Azhar University Hospital and after taking a written informed consent from the patients during period between April 2014 and May 2016.
All patients were subjected to full history and clinical examination, Plain chest X-ray, Sputum examination for Acid Fast Bacilli, ADA in pleural fluid, pleural biopsy and Culture and sensitivity of pleural fluid. Those patients were classified into (2) groups: Group (I): Twenty (20) patients with tuber-culous pleural effusion. Group (2): Twenty (20) patients without tuberculous pleural effusion.
Results: Patients with tuberculous pleural effusion had significantly high ADA level in pleural fluid than patients with non-tuberculus effusion (parapneuomonic and malignant effusion) with p<0.001 with cutoff point in pleural fluid was 68.8 IU/l, sensitivity and specificity were 90% and Positive predictive value was 90%.
Conclusion: Adenosine deaminase ADA can be used in diagnosis tuberculous pleural effusion with significantly increase ADA level in pleural fluid than those with malignant, parapneumonic effusion. So Adenosine Deaminase ADA is a non invasive, inexpensive and repeatable test provides the results quickly which help to start early treatment.