Title: Diagnostic Accuracy of Cerebrospinal Fluid Adenosine Deaminase Activity in Tuberculous Meningitis

Authors: Dr Radhika Krishnaswamy, Priyadharshini K

 DOI:  http://dx.doi.org/10.18535/jmscr/v4i9.43

Abstract

Tuberculous meningitis remains an important cause of morbidity and mortality in developing countries like India.It often poses diagnostic problem to the clinicians, and the prognosis of the disease depends on the stage at which the treatment is started. Adenosine deaminase (ADA) activity is a quick noninvasive method to diagnose of tuberculous meningitis.(TBM) compared to other methods which are less diagnostic and time consuming. The present study was conducted to evaluate the diagnostic accuracy of a cutoff point of 8IU/L of ADA activity in the cerebrospinal fluid for the diagnosis of tuberculous meningitis(TBM) .CSF from 85 patients suffering from meningitis and other CNS disorders were collected and ADA activity was determined..There was a significant elevation of ADA in TBM patients compared to Non TBM group which consisted of bacterial meningitis, encephalitis and other cases. The study showed  a sensitivity, specificity and accuracy of of 95% ,92%and 92% respectively In conclusion ,the results of the present study confirms  that CSFADA activity, withthe cut off  value  of 8 IU/L  is found to have  good sensitivity, specificity and accuracy and can be a  good diagnostic marker for tuberculous meningitis. It is simple, inexpensive, takes less time to perform and thus can be considered as a rapid diagnostic test for tuberculous meningitis.

Key words:   ADA,CSF, tuberculous meningitis, T lymphocytes.

References

1.      Kennedy D. H., Fallon R. J. Tuberculous meningitis. The Journal of the American Medical Association. 1979;241(3):264–268. doi: 10.1001/jama.241.3.264. [Pub Med]  [Cross Ref]

2.      Kilpatrick M. E., Girgis N. I., Yassin M. W., Abu El Ella A. A. Tuberculous meningitis—clinical and laboratory review of 100 patients. Journal of Hygiene. 1986;96 (2):231–238. doi: 10.1017/s0022-172400066006. [PMC free article] [Pub Med] [Cross Ref]

3.      Leonard J. M., Des Prez R. M. Tuberculous meningitis. Infectious disease clinics of North America. 1990;4(4):769–787. [PubMed]

4.      Traub M., Colchester A. C. F., Kingsley D. P. E., Swash M. Tuberculosis of the central nervous system. Quarterly Journal of Medicine. 1984;53(209):81–100. [Pub Med]

5.      Dubé M. P., Holtom P. D., Larsen R. A. Tuberculous meningitis in patients with and without human immunodeficiency virus infection. The American Journal of Medicine. 1992;93(5):520–524. doi: 10.1016/0002-9343(92)90579-z. [Pub Med] [Cross Ref]

6.      Kent S. J., Crowe S. M., Yung A., Lucas C. R., Mijch A. M. Tuberculous menin-gitis: a 30-year review. Clinical Infectious Diseases. 1993;17(6):987–994. doi: 10.1 093/clinids/17.6.987.[PubMed][Cross Ref]

7.      Verdon R., Chevret S., Laissy J.-P., Wolff M. Tuberculous meningitis in adults: review of 48 cases. Clinical Infectious Diseases. 1996;22(6):982–988. doi: 10.1093/clinids/22.6.982. [PubMed] [Cross Ref]

8.      SullivaJ,Osborne WRA, Wedgewood RJ. Adenosine deaminase activity in lympho-cytes. Br. J. Haematol 1977,37:157-8

9.      Banales JL, Picda PR, Fitzerald JM, Rubio H, Salmon M, Lezama MS. Adenosine deaminase in the diagnosis of tubercular pleural effusions. A report of 278 patients and review of literature. Chest 1991;99: 355-7

10.  Martinez Vazquez JM, Ocana I, Ribera E, Segura RM. Adenosine deaminase activity in tubercular peritonitis. Gut 1986;27: 1049-53

11.  Martinez Vazquez JM, Ocana I Ribera E, Segura RM , Serrat R,  Sagarista J. Adenosine deaminase activity in tubercular pericarditis .Thorax  1986;41:888-9

12.  Piras MA, Gakis C .Cerebrospinal  fluid Adenosine deaminase activity in tubercular meningitis .Enzyme 1973;14:31-37

13.  Malan C, Donal PR, Golden M, Taljaard JJF. Adenosine deaminase levels in Cerebrospinal  fluid in the diagnosis of tubercular meningitis .J Trop Med Hyg 1984;38:217-20

14.  Selakumar N, Vanajkumar, Duraipandian M, Thillothammal M, Prabakar R. Cerebrospinal  fluid Adenosine deaminase and lysozyme levels in the diagnosis of tubercular meningitis. Indian J Tub 1991;38:217-20

15.  Guisti, G, Galanti, B Adenosine deaminase. Bergmeyer, HU eds. Methods of enzymatic     analysis 1974,1092-1096 Academic Press. New York, NY

16.  Kaplan, A The determination of urea, ammonia, and urease. Methods Biochem Anal       1969;17,311-324

17.  Bernard Rosner (2000), Fundamentals of Biostatistics, 5th Edition, Duxbury, page 80-240.

18.  M. Venkataswamy Reddy (2002), Statistics for Mental Health Care Research, NIMHANS publication, INDIA, page 108-144.

19.  SunderRao P S S, Richard J(2006) : An Introduction to Biostatistics, A manual for students in health sciences , New Delhi: Prentice hall of India. 86-160.

20.  Baganha MF, Pegvo M,  Lima MA, Gasper EV, Cardeiro AR.Serum and pleural adenosine deaminase; correlatipon with lymphocytic populations. Chest 1990;87:605-10

21.  Ribera E, Martinez Vazquez JM,Ocana I, Segura RM,Pascual C .Activity of adenosine deaminase in cerebrospinal fluid for the diagnosis and follow up of tuberculous  meningitis. J Infec Dis 1987;155:603-7

22.  Petterson T, Klockars M, WeberTH, Somer H. Diagnostic value of cerebrospinal fluid adenosine deaminase determination. Scand J Infec  Dis 1991;23:97-100

23.  Segura RM. Pascual C, Ocana I et al.Adenosinedeaminase in body fluids :a useful diagnostic tool in tuberculosis Clin Biochem1989;22:141-8

24.  Prasad R, Kumar A, Khanna BK et al. CSF-ADA for diagnosis of TBM. Ind J Tub 1991;38:99-102

Corresponding Author

Dr Radhika Krishnaswamy

Associate Professor, Dept of Biochemistry

St.John’s Medical College, Bangalore-560034, Karnataka India

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