%0 Journal Article
%T Predictive Role of ADA in Bronchoalveolar Lavage Fluid in Making the Diagnosis of Pulmonary Tuberculosis
%A Fariba Binesh
%A Abolhassan Halvani
%J Pulmonary Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/851518
%X Current diagnostic tests for tuberculosis (TB) are time-consuming. The aim of this study was to evaluate the diagnostic usefulness of ADA in bronchoalveolar lavage fluid in patients with pulmonary TB. A cross-sectional study was performed in Yazd, Iran, between 2009 and 2010. Patients suspected of pulmonary TB with negative sputum smear for AFB were included in the study. Mean ADA levels in BAL fluids were measured and compared between study groups. Sixty-three patients were enrolled in the study among which 15 cases had pulmonary TB, 33 had pulmonary diseases other than TB, and 15 subjects with normal bronchoscopy results were considered as controls. Mean ADA levels in BAL fluid were , , and , respectively. This rate was significantly higher in the pulmonary TB group compared to the other two groups ( ). Using ROC curve with a cut-off value of 3.5£¿IU/L, the highest sensitivity (57%) and specificity (84%) were obtained in diagnosis of TB. The results showed that although ADA activity in BAL fluid of pulmonary TB patients was higher than those seen in other diseases, a negative test does not rule out pulmonary TB. 1. Introduction Tuberculosis (TB) is the second most important cause of death from infectious diseases in the world [1]. It is a major public health problem in developing countries including Iran. Multidrug resistance in tuberculosis and its association with acquired immunodeficiency syndrome (AIDS) have further highlighted the importance of this disease. The diagnosis is usually based on clinical presentation, radiologic findings, and positive tuberculin and/or skin tests. However, clinicoradiological features are variable and the latter tests may be falsely negative. The gold standard of TB diagnosis requires the growth of Mycobacterium in specimen cultures, but the cultures are time-consuming and have low positivity rates, with a mean sensitivity of 43%¨C83% depending on the quality of samples cultured and methods utilized [2]. Since delay is unacceptable in emergency situations, it is necessary to find faster methods with higher sensitivity. The polymerase chain reaction (PCR) assay has shown good sensitivity and specificity in some studies [3], but it is not cost-effective and few centers use it in Iran. Several biomarkers like adenosine deaminase (ADA), interferon gamma (IFN-¦Ã), and a variety of tumor markers and cytokines have been proposed as alternative noninvasive means of establishing tuberculous etiology [4]. ADA is an enzyme involved in purine catabolism, catalyzing the pathway from adenosine to inosine and is known as a cellular
%U http://www.hindawi.com/journals/pm/2013/851518/