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%–83% 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-γ), 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
References
[1]
G. Caramori, L. Lasagna, A. G. Casalini et al., “Immune response to Mycobacterium tuberculosis infection in the parietal pleura of patients with tuberculous pleurisy,” PLoS ONE, vol. 6, no. 7, Article ID e22637, 2011.
[2]
L. J. Burgess, C. G. Swanepoel, and J. J. F. Taljaard, “The use of adenosine deaminase as a diagnostic tool for peritoneal tuberculosis,” Tuberculosis, vol. 81, no. 3, pp. 243–248, 2001.
[3]
V. Hallur, M. Sharma, S. Sethi, et al., “Development and evaluation of multiplex PCR in rapid diagnosis of abdominal tuberculosis,” Diagnostic Microbiology and Infectious Disease, vol. 76, no. 1, pp. 51–55, 2013.
[4]
Z. D. Daniil, E. Zintzaras, T. Kiropoulos et al., “Discrimination of exudative pleural effusions based on multiple biological parameters,” European Respiratory Journal, vol. 30, no. 5, pp. 957–964, 2007.
[5]
J. Klimiuk and R. Krenke, “Role of biomarkers in making the diagnosis of tuberculous pleurisy,” Pneumonologia i Alergologia Polska, vol. 79, no. 4, pp. 288–297, 2011.
[6]
A. Moghtaderi, A. Niazi, R. Alavi-Naini, S. Yaghoobi, and B. Narouie, “Comparative analysis of cerebrospinal fluid adenosine deaminase in tuberculous and non-tuberculous meningitis,” Clinical Neurology and Neurosurgery, vol. 112, no. 6, pp. 459–462, 2010.
[7]
C. Foocharoen, C. Sarntipipattana, T. Foocharoen et al., “Synovial fluid adenosine deaminase activity to diagnose tuberculous septic arthritis,” Southeast Asian Journal of Tropical Medicine and Public Health, vol. 42, no. 2, pp. 331–337, 2011.
[8]
O. Kayacan, D. Karnak, M. Delibalta, S. Beder, L. Karaca, and H. Tutkak, “Adenosine deaminase activity in bronchoalveolar lavage in Turkish patients with smear negative pulmonary tuberculosis,” Respiratory Medicine, vol. 96, no. 7, pp. 536–541, 2002.
[9]
W. Reechaipichitkul, V. Lulitanond, B. Patjanasoontorn, W. Boonsawat, and A. Phunmanee, “Diagnostic yield of adenosine deaminase in bronchoalveolar lavage,” Southeast Asian Journal of Tropical Medicine and Public Health, vol. 35, no. 3, pp. 730–734, 2004.
[10]
M. Kubota, M. Katagiri, N. Yanase, K. Soma, and T. Tomita, “Measurement of adenosine deaminase activity in bronchoalveolar lavage fluids as a tool for diagnosing miliary tuberculosis,” Nihon Kyobu Shikkan Gakkai Zasshi, vol. 34, no. 2, pp. 139–144, 1996.
[11]
D. Orphanidou, M. Gaga, A. Rasidakis et al., “Tumour necrosis factor, interleukin-1 and adenosine deaminase in tuberculous pleural effusion,” Respiratory Medicine, vol. 90, no. 2, pp. 95–98, 1996.
[12]
M. A. Piras, C. Gakis, M. Budroni, and G. Andreoni, “Adenosine deaminase activity in pleural effusions: an aid to differential diagnosis,” British Medical Journal, vol. 2, no. 6154, pp. 1751–1752, 1978.
[13]
L. Valdes, E. San Jose, D. Alvarez et al., “Diagnosis of tuberculous pleurisy using the biologic parameters adenosine deaminase, lysozyme, and interferon gamma,” Chest, vol. 103, no. 2, pp. 458–465, 1993.
[14]
J. F. Bueso, H. V. Hernando, J. P. Garcia-Buela, L. D. Juncal, M. T. M. Egana, and M. C. M. Martinez, “Diagnostic value of simultaneous determination of pleural adenosine deaminase and pleural lysozyme/serum lysozyme ratio in pleural effusions,” Chest, vol. 93, no. 2, pp. 303–307, 1988.
[15]
D. Orphanidou, G. Stratakos, A. Rasidakis et al., “Adenosine deaminase activity and lysozyme levels in bronchoalveolar lavage fluid in patients with pulmonary tuberculosis,” International Journal of Tuberculosis and Lung Disease, vol. 2, no. 2, pp. 147–152, 1998.
[16]
V. Boonsarngsuk, S. Suwannaphong, and C. Laohavich, “Combination of adenosine deaminase activity and polymerase chain reaction in bronchoalveolar lavage fluid in the diagnosis of smear-negative active pulmonary tuberculosis,” International Journal of Infectious Diseases, vol. 16, no. 9, pp. e663–e668, 2012.
[17]
S. H. Choi, Y. S. Kim, I. G. Bae et al., “The possible role of cerebrospinal fluid adenosine deaminase activity in the diagnosis of tuberculous meningitis in adults,” Clinical Neurology and Neurosurgery, vol. 104, no. 1, pp. 10–15, 2002.
[18]
S. Greco, E. Girardi, R. Masciangelo, G. B. Capoccetta, and C. Saltini, “Adenosine deaminase and interferon gamma measurements for the diagnosis of tuberculous pleurisy: a meta-analysis,” International Journal of Tuberculosis and Lung Disease, vol. 7, no. 8, pp. 777–786, 2003.
