back to 2011, vol. 17, b. 1

Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2011, vol. 17, book 1
Subject Collection: Medicine
Page: 130-134
DOI: 10.5272/jimab.2011171.130
Online date: 30 June, 2011

J of IMAB 2011; 17(1):130-134
Stevanovic Goran, Mijomir Pelemis, Milorad Pavlovic, Lidija Lavadinovic, Zorica Dakic, Ivana Milosevic, Branko Milosevic.
Institute for infectious and tropical diseases, Clinical center of Serbia, Belgrade, Serbia

Extra pulmonary tuberculosis (EPTB) is a growing problem worldwide. Due to the nature of the disease, the diversity of clinical pictures as well as its minor epidemiological importance, the diagnosis is difficult and often late.
In addition to standard TB diagnostic techniques use of new biochemical (surrogate markers) are increased.
With this work we wanted to examine the usefulness of serum adenosine deaminase levels as a diagnostic parameter for EPTB.
The work included 116 patients with fever of unknown origin in which tuberculosis or infectious mononucleosis was not proven and 51 person who had proven EPTB. Correlated adenosine deaminase levels between these two groups we obtained significantly higher values ​​in patients with EPTB. The calculated sensitivity was 0.56, specificity 0.89, positive predictive value 0.80 and negative predictive value 0.72. Certain reducing of the values observed during anti TB therapy.
In previous studies the diagnostic importance of adenosine deaminase in the diagnosis of tuberculosis serosityes was demonstrated. The significance of serum levels in diagnosis is rarely evaluated during EPTB. Our findings are similar to the results of authors who have conducted such testing in the pediatric population.
Increased concentrations of serum adenosine deaminase have shown the potential of usable screening test and can be used as an indicative EPTB parameter.  To fully assess its diagnostic significance require future clinical research.

Key words: fever of unknown origin, diagnostic, biochemical markers, tuberculosis.

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1. Dye C, Scheele S, Dolin P, Pathania V, Raviglione MC. Consensus statement. Global burden of tuberculosis: estimated incidence, prevalence and mortality by country. WHO Global Surveillance and Monitoring Project. JAMA. 1999 Aug 18;282(7):677-86. [PubMed][CrossRef  doi: 10.1001/jama.282.7.677]
2. Golden MP, Vikram HR. Extrapulmonary tuberculosis: An overview. Am Fam Physician. 2005 Nov 1;72(9) 1761-8 [PubMed]
3. Centers for disease control and prevention (CDC). Trends in tuberculosis – United States, 1998-2003. MMWR Morb Mortal Wkly Rep. 2004 Mar 19;53(10):209-14. Erratum in MMWR Morb Mortal Wkly Rep. 2004 Mar 26;53(11):246.  [PubMed]
4. Gledovic Z, Vlajinac H, Pekmezovic T, Grujicic-Sipetic S, Grgurevic A, Pesut D. Burden of tuberculosis in Serbia. Am J Infect Control. 2006 Dec;34(10):676–9 [PubMed]
5. Pešut DP, Gledović ZB, Grgurević AD, Nagorni-Obradović LJM and Adžić TN. Tuberculosis Incidence in Elderly in Serbia: Key Trends in Socioeconomic Transition. Croat Med J. 2008 Dec; 49(6): 807–812 [PubMed] [CrossRef doi: 10.3325/cmj.2008.49.807]
7. Pelemis M, Stevanovic G, Pavlovic M, Nikolic S, Lavadinovic L, Milosevic B, Poluga J, Milosevic I, Nikolic J, Divac N, Prostran M. Importance of  extrapulmonary tuberculosis during evaluation of patients with fever of unknown origin. Oral presentation; 26th International congress of chemotherapy and infection, june, 2009, Toronto, Canada. (Pulication in International Journal of Antimicrobial AgentsVol. 34, Suppl2 (July 2009) O45, S16.)
8. Gupta BK, Bharat V, Bandyopadhyay D. Sensitivity, specificity, negative and positive predictive values of adenosine deaminase in patients of tubercular and non-tubercular serosal effusion in India. J Clin Med Res. 2010 May 19;2(3):121-6 [PubMed]
9. Pelemis M, Pavlovic M, Lavadinovic L, Stevanovic G, Milosevic B, Sasić M, Canic T. Extrapulmonary tuberculosis – problem in differential diagnosis in patients with fever of unknown origin. Journal of Antimicrobial Chemotherapy, 21st Interntional Congress of Chemotherapy, Birmingham, UK, 4-7 july, 1999, Supplement A to Vol 44; 121
10. Agadi S. Diagnosis of tuberculosis. Lancet 2003 Jun 14;361(9374):2082; author reply 2082-3. [PubMed]
11. Radford AJ, Rothel JS. Diagnosis of tuberculosis. Lancet 2003 Jun 14;361(9374):2083 [PubMed]
12. Valdés L, Pose A, San José E, Martínez Vázquez JM. Tuberculous pleural effusions. Eur J Intern Med. 2003 Mar; 14(2): 77-88. [PubMed]
13. Light RW. Management of pleural effusions. J Formos Med Assoc. 2000 Jul; 99(7):523-31. [PubMed]
14. Ferrer J. Pleural tuberculosis. Eur Respir J. 1997 Apr;10(4):942-7 [PubMed]
15. Fowler NO. Tuberculous pericarditis. JAMA. 1991 Jul 3;266(1):99-103 [PubMed]
16. Trautner BW, Darouiche RO. Tuberculous pericarditis: optimal diagnosis and management. Clin Infect Dis. 2001 Oct 1;33(7):954-61. Epub 2001 Aug 22. [PubMed] [CrossRef doi: 10.1086/322621]
17. Strang JIG, Kakaza HHS, Gibson DG, Girling DJ, Nunn AJ, Fox W. Controlled trial of prednisolone as adjuvant in treatment of tuberculous constrictive pericarditis in Transkei. Lancet. 1987 Dec 19;2(8573):1418-22 [PubMed]
18. Thwaites GE, Chau TT, Stepniewska K, Phu NH, Chuong LV, Sinh DX, et al. Diagnosis of adult tuberculous meningitis by use of clinical and laboratory features. Lancet. 2002 Oct 26;360(9342):1287-92. [PubMed] [CrossRef doi:10.1016/S0140-6736(02)11318-3]
19. Nikolić S. Tuberkulozni meningitis u: Infektivne bolesti udžbenik za studente medicine, Medicinski fakultet Univerziteta u Beogradu, CIBID, 2007: 89-93
20. Ibrarullah M, Mohan A, Sarkari A, Srinivas M, Mishra A, Sundar TS. Abdominal tuberculosis: diagnosis by laparoscopy and colonoscopy. Trop Gastroenterol. 2002 Jul-Sep;23(3):150-3 [PubMed]
21. Sharma SK, Suresh V, Mohan A, Kaur P, Saha P, Kumar A, et al. A prospective study of sensitivity and specificity of adenosine deaminase estimation in the diagnosis of tuberculosis pleural effusion. Indian J Chest Dis Allied Sci. 2001 Jul-Sep; 43(3):149-55. [PubMed]
22. Mathur PC, Tiwari KK, Sushima T, Tiwari D. Diagnostic value of adenosine deaminase (ADA) activity in tubercular serositis. Indian J Tuberc 2006; 53: 92-95
23. Piras MA, Gakis C, Budroni M, Andreoni G. Adenosine deaminase activity in pleural effusions: an aid to differential diagnosis. Br Med J 1978 Dec 23-30;2(6154):1751-1752 [PubMed] [CrossRef doi: 10.1136/bmj.2.6154.1751-a]
24. Goto M, Noguchi Y, Koyama H, Hira K, Shimbo T, Fukui T. Diagnostic value of adenosine deaminase in tuberculous pleural effusion: a meta-analysis. Ann Clin Biochem. 2003 Jul;40(Pt 4):374-381 [PubMed] [CrossRef doi:10.1258/000456303766477011]
25. Dinnes J, Deeks J, Kunst H, Gibson A, Cummins E, Waugh N, et al. A systematic review of rapid diagnostic tests for the detection of tuberculosis infection. Health Technol Assess. 2007 Jan;11(3):1-196. [PubMed
26. Zaric B, Kuruc V, markovic M, Canak V, Milovancev A, Jovanovic S, Sarcev T. Diagnostic tools for tuberculous pleurisy: Where is the place of Adenosine deaminase (ADA?) Chest 2007; 132 (4): 463s
27. Prasad R, Kumar A, Khanna BK. CSF-ADA for the diagnosis of TBM. Ind Jour Tub., 1991;38:99-102
28. Mishra OP, Loiwal V, Ali Z, Nath G, Chandra L, Das BK. Cerebrospinal fluid adenosine deaminase activity and C-reactive protein in tuberculous and partially treated bacterial meningitis. Indian Pediatr. 1995 Aug;32(8):886-889 [PubMed]
29. Blake J, Berman P. The use of adenosine demaninase assays in the diagnosis of tuberculosis. S Afr Med J. 1982 Jul 3;62(1):19-21. [PubMed]
30. Srinivasa RK, Kumar HA, Rudresh BM, Srinivas T, Bhat KH. A comparative study and evaluation of serum adenosine deaminase activity in the diagnosis of pulmonary tuberculosis. Biomed Res. 2010 (2): 189-94
31. Mishra OP, Yusaf S, Ali Z, Nath G, Das BK. Brief report. Adenosine deaminase activity and lysozyme levels in children with tuberculosisJ Trop Pediatr.2000 Jun;46(3):175-178. [PubMed] [CrossRef doi: 10.1093/tropej/46.3.175]
32. Hitoglou S, Hatzistilianou M, Gougoustamou D, Athanassiadou F, Kotsis A and Catriu D. Adenosine deaminase activity and its isoenzyme pattern in patients with juvenile rheumatoid arthritis and systemic lupus erythematosus, Clin Rheumatol. 2001 20(6):411–416. [PubMed] [CrossRef doi: 10.1007/s100670170005]

Please cite this article as: Stevanovic G, Pelemis M, Pavlovic M, Lavadinovic L, Dakic Z, Milosevic I, Milosevic B. SIGNIFICANCE OF ADENOSINE DEAMINASE SERUM CONCENTRATIONS IN THE DIAGNOSIS OF EXTRA - PULMONARY TUBERCULOSIS. J of IMAB 2011; 17(1):130-134. doi: 10.5272/jimab.2011171.130

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