Combined use of pleural adenosine deaminase with lymphocyte/neutrophil ratio: Increased specificity for the diagnosis of tuberculous pleuritis

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dc.contributor.authorBurgess L.J.
dc.contributor.authorMaritz F.J.
dc.contributor.authorLe Roux I.
dc.contributor.authorTaljaard J.J.F.
dc.date.accessioned2011-05-15T16:16:01Z
dc.date.available2011-05-15T16:16:01Z
dc.date.issued1996
dc.description.abstractIncreased pleural fluid adenosine deaminase (ADA) activity is classically associated with tuberculous pleuritis. However, increased activity can also occur in a number of other diseases and this may negatively affect the diagnostic utility of ADA measurements and decrease its specificity for the diagnosis of tuberculosis (TB). The presence of ADA in pleural fluids reflects the cellular immune response in the pleural cavity and in particularly, the activation of T lymphocytes. Different disease entities are typically associated with the presence of particular types of leukocytes. Objective: To determine whether the combined use of ADA activity and differential cell counts would provide a more efficient means for diagnosing tuberculous pleurisy than the use of ADA levels alone. Methods: Biochemistry, cytology, and microbiology studies were performed on 472 consecutive pleural fluids. ADA and differential cell counts were determined on all exudative effusions. Results: ADA activity in tuberculous effusions was significantly higher than in any other diagnostic group (p<0.005). At a level of 50 U/L, the sensitivity, specificity, positive predictive value (ppv), negative predictive value (npv), and efficiency for the identification of TB were calculated at 91%, 81%, 84%, 89%, and 86%, respectively. When the additional requirement of a lymphocyte neutrophil ratio of 0.75 or greater was included, the sensitivity, specificity, ppv, npv, and efficiency for the identification of TB were calculated at 88%, 95%, 95%, 88%, and 92%, respectively. Conclusion: ADA, especially when combined with differential cell counts and lymphocyte/neutrophil ratios, remains a useful test in the diagnosis tuberculous pleuritis.
dc.description.versionArticle
dc.identifier.citationChest
dc.identifier.citation109
dc.identifier.citation2
dc.identifier.issn00123692
dc.identifier.urihttp://hdl.handle.net/10019.1/13595
dc.subjectadenosine deaminase
dc.subjectadolescent
dc.subjectadult
dc.subjectaged
dc.subjectarticle
dc.subjectchild
dc.subjectcytology
dc.subjectdiagnostic accuracy
dc.subjectdiagnostic approach route
dc.subjectenzyme assay
dc.subjectfemale
dc.subjecthuman
dc.subjectinfant
dc.subjectlung tuberculosis
dc.subjectlymphocyte count
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectpleura fluid
dc.subjectpriority journal
dc.subjectt lymphocyte activation
dc.subjecttuberculous pleurisy
dc.subjectAdenosine Deaminase
dc.subjectAdolescent
dc.subjectAdult
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectChild
dc.subjectChild, Preschool
dc.subjectEnzyme Tests
dc.subjectFemale
dc.subjectHumans
dc.subjectInfant
dc.subjectLeukocyte Count
dc.subjectLymphocyte Count
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectNeutrophils
dc.subjectPleural Effusion
dc.subjectProspective Studies
dc.subjectSensitivity and Specificity
dc.subjectTuberculosis, Pleural
dc.titleCombined use of pleural adenosine deaminase with lymphocyte/neutrophil ratio: Increased specificity for the diagnosis of tuberculous pleuritis
dc.typeArticle
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