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Laamara L, Benaissa E, Achemlal A, Bounakhla A, Bssaibis F, BenLahlou Y, Maleb A, Chadli M, Elouennass M. Peritoneal tuberculosis, an underestimated diagnosis: a case report. Access Microbiol 2024; 6:000753.v3. [PMID: 38868373 PMCID: PMC11165665 DOI: 10.1099/acmi.0.000753.v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/02/2024] [Indexed: 06/14/2024] Open
Abstract
Tuberculosis is an infectious disease that most often affects the lungs, caused by human-to-human transmission of Mycobacterium tuberculosis. Peritoneal tuberculosis is an extra-pulmonary form of the disease that usually manifests as an ascitic syndrome, with or without fever, in a context of altered general condition, often in endemic areas. The diagnosis of peritoneal tuberculosis is not always easy, as the clinical signs are often insidious and unspecific. We report a case of peritoneal tuberculosis in an 18-year-old female, who had presented for 10 days with a progressive increase in abdominal volume associated with vomiting and diarrhoea.
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Affiliation(s)
- Leila Laamara
- Bacteriology Department, Mohammed V Military Teaching Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Elmostafa Benaissa
- Bacteriology Department, Mohammed V Military Teaching Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Amine Achemlal
- Gastroenterology Department, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Amal Bounakhla
- Bacteriology Department, Mohammed V Military Teaching Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Fatna Bssaibis
- Bacteriology Department, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Yassine BenLahlou
- Bacteriology Department, Mohammed V Military Teaching Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Adil Maleb
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mariama Chadli
- Bacteriology Department, Mohammed V Military Teaching Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mostafa Elouennass
- Bacteriology Department, Mohammed V Military Teaching Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Mahajan M, Prasad ML, Kumar P, Kumar A, Chatterjee N, Singh S, Marandi S, Prasad MK. An Updated Systematic Review and Meta-Analysis for the Diagnostic Test Accuracy of Ascitic Fluid Adenosine Deaminase in Tuberculous Peritonitis. Infect Chemother 2023; 55:264-277. [PMID: 37407244 DOI: 10.3947/ic.2023.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/23/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Tuberculous peritonitis is difficult to diagnose due to its non-specific clinical manifestations and lack of proper diagnostic modalities. Current meta-analysis was performed to find the overall diagnostic accuracy of adenosine deaminase (ADA) in diagnosing tuberculous peritonitis. MATERIALS AND METHODS PubMed, Google Scholar, and Cochrane library were searched to retrieve the published studies which assessed the role of ascitic fluid ADA in diagnosing tuberculous peritonitis from Jan 1980 to June 2022. This meta-analysis included 20 studies and 2,291 participants after fulfilling the inclusion criteria. RESULTS The pooled sensitivity was 0.90 (95% confidence interval [CI]: 0.85 - 0.94) and pooled specificity was 0.94 (95% CI: 0.92 - 0.95). The positive likelihood ratio was 15.20 (95% CI: 11.70 - 19.80), negative likelihood ratio was 0.10 (95% CI: 0.07 - 0.16) and diagnostic odds ratio was 149 (95% CI: 86 - 255). The area under the summary receiver operating characteristic curve was 0.97. Cut- off value and sample size were found to be the sources of heterogeneity in the mete-regression analysis. CONCLUSION Ascitic fluid ADA is a useful test for the diagnosis of tuberculous peritonitis with good sensitivity and specificity however, with very low certainty of evidence evaluated by Grading of Recommendations, Assessment, Development and Evaluation approach. Further well- designed studies are needed to validate the diagnostic accuracy of ascitic fluid ADA for tuberculous peritonitis.
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Affiliation(s)
- Mayank Mahajan
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | | | - Pramod Kumar
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Amit Kumar
- Department of Laboratory Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Neha Chatterjee
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Shreya Singh
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Sujeet Marandi
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
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Zhou R, Qiu X, Ying J, Yue Y, Ruan T, Yu L, Liu Q, Sun X, Wang S, Qu Y, Li X, Mu D. Diagnostic performance of adenosine deaminase for abdominal tuberculosis: A systematic review and meta-analysis. Front Public Health 2022; 10:938544. [PMID: 36211645 PMCID: PMC9533650 DOI: 10.3389/fpubh.2022.938544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/29/2022] [Indexed: 01/25/2023] Open
Abstract
Background and aim Abdominal tuberculosis (TB) is a common type of extrapulmonary TB with an insidious onset and non-specific symptoms. Adenosine deaminase (ADA) levels increase rapidly in the early stages of abdominal TB. However, it remains unclear whether ADA serves as a diagnostic marker for abdominal TB. Methods We performed a systematic literature search for relevant articles published in PubMed, Web of Science, Cochrane Library, and Embase up to April 2022. First, we used the Quality Assessment of Diagnostic Accuracy Studies tool-2 (QUADAS-2), to evaluate the quality of the included articles. Bivariate and hierarchical summary receiver operating characteristic (HSROC) models were then utilized to analyze pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUROC). In addition, we explored a subgroup analysis for potential heterogeneity and publication bias among the included literature. Results Twenty-four articles (3,044 participants, 3,044 samples) which met the eligibility criteria were included in this study. The pooled sensitivity and specificity of ADA for abdominal TB detection were 93% [95% confidence interval (CI): 0.89-0.95] and 95% (95% CI: 0.93-0.96), respectively. PLR and NLR were 18.6 (95% CI: 14.0-24.6) and 0.08 (95% CI: 0.05-0.12), respectively. DOR and AUROC were 236 (95% CI: 134-415) and 0.98 (95% CI: 0.96-0.99), respectively. Furthermore, no heterogeneity or publication bias was found. Conclusions Our meta-analysis found ADA to be of excellent diagnostic value for abdominal TB and could be used as an auxiliary diagnostic tool. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022297931.
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Affiliation(s)
- Ruixi Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xia Qiu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Junjie Ying
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China,*Correspondence: Junjie Ying
| | - Yan Yue
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Tiechao Ruan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Luting Yu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Qian Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xuemei Sun
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Shaopu Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xihong Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China,Dezhi Mu
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Çakırlar FK. Application of Biomarkers in the Diagnostic Distinction of Bacterial and Viral Infections. Biomark Med 2022. [DOI: 10.2174/9789815040463122010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Infectious diseases, which pose a great threat worldwide, have a significant
impact on public health and the world economy. It contributes to increased healthcare
costs, unnecessary drug-related side effects, and increased antimicrobial resistance. It is
not always easy to distinguish the etiological differentiation of diseases that can
develop with bacteria and viruses. Therefore, one of the biggest challenges in medicine
is how to correctly distinguish between the different causes of these infections and how
to manage the patient. Because bacterial and viral infections often present similar
symptoms. The real decision is whether the infection is caused by bacteria or viruses
and whether to treat the patient with antibiotics. There are many different
methodological approaches to diagnosing infections. Biomarkers have been used in the
diagnosis of diseases and other conditions for many years. Biomarkers are molecules
found in blood and body fluids in measurable amounts, which can evaluate biological
and pathological processes. These key indicators can provide vital information in
determining disease prognosis, predicting response to treatments, adverse events and
drug interactions, and identifying key risks. An effective biomarker is extremely
important for the early diagnosis of various diseases. The explosion of interest in
biomarker research is driving the development of new predictive, diagnostic, and
prognostic products in modern medical practice. The purpose of this review is to
demonstrate the use and diagnostic potential of current and investigational biomarkers
in the distinction between bacterial and viral infections.
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Affiliation(s)
- Fatma Köksal Çakırlar
- Faculty of Cerrahpaşa Medicine, University of İstanbul- Cerrahpaşa,Department of Medical Microbiology,Department of Medical Microbiology, Faculty of Cerrahpaşa Medicine, University of İstanbul- Cerrahpaşa, Istanbul, Turkey,Istanbul,Turkey
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Loukil I, Maalej Y, Zouari A, Rjab H. [Role of laparoscopy in the diagnosis of peritoneal tuberculosis in an endemic area of Tunisia]. Pan Afr Med J 2021; 40:103. [PMID: 34887978 PMCID: PMC8627138 DOI: 10.11604/pamj.2021.40.103.28568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/05/2021] [Indexed: 11/11/2022] Open
Abstract
Tuberculosis is a public health problem in Tunisia. Tataouine governorate is an endemic area. Peritoneal involvement occurs in 1 - 2% of cases. We here report a retrospective, descriptive epidemiological study of 32 patients operated in the Department of Surgery at the Tataouine Hospital between 2010 and 2020. Laparoscopy was mainly performed (28 patients) to take biopsy samples for histologic confirmation of peritoneal tuberculosis. Twenty-four women and 8 men were involved in the study, with a M/F ratio of 0.33. The median age was 43 years, ranging from 14 to 78 years. Diagnostic laparoscopy was performed in 28 cases (87.5%). Given the intraoperative macroscopic aspect, the diagnosis of peritoneal tuberculosis was strongly suspected in 16 patients (50%). The anatomopathological study confirmed the diagnosis in all patients. The purpose of this study is to highlight the epidemiological, clinical features of peritoneal tuberculosis in an endemic region of Tunisia as well as the current role of laparoscopy as a rapid and effective diagnostic procedure.
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Affiliation(s)
- Issam Loukil
- Service de Chirurgie Générale Tataouine, Tataouine, Tunisie
| | - Yassin Maalej
- Service de Chirurgie Générale Tataouine, Tataouine, Tunisie
| | - Amine Zouari
- Service de Chirurgie Générale Sfax, Sfax, Tunisie
| | - Haythem Rjab
- Service de Chirurgie Générale Sfax, Sfax, Tunisie
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Diagnosis of Peritoneal Tuberculosis from Primary Peritoneal Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910407. [PMID: 34639707 PMCID: PMC8508481 DOI: 10.3390/ijerph181910407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 12/01/2022]
Abstract
Peritoneal tuberculosis (PTB) is an uncommon extrapulmonary infection mimickng primary peritoneal cancer (PPC). We retrospectively included 23 women with PTB and 47 women with PPC treated in a medical center to study the clinical and radiological features that differentiate PTB from PPC. Body temperature above 38 °C was a unique feature of PTB (34.7% versus 0%, p < 0.001). Body Mass Index (BMI) was lower (21.9 ± 3.7 versus 25.2 ± 4.1, p = 0.003), white blood cell (WBC) count was lower (5179.6 ± 1502.2 versus 7716.2 ± 2741.8, p < 0.001), and CA-125 level was lower (508.0 ± 266.1 versus 2130.1 ± 2367.2 U/mL, p < 0.001) in PTB compared with PPC. Imaging detected more pulmonary infiltration and consolidation (52.2% versus 6.4%, p < 0.001), and less omental/mesentery changes (52% versus 83%, p < 0.001) in PTB compared with PPC. The operated patients received earlier treatment compared to patients without operation (7.9 ± 5.3 days versus 17.2 ± 11.0 days, p = 0.010). In conclusion, fever above 38 °C, lower BMI, lower WBC count, less elevated CA-125 level, and imaging of less omental involvement were features of PTB differentiated from PPC.
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Sun J, Zhang H, Song Z, Jin L, Yang J, Gu J, Ye D, Yu X, Yang J. The negative impact of increasing age and underlying cirrhosis on the sensitivity of adenosine deaminase in the diagnosis of tuberculous peritonitis: a cross-sectional study in eastern China. Int J Infect Dis 2021; 110:204-212. [PMID: 34332087 DOI: 10.1016/j.ijid.2021.07.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/19/2021] [Accepted: 07/25/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Our study aimed to evaluate the correlation between the sensitivity of adenosine deaminase (ADA) testing for the diagnosis of tuberculous peritonitis (TBP) and patient age or cirrhosis status. METHODS Clinical data for patients clinically diagnosed with TPB (n = 132) or not (n = 147) were assessed. ADA activity was compared among three age groups (< 45 yr, 45-60 yr, and ≥ 60 yr) and among cirrhosis-related subgroups. Cut-off values for the ADA test were analyzed among three patient populations (young non-cirrhotic, n = 97; older non-cirrhotic, n = 115; cirrhotic, n = 67), and validated in a cohort of 259 participants. RESULTS According to the multivariate regression analyses, age < 45 yr is highly predictive of TBP risk. The young non-cirrhotic TBP patients had higher ADA activity than the middle-aged or old controls (p < 0.01). Significantly decreased activity and efficacy of ADA were observed in the cirrhotic subgroup/population, regardless of age or cohort. For the above-mentioned two non-cirrhotic populations in the validation cohort, the ADA test showed excellent performance using thresholds of 30.5 IU/L and 20.5 IU/L, with respective sensitivities of 91.1% and 92.6%. CONCLUSIONS ADA activity is negatively associated with increasing age and underlying cirrhosis. Optimizing cut-off values for the ADA test can increase its sensitivity in non-cirrhotic individuals older than 45 years.
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Affiliation(s)
- Jian Sun
- Department of Infectious Diseases, the First Affiliated Hospital of Wannan Medical College, Wuhu 241000, China
| | - Huatang Zhang
- Department of Infectious Diseases, the First Hospital of Quanzhou, Fujian Medical University, Quanzhou 362000, China
| | - Zhiwei Song
- Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou 318000, China
| | - Lei Jin
- Department of Gastroenterology, the Second Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Jian Yang
- Department of Infectious Diseases, the First Affiliated Hospital of Wannan Medical College, Wuhu 241000, China
| | - Jun Gu
- Department of Gastroenterology, the Second Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Dan Ye
- Department of Infectious Diseases, Taizhou Municipal Hospital, Taizhou 318000, China
| | - Xueping Yu
- Department of Infectious Diseases, the First Hospital of Quanzhou, Fujian Medical University, Quanzhou 362000, China.
| | - Jianghua Yang
- Department of Infectious Diseases, the First Affiliated Hospital of Wannan Medical College, Wuhu 241000, China.
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Dal Ben D, Antonioli L, Lambertucci C, Spinaci A, Fornai M, D'Antongiovanni V, Pellegrini C, Blandizzi C, Volpini R. Approaches for designing and discovering purinergic drugs for gastrointestinal diseases. Expert Opin Drug Discov 2020; 15:687-703. [PMID: 32228110 DOI: 10.1080/17460441.2020.1743673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Purines finely modulate physiological motor, secretory, and sensory functions in the gastrointestinal tract. Their activity is mediated by the purinergic signaling machinery, including receptors and enzymes regulating their synthesis, release, and degradation. Several gastrointestinal dysfunctions are characterized by alterations affecting the purinergic system. AREAS COVERED The authors provide an overview on the purinergic receptor signaling machinery, the molecules and proteins involved, and a summary of medicinal chemistry efforts aimed at developing novel compounds able to modulate the activity of each player involved in this machinery. The involvement of purinergic signaling in gastrointestinal motor, secretory, and sensory functions and dysfunctions, and the potential therapeutic applications of purinergic signaling modulators, are then described. EXPERT OPINION A number of preclinical and clinical studies demonstrate that the pharmacological manipulation of purinergic signaling represents a viable way to counteract several gastrointestinal diseases. At present, the paucity of purinergic therapies is related to the lack of receptor-subtype-specific agonists and antagonists that are effective in vivo. In this regard, the development of novel therapeutic strategies should be focused to include tools able to control the P1 and P2 receptor expression as well as modulators of the breakdown or transport of purines.
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Affiliation(s)
- Diego Dal Ben
- School of Pharmacy, Medicinal Chemistry Unit, University of Camerino , Camerino, Italy
| | - Luca Antonioli
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa , Pisa, Italy
| | - Catia Lambertucci
- School of Pharmacy, Medicinal Chemistry Unit, University of Camerino , Camerino, Italy
| | - Andrea Spinaci
- School of Pharmacy, Medicinal Chemistry Unit, University of Camerino , Camerino, Italy
| | - Matteo Fornai
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa , Pisa, Italy
| | - Vanessa D'Antongiovanni
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa , Pisa, Italy
| | | | - Corrado Blandizzi
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa , Pisa, Italy
| | - Rosaria Volpini
- School of Pharmacy, Medicinal Chemistry Unit, University of Camerino , Camerino, Italy
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Use of adenosine deaminase (ADA) to diagnose suspected peritoneal tuberculosis in Rwanda: a cross-sectional study. BMC Infect Dis 2020; 20:239. [PMID: 32197582 PMCID: PMC7085165 DOI: 10.1186/s12879-020-04965-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background Peritoneal tuberculosis is the most common cause of low albumin gradient ascites in developing countries, but it can be easily confused with other causes of ascites. Peritoneal tuberculosis requires early recognition of symptoms and signs in order to make a quick diagnosis for appropriate treatment. Measurement of adenosine deaminase (ADA) level > 39 in ascites fluid is an established test to diagnose peritoneal tuberculosis. Many low-income countries do not currently test for adenosine deaminase in ascites fluid, including Rwanda. Method Cross-sectional, descriptive study conducted through the Internal Medicine Department of three university teaching hospitals in Rwanda. Participants were patients older than 16 years presenting to tertiary referral hospitals with ascites of unknown cause. Results Of 103 ascites fluid samples collected, 52 of them (50.5%) had an elevated ADA, consistent with a presumptive diagnosis of peritoneal TB. Among those 52 subjects diagnosed with peritoneal TB, 39 out of 52 (75%) did not receive anti-TB medications. Among the 17 subjects who were treated with anti-TB medications, 4 of 17 (23.6%) did not have peritoneal TB based on ADA level. Samples with low-albumin gradient ascites were more likely to have high ADA ≥39 IU/L (p = 0.039). Conclusion Our findings suggest that 3out of 4 patients with PTB in Rwanda are not getting TB treatment and 1 in 4 patients who are taking TB medications do not need it. Even if the true number of Rwandans who are being undertreated and overtreated is less than our study suggests, these results should prompt a larger study of peritoneal tuberculosis. Adding adenosine deaminase (ADA) to the diagnostic tools available to clinicians could help achieve the goal of correctly putting every Rwandan with tuberculosis on treatment, while avoiding unnecessary tuberculosis medications in those who do not have the disease.
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Dhaliwal NK, Narang D, Chandra M, Filia G, Singh ST. Evaluation of adenosine deaminase activity in serum of cattle and buffaloes in the diagnosis of bovine tuberculosis. Vet World 2020; 13:110-113. [PMID: 32158159 PMCID: PMC7020137 DOI: 10.14202/vetworld.2020.110-113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/05/2019] [Indexed: 11/16/2022] Open
Abstract
Background and Aim: Bovine tuberculosis (bTB) is a chronic bacterial disease of cattle caused by Mycobacterium bovis. bTB causes severe economic losses resulting from livestock deaths, chronic disease, and trade restrictions. Determination of serum levels of adenosine deaminase (ADA), an enzyme produced by monocytes/macrophages and lymphocytes, has been used in the diagnosis of human TB. This study aimed to evaluate the role of ADA enzyme activity in the diagnosis of bTB. Materials and Methods: In this study, a total of 100 animals (cattle and buffaloes) were screened for bTB by comparative intradermal tuberculin test (CITT) and interferon-γ (IFN-γ) test and in serum samples obtained from 100 screened animals, ADA seric activity was evaluated using ADA-MTB kit procured from Tulip Diagnostics. Results: A total of 18 animals were positive TB reactors by CITT, 8 were positive by IFN-γ, and 4 animals were positive by both CITT and IFN-γ. The average ADA value of bTB-positive animals either by CITT, IFN-γ, or both CITT and IFN-γ was 12.55 U/L, 14.8 U/L, and 18.36 U/L, respectively, in CID negative, it was 10.57 U/L and in IFN-γ negative, it was 10.59 U/L. Conclusion: The average ADA value of bTB-positive animals positive either by CITT, IFN-γ, or both CITT and IFN-γ was more than the average ADA value in animals negative for bTB by either of the tests.
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Affiliation(s)
- Navdeep Kaur Dhaliwal
- Department of Veterinary Microbiology, College of Veterinary Sciences, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab, India
| | - Deepti Narang
- Department of Veterinary Microbiology, College of Veterinary Sciences, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab, India
| | - Mudit Chandra
- Department of Veterinary Microbiology, College of Veterinary Sciences, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab, India
| | - Gursimran Filia
- Department of Veterinary Microbiology, College of Veterinary Sciences, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab, India
| | - Sikh Tejinder Singh
- Department of Veterinary Microbiology, College of Veterinary Sciences, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab, India
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Garbuzenko DV, Arefyev NO. Current approaches to the management of patients with cirrhotic ascites. World J Gastroenterol 2019; 25:3738-3752. [PMID: 31391769 PMCID: PMC6676543 DOI: 10.3748/wjg.v25.i28.3738] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/09/2019] [Accepted: 06/25/2019] [Indexed: 02/06/2023] Open
Abstract
This review describes current approaches to the management of patients with cirrhotic ascites in relation to the severity of its clinical manifestations. The PubMed database, the Google Scholar retrieval system, the Cochrane Database of Systematic Reviews, and the reference lists from related articles were used to search for relevant publications. Articles corresponding to the aim of the review were selected for 1991-2018 using the keywords: "liver cirrhosis," "portal hypertension," "ascites," "pathogenesis," "diagnostics," and "treatment." Uncomplicated and refractory ascites in patients with cirrhosis were the inclusion criteria. The literature analysis has shown that despite the achievements of modern hepatology, the presence of ascites is associated with poor prognosis and high mortality. The key to successful management of patients with ascites may be the stratification of the risk of an adverse outcome and personalized therapy. Pathogenetically based approach to the choice of pharmacotherapy and optimization of minimally invasive methods of treatment may improve the quality of life and increase the survival rate of this category of patients.
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Affiliation(s)
| | - Nikolay Olegovich Arefyev
- Department of Pathological Anatomy and Forensic Medicine, South Ural State Medical University, Chelyabinsk 454092, Russia
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12
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Wu DC, Averbukh LD, Wu GY. Diagnostic and Therapeutic Strategies for Peritoneal Tuberculosis: A Review. J Clin Transl Hepatol 2019; 7:140-148. [PMID: 31293914 PMCID: PMC6609850 DOI: 10.14218/jcth.2018.00062] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/08/2019] [Accepted: 03/14/2019] [Indexed: 02/07/2023] Open
Abstract
Peritoneal tuberculosis (PTB), although rarer than its pulmonary counterpart, is a serious health concern in regions of the world with high tuberculosis prevalence. Individuals with baseline immunocompromise condition, whether acquired or medically induced, are at greatest risk for experiencing PTB. While medical treatment of the condition is similar to that of the pulmonary disease, the generally immunocompromised state of those infected with PTB, along with a lack of highly sensitive and specific testing methods make early diagnosis difficult. This review discusses the risks factors, clinical features, diagnostic methods, and treatment options for PTB.
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Affiliation(s)
| | - Leon D. Averbukh
- *Correspondence to: Leon D. Averbukh, Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, 236 Farmington Ave., Farmington, CT 06030, USA. Tel: +1-347-306-4752, Fax: +1-860-679-4613, E-mail:
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13
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KASL clinical practice guidelines for liver cirrhosis: Ascites and related complications. Clin Mol Hepatol 2018; 24:230-277. [PMID: 29991196 PMCID: PMC6166105 DOI: 10.3350/cmh.2018.1005] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 04/06/2018] [Indexed: 02/07/2023] Open
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Saini V, Lokhande B, Jaswal S, Aggarwal D, Garg K, Kaur J. Role of serum adenosine deaminase in pulmonary tuberculosis. Indian J Tuberc 2017; 65:30-34. [PMID: 29332644 DOI: 10.1016/j.ijtb.2017.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/17/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Definitive laboratory diagnosis and confirmation of tuberculosis remains a major challenge because of lack of specificity and sensitivity of diagnostic methods especially in sputum smear negative tuberculosis. Many studies have proved the role of ADA in diagnosis of tuberculosis in effusion fluids and a decrease in ADA activity after treatment. This study was aimed to investigate the role of serum ADA level as an early diagnostic and prognostic marker for pulmonary tuberculosis (PTB). MATERIAL AND METHODS This was a cohort study done on patients visiting the OPD Clinics of the department of Pulmonary Medicine at GMCH, Chandigarh. 50 sputum positive and 50 sputum negative tuberculosis patients and 100 controls were recruited. Serum ADA levels were measured at the start of treatment and again after two months of treatment. Its correlation with severity of disease was seen. RESULTS Mean serum ADA (IU/L) was found to be 35.293±30.941 in PTB patients and 11.819±8.023 in control groups and the difference was found to be highly significant (P<0.00). Mean ADA was 31.107±29.32 in sputum positive patients, 39.478±32.22 in sputum negative and 11.819±8.0235 in control groups. No statistically significant difference was observed amongst sputum positive and sputum negative patients. The levels decreased significantly after intensive phase of treatment. At the cut off values of 14.6IU/L, serum ADA had 78% sensitivity and 76% specificity (AUC=0.801, P value<0.00) to differentiate between PTB from healthy controls. CONCLUSION Serum ADA levels may be used as a biomarker for diagnosis of PTB and to evaluate the response to treatment at follow up.
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Affiliation(s)
- Varinder Saini
- Professor, Department of Pulmonary Medicine, Government Medical College and Hospital, Sector 32, Chandigarh, India.
| | - Bhaskar Lokhande
- Junior Resident, Department of Pulmonary Medicine, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Shivani Jaswal
- Professor, Department of Biochemistry, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Deepak Aggarwal
- Associate Professor, Department of Pulmonary Medicine, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Kranti Garg
- Assistant Professor, Department of Pulmonary Medicine, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Jasbinder Kaur
- Professor and Head, Department of Biochemistry, Government Medical College and Hospital, Sector 32, Chandigarh, India
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Saleh MA, Ramadan MM, Arram EO. Toll-like receptor-2 Arg753Gln and Arg677Trp polymorphisms and susceptibility to pulmonary and peritoneal tuberculosis. APMIS 2017; 125:558-564. [DOI: 10.1111/apm.12680] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/15/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Mohammed A. Saleh
- Department of Microbiology and Immunology; Faculty of Medicine; Al-Azhar University; New Damietta Egypt
| | - Mahmoud M. Ramadan
- Department of Cardiology; Faculty of Medicine; Mansoura University; Mansoura Egypt
| | - Eman O. Arram
- Department of Thoracic Medicine; Faculty of Medicine; Mansoura University; Mansoura Egypt
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Bourgain G, Sbai W, Luciano L, Massoure MP, Brardjanian S, Goin G, De Biasi C, Wolf A, Al Shukry A, Coton T. Hepato-peritoneal tuberculosis with negative interferon gamma assay (Quantiferon™) in an immunocompetent patient: A case report. Clin Res Hepatol Gastroenterol 2016; 40:e44-5. [PMID: 26774362 DOI: 10.1016/j.clinre.2015.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/11/2015] [Accepted: 11/16/2015] [Indexed: 02/04/2023]
Affiliation(s)
- G Bourgain
- Service de pathologie digestive, hôpital d'instruction des armées Laveran, CS 50004, 13384 Marseille cedex 13, France
| | - W Sbai
- Service de pathologie digestive, hôpital d'instruction des armées Laveran, CS 50004, 13384 Marseille cedex 13, France
| | - L Luciano
- Service de pathologie digestive, hôpital d'instruction des armées Laveran, CS 50004, 13384 Marseille cedex 13, France
| | - M P Massoure
- Service de pathologie digestive, hôpital d'instruction des armées Laveran, CS 50004, 13384 Marseille cedex 13, France
| | - S Brardjanian
- Service de pathologie digestive, hôpital d'instruction des armées Laveran, CS 50004, 13384 Marseille cedex 13, France
| | - G Goin
- Service de chirurgie viscérale, hôpital d'instruction des armées, CS 50004, 13384 Marseille cedex 13, France
| | - C De Biasi
- Laboratoire d'anatomo-pathologie, hôpital d'instruction des armées, CS 50004, 13384 Marseille cedex 13, France
| | - A Wolf
- Laboratoire de biologie, hôpital d'instruction des armées, CS 50004, 13384 Marseille cedex 13, France
| | - A Al Shukry
- Service d'ORL, hôpital d'instruction des armées, CS 50004, 13384 Marseille cedex 13, France
| | - T Coton
- Service de pathologie digestive, hôpital d'instruction des armées Laveran, CS 50004, 13384 Marseille cedex 13, France.
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Farhadian S, Shenoi SV, Villanueva MS. A 33-year-old Haitian immigrant with 7 months of abdominal pain and progressive distension. BMJ Case Rep 2014; 2014:bcr2014205371. [PMID: 25008341 PMCID: PMC4091201 DOI: 10.1136/bcr-2014-205371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2014] [Indexed: 11/04/2022] Open
Abstract
We report a case of a 33-year-old previously healthy Haitian immigrant with a 7-month history of abdominal pain, fever and ascites. He had a history of positive tuberculin skin test but never underwent treatment for latent tuberculosis (TB) infection. Initial examination showed abdominal distension. Abdominal CT scan showed mild ascites, abnormal soft tissue in the greater omentum and small bowel mesentery, retroperitoneal adenopathy, peritoneal thickening and dilated loops of small bowel. Paracentesis and thoracentesis were initially non-diagnostic. HIV testing was negative. The differential diagnosis included lymphoma and TB peritonitis. The omental mass was biopsied under ultrasound guidance, and histopathology revealed non-necrotising granulomas. Sputum cultures and omental biopsy cultures subsequently grew Mycobacterium tuberculosis, and a diagnosis was made of pulmonary TB with TB peritonitis. The patient responded well to the initiation of anti-TB treatment.
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MESH Headings
- Abdomen/microbiology
- Abdomen/pathology
- Abdominal Pain/diagnosis
- Abdominal Pain/etiology
- Abdominal Pain/pathology
- Adult
- Antitubercular Agents/therapeutic use
- Ascites/diagnosis
- Ascites/etiology
- Biopsy
- Diagnosis, Differential
- Emigrants and Immigrants
- Granuloma/pathology
- Humans
- Male
- Mycobacterium tuberculosis
- Omentum/microbiology
- Omentum/pathology
- Peritonitis, Tuberculous/complications
- Peritonitis, Tuberculous/diagnosis
- Peritonitis, Tuberculous/microbiology
- Peritonitis, Tuberculous/pathology
- Sputum/microbiology
- Tomography, X-Ray Computed
- Tuberculin Test
- Tuberculosis, Gastrointestinal/complications
- Tuberculosis, Gastrointestinal/diagnosis
- Tuberculosis, Gastrointestinal/microbiology
- Tuberculosis, Gastrointestinal/pathology
- Tuberculosis, Pulmonary/complications
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/microbiology
- Tuberculosis, Pulmonary/pathology
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Affiliation(s)
- Shelli Farhadian
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Sheela V Shenoi
- Department of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Merceditas S Villanueva
- Department of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
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Bieber SD, Anderson AE, Mehrotra R. Diagnostic testing for peritonitis in patients undergoing peritoneal dialysis. Semin Dial 2014; 27:602-6. [PMID: 25039456 DOI: 10.1111/sdi.12270] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Scott D Bieber
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington
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Diagnostic value of adenosine deaminase in ascites for tuberculosis ascites: a meta-analysis. Diagn Microbiol Infect Dis 2014; 79:102-7. [DOI: 10.1016/j.diagmicrobio.2013.12.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 04/22/2013] [Accepted: 12/15/2013] [Indexed: 12/13/2022]
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Chen W, Fan JH, Luo W, Peng P, Su SB. Effectiveness of interferon-gamma release assays for differentiating intestinal tuberculosis from Crohn’s disease: A meta-analysis. World J Gastroenterol 2013; 19:8133-8140. [PMID: 24307809 PMCID: PMC3848163 DOI: 10.3748/wjg.v19.i44.8133] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 09/14/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical usefulness of interferon-gamma release assays (IGRAs) in the differential diagnosis of intestinal tuberculosis (ITB) from Crohn’s disease (CD) by meta-analysis.
METHODS: A systematic search of English language studies was performed. We searched the following databases: Medline, Embase, Web of Science and the Cochrane Library. The Standards for Reporting Diagnostic Accuracy initiative and Quality Assessment for Studies of Diagnostic Accuracy tool were used to assess the methodological quality of the studies. Sensitivity, specificity, and other measures of the accuracy of IGRAs in the differential diagnosis of ITB from CD were pooled and analyzed using random-effects models. Receiver operating characteristic curves were applied to summarize overall test performance. Two reviewers independently judged study eligibility while screening the citations.
RESULTS: Five studies met the inclusion criteria. The average inter-rater agreement between the two reviewers for items in the quality checklist was 0.95. Analysis of IGRAs for the differential diagnosis of ITB from CD produced summary estimates as follows: sensitivity, 0.74 (95%CI: 0.68-0.80); specificity, 0.87 (95%CI: 0.82-0.90); positive likelihood ratio, 5.98 (95%CI: 3.79-9.43); negative likelihood ratio, 0.28 (95%CI: 0.18-0.43); and diagnostic odds ratio, 26.21 (95%CI: 14.15-48.57). The area under the curve was 0.92. The evaluation of publication bias was not significant (P = 0.235).
CONCLUSION: Although IGRAs are not sensitive enough, they provide good specificity for the accurate diagnosis of ITB, which may be helpful in the differential diagnosis of ITB from CD.
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Shen YC, Wang T, Chen L, Yang T, Wan C, Hu QJ, Wen FQ. Diagnostic accuracy of adenosine deaminase for tuberculous peritonitis: a meta-analysis. Arch Med Sci 2013; 9:601-7. [PMID: 24049517 PMCID: PMC3776182 DOI: 10.5114/aoms.2013.36904] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 01/11/2013] [Accepted: 01/21/2013] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Tuberculous peritonitis remains a diagnostic challenge for clinicians. Many studies have investigated the usefulness of adenosine deaminase (ADA) in ascites for the diagnosis of tuberculous peritonitis; however, the overall diagnostic accuracy of ADA for tuberculous peritonitis remains unclear. The aim of the present meta-analysis was to determine the overall accuracy of ADA measurements in the diagnosis of tuberculous peritonitis. MATERIAL AND METHODS We performed a systematic search in PubMed and Embase to identify published studies that evaluated the diagnostic role of ADA for tuberculous peritonitis. Quality was assessed according to standardized Quality Assessment of Diagnostic Accuracy Studies criteria. Sensitivity, specificity and other measures of accuracy of ADA assay in order to diagnose tuberculous peritonitis were pooled using random effects models. Summary receiver operating characteristic curve (SROC) was used to summarize overall test performance. RESULTS Sixteen studies met inclusion criteria for the present meta-analysis. The pooled sensitivity and specificity for diagnosing tuberculous peritonitis were 0.93 (95% CI: 0.89-0.95) and 0.96 (95% CI: 0.94-0.97), respectively. The positive likelihood ratio was 15.80 (95% CI: 10.87-22.95), negative likelihood ratio was 0.09 (95% CI: 0.05-0.16) and diagnostic odds ratio was 249.28 (95% CI: 113.11-549.39). The area under the SROC was 0.98. CONCLUSIONS Ascitic ADA determination is a relatively sensitive and specific test for the diagnosis of tuberculous peritonitis. Measurement of ADA in ascites is thus likely to be a useful diagnostic method for tuberculous peritonitis.
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Affiliation(s)
- Yong-Chun Shen
- Division of Medicine, West China Hospital of Sichuan University, Chengdu, P.R. China
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Antonioli L, Colucci R, Pellegrini C, Giustarini G, Tuccori M, Blandizzi C, Fornai M. The role of purinergic pathways in the pathophysiology of gut diseases: pharmacological modulation and potential therapeutic applications. Pharmacol Ther 2013; 139:157-88. [PMID: 23588157 DOI: 10.1016/j.pharmthera.2013.04.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 03/15/2013] [Indexed: 02/08/2023]
Abstract
Gut homeostasis results from complex neuro-immune interactions aimed at triggering stereotypical and specific programs of coordinated mucosal secretion and powerful motor propulsion. A prominent role in the regulation of this highly integrated network, comprising a variety of immune/inflammatory cells and the enteric nervous system, is played by purinergic mediators. The cells of the digestive tract are literally plunged into a "biological sea" of functionally active nucleotides and nucleosides, which carry out the critical task of driving regulatory interventions on cellular functions through the activation of P1 and P2 receptors. Intensive research efforts are being made to achieve an integrated view of the purinergic system, since it is emerging that the various components of purinergic pathways (i.e., enzymes, transporters, mediators and receptors) are mutually linked entities, deputed to finely modulating the magnitude and the duration of purinergic signaling, and that alterations occurring in this balanced network could be intimately involved in the pathophysiology of several gut disorders. This review article intends to provide a critical appraisal of current knowledge on the purinergic system role in the regulation of gastrointestinal functions, considering these pathways as a whole integrated network, which is capable of finely controlling the levels of bioactive nucleotides and nucleosides in the biophase of their respective receptors. Special attention is paid to the mechanisms through which alterations in the various compartments of the purinergic system could contribute to the pathophysiology of gut disorders, and to the possibility of counteracting such dysfunctions by means of pharmacological interventions on purinergic molecular targets.
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Affiliation(s)
- Luca Antonioli
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.
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Su SB, Qin SY, Guo XY, Luo W, Jiang HX. Assessment by meta-analysis of interferon-gamma for the diagnosis of tuberculous peritonitis. World J Gastroenterol 2013; 19:1645-1651. [PMID: 23539367 PMCID: PMC3602483 DOI: 10.3748/wjg.v19.i10.1645] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 01/24/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the performance and diagnostic accuracy of interferon-gamma (IFN-γ) for tuberculous peritonitis (TBP) by meta-analysis.
METHODS: A systematic search of English language studies was performed. We searched the following electronic databases: MEDLINE, EMBASE, Web of Science, BIOSIS, LILACS and the Cochrane Library. The Standards for Reporting Diagnostic Accuracy initiative and Quality Assessment for Studies of Diagnostic Accuracy tool were used to assess the methodological quality of the studies. Sensitivity, specificity, and other measures of the accuracy of IFN-γ concentration in the diagnosis of peritoneal effusion were pooled using random-effects models. Receiver operating characteristic (ROC) curves were applied to summarize overall test performance. Two reviewers independently judged study eligibility while screening the citations.
RESULTS: Six studies met the inclusion criteria. The average inter-rater agreement between the two reviewers for items in the quality checklist was 0.92. Analysis of IFN-γ level for TBP diagnosis yielded a summary estimate: sensitivity, 0.93 (95%CI, 0.87-0.97); specificity, 0.99 (95%CI, 0.97-1.00); positive likelihood ratio (PLR), 41.49 (95%CI, 18.80-91.55); negative likelihood ratio (NLR), 0.11 (95%CI, 0.06-0.19); and diagnostic odds ratio (DOR), 678.02 (95%CI, 209.91-2190.09). χ2 values of the sensitivity, specificity, PLR, NLR and DOR were 5.66 (P = 0.3407), 6.37 (P = 0.2715), 1.38 (P = 0.9265), 5.46 (P = 0.3621) and 1.42 (P = 0.9220), respectively. The summary receiver ROC curve was positioned near the desirable upper left corner and the maximum joint sensitivity and specificity was 0.97. The area under the curve was 0.99. The evaluation of publication bias was not significant (P = 0.922).
CONCLUSION: IFN-γ may be a sensitive and specific marker for the accurate diagnosis of TBP. The level of IFN-γ may contribute to the accurate differentiation of tuberculosis (TB) ascites from non-TB ascites.
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Liao YJ, Wu CY, Lee SW, Lee CL, Yang SS, Chang CS, Lee TY. Adenosine deaminase activity in tuberculous peritonitis among patients with underlying liver cirrhosis. World J Gastroenterol 2012; 18:5260-5. [PMID: 23066321 PMCID: PMC3468859 DOI: 10.3748/wjg.v18.i37.5260] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 05/29/2012] [Accepted: 06/08/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the value of adenosine deaminase (ADA) for early detection of tuberculous peritonitis (TBP) among cirrhotic patients.
METHODS: We retrospectively analyzed 22 patients with TBP from July 1990 to June 2010. Twenty-five cirrhotic patients with uninfected ascites were prospectively enrolled as the cirrhosis control group from July 2010 to June 2011. An additional group of 217 patients whose ascites ADA levels were checked in various clinical conditions were reviewed from July 2008 to June 2010 as the validation group.
RESULTS: The mean ascites ADA value of cirrhotic patients with TBP (cirrhotic TBP group, n = 8) was not significantly different from that of non-cirrhotic patients (non-cirrhotic TBP group, n = 14; 58.1 ± 18.8 U/L vs 70.6 ± 29.8 U/L, P = 0.29), but the mean ascites ADA value of the cirrhotic TBP group was significantly higher than that of the cirrhosis control group (58.1 ± 18.8 U/L vs 7.0 ± 3.7 U/L, P < 0.001). ADA values were correlated with total protein values (r = 0.909, P < 0.001). Using 27 U/L as the cut-off value of ADA, the sensitivity and specificity were 100% and 93.3%, respectively, for detecting TBP in the validation group.
CONCLUSION: Even with lower ADA activity in ascites among cirrhotic patients, ADA values were significantly elevated during TBP, indicating that ADA can still be a valuable diagnostic tool.
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Song HY, Wang B. Tuberculous peritonitis in patients from an underdeveloped region: A retrospective analysis of 40 cases. Shijie Huaren Xiaohua Zazhi 2012; 20:1998-2005. [DOI: 10.11569/wcjd.v20.i21.1998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the characteristics of tuberculous peritonitis in patients from an underdeveloped region.
METHODS: The clinical data for 40 patients with tuberculous peritonitis were analyzed to summarize the features of tuberculosis peritonitis in terms of its history, clinical manifestations, laboratory testing, auxiliary examination, diagnosis, and differential diagnosis.
RESULTS: In our series, tuberculous peritonitis was more common in patients between 20-40 years old (57.5%), and only 22.5% of patients had a previous history of tuberculosis or chronic diseases. Tuberculous peritonitis usually had a chronic onset (85%). Common manifestations were abdominal distention (85%), anorexia (67.5%), fever (52.5%), and abdominal pain (47.5%). The signs of ascites (67.5%) and abdominal tenderness (65%) were common. Serological tests had low specificity. Ascites was exudative. Ascites ADA > 33 U/L and monocyte predominance may contribute to the diagnosis of tuberculous peritonitis. The positive rates of ascites acid-fast bacillus smear and Mycobacterium tuberculosis culture were low (4.75% and 0%, respectively). The positive rate of PPD test and abnormal rate of chest X-ray were both 37.5%. The abnormal rate of abdominal CT and B-mode ultrasound scan were both 78%. The uterus and annexes were involved in 72.7% of female TBP patients. Five cases (12.5%) were misdiagnosed, of whom 3 were misdiagnosed as gynecologic tumors. Only 4 cases (10%) were confirmed by microbiology or pathology, and the remaining 36 cases (90%) relies on experimental anti-TB treatment to achieve the diagnosis.
CONCLUSION: In underdeveloped regions, the vast majority of tuberculous peritonitis cases are diagnosed by experimental anti-TB treatment due to the limited availability of laparoscopy or B ultrasound-guided biopsy.
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Chander A, Shrestha CD. Diagnostic value of serum adenosine deaminase levels in sputum smear negative pulmonary tuberculosis patients in Nepalese population. Asian Pac J Trop Biomed 2012. [DOI: 10.1016/s2221-1691(12)60517-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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