The usefulness of adenosine deaminase in the diagnosis of tuberculous pericarditis

Diagnostic approach to a cardiac mass: a case report of misdiagnosed cardiac synovial sarcoma

Background

Cardiac synovial sarcoma (CSS) is an extremely rare malignant tumour with a poor prognosis. We report the case of a 31-year-old woman who presented with a CSS in the right atrium and was initially misdiagnosed with a tuberculoma. The aim of this article is to focus on the importance of having broad differential diagnoses including rare entities.

Case summary

A 31-year-old White woman, with a close contact with a relative having pulmonary tuberculosis, presented to the emergency unit with severe dyspnoea. Chest radiography and echocardiography showed a large pericardial effusion with a mass in the right atrium. Pericardiocentesis removed bloody exudative fluid with adenosine desaminase at 17 UI/L and no malignant cells in the cytological study. Cardiac magnetic resonance revealed a tuberculoma of the right atrium. Intraoperatively, the mass was only biopsied because of the local invasion. Histological study concluded to a CSS. The patient died 3 days later.

Discussion

This case highlights the importance of having broad differential diagnoses including rare entities. Histology was the key investigation for the diagnosis of CSS which has no clinical nor laboratory or imaging pathognomonic signs.

Evaluation of adenosine deaminase activity in serum of cattle and buffaloes in the diagnosis of bovine tuberculosis

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.

Correlation study between ADA and IFN-γ gene polymorphisms and the risk of developing tuberculous pericarditis

OBJECTIVE

To study the correlation between adenosine deaminase (ADA) and IFN-γ gene polymorphism and the risk of tuberculous pericarditis (TBP).

METHODS

Two-hundred and forty-five patients with TBP were enrolled as a study group, including 140 males and 105 females. According to the general information of TBP patients in the study group, 115 patients with non-tuberculous pericarditis were recruited as the control group. Four ADA single nucleotide polymorphisms (SNPs; rs121908715, rs79281338, rs121908723, and rs61737144) and the rs2069707 locus of the IFN-γ polymorphism were detected using PCR and Sanger sequencing.

RESULTS

Carriers with the T allele at the rs121908715 locus of ADA had a higher risk of TBP (adjusted OR = 3.986, 95% CI = 1.858-8.718, p < 0.001). There was a significantly higher risk of TBP in carriers with the G allele at the rs121908723 locus of ADA (adjusted OR = 2.334, 95% CI = 1.084-5.102, p = 0.018). The risk of TBP was higher in carriers with the G allele at the rs2069707 locus of IFN-γ (adjusted OR = 2.844, 95% CI = 1.399-5.853, p = 0.002). TB patients who carry both the T allele at the rs121908715 locus of ADA and the G allele of the IFN-γ gene, or who both carry the G allele at the rs126908723 locus of ADA and the G allele at the rs2069707 locus of IFN-γ have a higher risk of contracting TBP (adjusted OR = 11.034, 95% CI = 2.781-15.328, p < 0.001 and adjusted OR = 10.315, 95% CI = 4.522-13.854, p < 0.001).

CONCLUSION

The ADA SNPs rs12190871 and rs121908723, and the rs2069707 locus SNPs of IFN-γ are risk factors for contracting TBP.

Role of serum adenosine deaminase in pulmonary tuberculosis

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.

Predictive factors for unfavorable outcomes of tuberculous pericarditis in human immunodeficiency virus-uninfected patients in an intermediate tuberculosis burden country

BACKGROUND

In areas where Mycobacterium tuberculosis is endemic, tuberculosis is known to be the most common cause of pericarditis. However, the difficulty in diagnosis may lead to late complications such as constrictive pericarditis and increased mortality. Therefore, identification of patients at a high risk for poor prognosis, and prompt initiation of treatment are important in the outcome of TB pericarditis. The aim of this study is to identify the predictive factors for unfavorable outcomes of TB pericarditis in HIV-uninfected persons in an intermediate tuberculosis burden country.

METHODS

A retrospective review of 87 cases of TB pericarditis diagnosed at a tertiary referral hospital in South Korea was performed. Clinical characteristics, treatment outcomes, complications during treatment, duration of treatment, and medication history were reviewed. Unfavorable outcome was defined as constrictive pericarditis identified on echocardiography performed 3 to 6 months after initial diagnosis of TB pericarditis, cardiac tamponade requiring emergency pericardiocentesis, or death. Predictive factors for unfavorable outcomes were identified.

RESULTS

Of the 87 patients, 44 (50.6%) had unfavorable outcomes; cardiac tamponade (n = 36), constrictive pericarditis (n = 18), and mortality (n = 4). 14 patients experienced both cardiac tamponade and constrictive pericarditis. During a 1 year out-patient clinic follow up, 4 patients required repeat pericardiocentesis and pericardiectomy was performed in 0 patients. In the multivariate analysis, patients with large amounts of pericardial effusion (P = .003), those with hypoalbuminemia (P = .011), and those without cardiovascular disease (P = .011) were found to have a higher risk of unfavorable outcomes.

CONCLUSION

HIV-uninfected patients with TB pericarditis are at a higher risk for unfavorable outcomes when presenting with low serum albumin, with large pericardial effusions, and without cardiovascular disease.

Determination of serum adenosine deaminase and xanthine oxidase levels in patients with crimean-congo hemorrhagic fever

OBJECTIVE

Crimean-Congo hemorrhagic fever is an acute viral hemorrhagic fever with a high mortality rate. Despite increasing knowledge about hemorrhagic fever viruses, little is known about the pathogenesis of Crimean-Congo hemorrhagic fever. In this study, we measured serum adenosine deaminase and xanthine oxidase levels in Crimean-Congo hemorrhagic fever patients.

METHODS

Serum adenosine deaminase levels were measured with a sensitive colorimetric method described by Giusti and xanthine oxidase levels by the method of Worthington in 30 consecutive hospitalized patients (mean age 42.6 +/- 21.0). Laboratory tests confirmed their diagnoses of Crimean-Congo hemorrhagic fever. Thirty-five subjects (mean age 42.9 +/- 19.1) served as the control group.

RESULTS

There was a significant difference in adenosine deaminase and xanthine oxidase levels between cases and controls (p<0.05). However, neither adenosine deaminase nor xanthine oxidase levels varied with the severity of disease in the cases assessed (p>0.05).

CONCLUSION

Adenosine deaminase and xanthine oxidase levels were increased in patients with Crimean-Congo hemorrhagic fever. Elevated serum xanthine oxidase activity in patients with Crimean-Congo hemorrhagic fever may be associated with reactive oxygen species generated by the xanthine/xanthine oxidase system during inflammatory responses. In addition, elevated lipid peroxidation may contribute to cell damage and hemorrhage. The association of cell damage and hemorrhage with xanthine oxidase activity should be further investigated in large-scale studies.

Adenosine deaminase and tuberculous meningitis--a systematic review with meta-analysis

Tuberculous meningitis (TBM) is a severe infection of the central nervous system, particularly in developing countries. Prompt diagnosis and treatment are necessary to decrease the high rates of disability and death associated with TBM. The diagnosis is often time and labour intensive; thus, a simple, accurate and rapid diagnostic test is needed. The adenosine deaminase (ADA) activity test is a rapid test that has been used for the diagnosis of the pleural, peritoneal and pericardial forms of tuberculosis. However, the usefulness of ADA in TBM is uncertain. The aim of this study was to evaluate ADA as a diagnostic test for TBM in a systematic review. A systematic search was performed of the medical literature (MEDLINE, LILACS, Web of Science and EMBASE). The ADA values from TBM cases and controls (diagnosed with other types of meningitis) were necessary to calculate the sensitivity and specificity. Out of a total of 522 studies, 13 were included in the meta-analysis (380 patients with TBM). The sensitivity, specificity and diagnostic odds ratios (DOR) were calculated based on arbitrary ADA cut-off values from 1 to 10 U/l. ADA values from 1 to 4 U/l (sensitivity >93% and specificity <80%) helped to exclude TBM; values between 4 and 8 U/l were insufficient to confirm or exclude the diagnosis of TBM (p = 0.07), and values >8 U/l (sensitivity <59% and specificity >96%) improved the diagnosis of TBM (p < 0.001). None of the cut-off values could be used to discriminate between TBM and bacterial meningitis. In conclusion, ADA cannot distinguish between bacterial meningitis and TBM, but using ranges of ADA values could be important to improve TBM diagnosis, particularly after bacterial meningitis has been ruled out. The different methods used to measure ADA and the heterogeneity of data do not allow standardization of this test as a routine.