The value of adenosine deaminase (ADA) determination in the diagnosis of tuberculous ascites

Brant, Cesar Q.; Silva Jr., Mario R.; Macedo, Erica P.; Vasconcelos, Claudio; Tamaki, Natalina; Ferraz, M. Lucia G.

doi:10.1590/S0036-46651995000500011

Abstracts

In order to evaluate the role of the determination of adenosine deaminase activity (ADA) in ascitic fluid for the diagnosis of tuberculosis, 44 patients were studied. Based on biochemical, cytological, histopathological and microbiological tests, the patients were divided into 5 groups: G1 - tuberculous ascites (n = 8); G2 - malignant ascites (n = 13); G3 - spontaneous bacterial peritonitis (n = 6); G4 - pancreatic ascites (n = 2); G5 - miscelaneous ascites (n = 15). ADA concentration were significantly higher in G1 (133.50 ± 24.74 U/l) compared to the other groups (G2 = 41.85 ± 52.07 U/l; G3 = 10.63 ± 5.87 U/l; G4 = 18.00 ± 7.07 U/l; G5 = 11.23 ± 7.66 U/l). At a cut-off value of >31 U/l, the sensitivity, specificity and positive and negative preditive values were 100%, 92%, 72% and 100%, respectively. ADA concentrations as high as in tuberculous ascites were only found in two malignant ascites caused by lymphoma. We conclude that ADA determination in ascitic fluid is a useful and reliable screening test for diagnosing tuberculous ascites. Values of ADA higher than 31 U/l indicate more invasive methods to confirm the diagnosis of tuberculosis.

Tuberculous peritonitis; Adenosine deaminase; Ascites

Com o objetivo de avaliar o papel da determinação da atividade da enzima adenosina deaminase (ADA) no diagnóstico da peritonite tuberculosa, foram estudados 44 pacientes. De acordo com os resultados das determinações bioquímicas, citológicas, histopatológicas e microbiológicas, os pacientes foram divididos nos seguintes grupos: G1 - ascite tuberculosa (n = 8); G2 - neoplásica (n = 13), G3 - peritonite bacteriana espontânea (n = 6), G4 -ascite pancreática (n = 2), G5 - miscelânea (n = 15). A concentração de ADA no grupo de pacientes com peritonite tuberculosa foi de 133.50 ± 24.74 U/l, significantemente mais elevada que nos outros grupos (G2 = 41.85 ± 52.07; G3 = 10.63 ± 5.87; G4 = 18.00 ± 7.07; G5 = 11.23 ± 7.66). Com um limite de corte de 31 U/l, a sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo para diagnóstico de tuberculose foram, respectivamente 100%, 92%, 72% e 100%. Valores de ADA tão elevados quanto na tuberculose só foram encontrados nas ascites neoplásicas causadas por linfomas. Com base nestes achados, consideramos que a determinação de ADA deve ser utilizada como um teste de triagem no diagnóstico diferencial das ascites. Valores de ADA acima de 31 U/l indicam a necessidade de testes invasivos (laparoscopia e/ou biópsia peritonial, para confirmação diagnóstica).

CLINICAL AND LABORATORIAL STUDIES

The value of adenosine deaminase (ADA) determination in the diagnosis of tuberculous ascites

Valor da determinação da adenosina deaminase (ADA) no diagnóstico da ascite tuberculosa

Cesar Q. Brant^I; Mario R. Silva Jr.^II; Erica P. Macedo^II; Claudio Vasconcelos^III; Natalina Tamaki^IV; M. Lucia G. Ferraz^V

^IR3 Residents, Discipline of Gastroenterology, EPM-UNIFESP, São Paulo, SP, Brazil

^IITrainees in the Discipline of Gastroenterology, EPM-UNIFESP, São Paulo, SP, Brazil

^IIIEx-Resident, Discipline of Gastroenterology, EPM-UNIFESP, São Paulo, SP, Brazil

^IVLaboratory Technician, Laboratório Fleury, São Paulo, SP, Brazil

^VAssistant Professor, Discipline of Gastroenterology, EPM-UNIFESP, São Paulo, SP, Brazil

^{Correspondence to} Correspondence to: Maria Lúcia Gomes Ferraz Rua Machado Bittencourt, 413/81 04044-001, São Paulo, SP, Brasil

SUMMARY

In order to evaluate the role of the determination of adenosine deaminase activity (ADA) in ascitic fluid for the diagnosis of tuberculosis, 44 patients were studied.

Based on biochemical, cytological, histopathological and microbiological tests, the patients were divided into 5 groups: G1 - tuberculous ascites (n = 8); G2 - malignant ascites (n = 13); G3 - spontaneous bacterial peritonitis (n = 6); G4 - pancreatic ascites (n = 2); G5 - miscelaneous ascites (n = 15).

ADA concentration were significantly higher in G1 (133.50 ± 24.74 U/l) compared to the other groups (G2 = 41.85 ± 52.07 U/l; G3 = 10.63 ± 5.87 U/l; G4 = 18.00 ± 7.07 U/l; G5 = 11.23 ± 7.66 U/l).

At a cut-off value of >31 U/l, the sensitivity, specificity and positive and negative preditive values were 100%, 92%, 72% and 100%, respectively. ADA concentrations as high as in tuberculous ascites were only found in two malignant ascites caused by lymphoma.

We conclude that ADA determination in ascitic fluid is a useful and reliable screening test for diagnosing tuberculous ascites. Values of ADA higher than 31 U/l indicate more invasive methods to confirm the diagnosis of tuberculosis.

Keywords: Tuberculous peritonitis; Adenosine deaminase; Ascites.

RESUMO

Com o objetivo de avaliar o papel da determinação da atividade da enzima adenosina deaminase (ADA) no diagnóstico da peritonite tuberculosa, foram estudados 44 pacientes. De acordo com os resultados das determinações bioquímicas, citológicas, histopatológicas e microbiológicas, os pacientes foram divididos nos seguintes grupos: G1 - ascite tuberculosa (n = 8); G2 - neoplásica (n = 13), G3 - peritonite bacteriana espontânea (n = 6), G4 -ascite pancreática (n = 2), G5 - miscelânea (n = 15).

A concentração de ADA no grupo de pacientes com peritonite tuberculosa foi de 133.50 ± 24.74 U/l, significantemente mais elevada que nos outros grupos (G2 = 41.85 ± 52.07; G3 = 10.63 ± 5.87; G4 = 18.00 ± 7.07; G5 = 11.23 ± 7.66). Com um limite de corte de 31 U/l, a sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo para diagnóstico de tuberculose foram, respectivamente 100%, 92%, 72% e 100%.

Valores de ADA tão elevados quanto na tuberculose só foram encontrados nas ascites neoplásicas causadas por linfomas.

Com base nestes achados, consideramos que a determinação de ADA deve ser utilizada como um teste de triagem no diagnóstico diferencial das ascites. Valores de ADA acima de 31 U/l indicam a necessidade de testes invasivos (laparoscopia e/ou biópsia peritonial, para confirmação diagnóstica)

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Recebido para publicação em 30/03/1995

Aceito para publicação em 07/11/1995

1. AGUADO, J.M.; PONS, F. & CASAFORT, F. - Tuberculous peritonitis: a study comparing cirrhotic and noncirrhotic patients. J . clin. Gastroent., 12: 550-554, 1990.
2. BHARGAVA, O.K., GUPTA, M.; HIJHAWAN, S.; DASARATHY, S. & KUSHWAHA, A.K. - Adenosine deaminase in peritoneal tuerculosis: diagnostic value in ascitic fluid and serum. Tubercle, 71: 121-126, 1990.
3. DINEEN, P.; HOMAN, W.P. & GRAFE, W.R. - Tuberculous peritonitis: 43 years experience in diagnosis and treatment. Ann. Surg., 184: 717-722, 1976.
4. DWIVEDI, M.; MISRA, S.P.; MISRA, V. & KUMAR, R. - Value of adenosine deaminase estimation in the diagnosis of tuberculous ascites. Amer, J. Gastroent., 85: 1123-1125, 1990.
5. FERNANDEZ-RODRIGUES, C.M.; PEREZ-ARGUELLES, B.S. & LEDO, L. - Ascites adenosine deaminase activity is decreased in tuberculous ascites with low protein adenosine deaminase activity is decreased in tuberculous ascites with low protein content. Amer. J. Gastroent., 86: 1500-1503, 1990.
6. GIMENEZ-ROCA, A.; XILOL, X.; CASTELLOTE, J. et al. - Valor del ADA en la tuberculosis peritoneal. Rev. esp. Enferm. apar. dig., 82: 32-34, 1992.
7. GUISTI, G. - Adenosine deaminase. In: BERGEMEYER, H.V., ed. Methods of enzymatic analysis. New York, Academic Press, 1974. p. 1092-1099.
8. MARTINEZ-VAGNEZ, J.M.; OCAŃA, I. & RIBERA, E. - Adenosine deaminase activity in the diagnosis of tuberculous peritonitis. Gut, 27: 1049-1053, 1986.
9. OLCOTT, C.T. & PACCHIONE, D. - Tuberculous peritonitis. Amer. Rev. Tuberc., 28: 27-61, 1993.
10. RUNYON, B.A. - Spontaneous bacterial peritonitis: an explosion of information. Hepatology, 8: 171-179, 1988.
11. SEGURA, R.M.; PASCUAL, C. & OCAŃA, I. - Adenosine deaminase in body fluids: a useful diagnostic tool in tuberculosis. Clin. Biochem.,22: 141-148, 1989.
12. SINGH, M.M.; BHARVAVA, A.N. & JAIN, K.P. - Tuberculous peritonitis. An evaluation of pathogenetic mechanisms, diagnostic procedures and therapeutic measures. New Engl. J. Med., 281: 1091-1014, 1969.
13. SMITH, G.H. - Treatment of infections in the patient with Adquired Immunodeficiency syndrome. Arch. intern. Med., 154: 949-973, 1994.
14. VOIGT, M.G.; KKALVARIA, I. & TRAY, C. - Diagnostic value of ascites adenosine deaminase in tuberculous peritonitis. Lancet, 8: 751-753, 1989.

Correspondence to:

Maria Lúcia Gomes Ferraz

Rua Machado Bittencourt, 413/81

04044-001, São Paulo, SP, Brasil

Publication Dates

Publication in this collection
21 Sept 2006
Date of issue
Oct 1995

History

Accepted
07 Nov 1995
Received
30 Mar 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. AGUADO, J.M.; PONS, F. & CASAFORT, F. - Tuberculous peritonitis: a study comparing cirrhotic and noncirrhotic patients. J . clin. Gastroent., 12: 550-554, 1990.

[2] 2. BHARGAVA, O.K., GUPTA, M.; HIJHAWAN, S.; DASARATHY, S. & KUSHWAHA, A.K. - Adenosine deaminase in peritoneal tuerculosis: diagnostic value in ascitic fluid and serum. Tubercle, 71: 121-126, 1990.

[3] 3. DINEEN, P.; HOMAN, W.P. & GRAFE, W.R. - Tuberculous peritonitis: 43 years experience in diagnosis and treatment. Ann. Surg., 184: 717-722, 1976.

[4] 4. DWIVEDI, M.; MISRA, S.P.; MISRA, V. & KUMAR, R. - Value of adenosine deaminase estimation in the diagnosis of tuberculous ascites. Amer, J. Gastroent., 85: 1123-1125, 1990.

[5] 5. FERNANDEZ-RODRIGUES, C.M.; PEREZ-ARGUELLES, B.S. & LEDO, L. - Ascites adenosine deaminase activity is decreased in tuberculous ascites with low protein adenosine deaminase activity is decreased in tuberculous ascites with low protein content. Amer. J. Gastroent., 86: 1500-1503, 1990.

[6] 6. GIMENEZ-ROCA, A.; XILOL, X.; CASTELLOTE, J. et al. - Valor del ADA en la tuberculosis peritoneal. Rev. esp. Enferm. apar. dig., 82: 32-34, 1992.

[7] 7. GUISTI, G. - Adenosine deaminase. In: BERGEMEYER, H.V., ed. Methods of enzymatic analysis. New York, Academic Press, 1974. p. 1092-1099.

[8] 8. MARTINEZ-VAGNEZ, J.M.; OCAŃA, I. & RIBERA, E. - Adenosine deaminase activity in the diagnosis of tuberculous peritonitis. Gut, 27: 1049-1053, 1986.

[9] 9. OLCOTT, C.T. & PACCHIONE, D. - Tuberculous peritonitis. Amer. Rev. Tuberc., 28: 27-61, 1993.

[10] 10. RUNYON, B.A. - Spontaneous bacterial peritonitis: an explosion of information. Hepatology, 8: 171-179, 1988.

[11] 11. SEGURA, R.M.; PASCUAL, C. & OCAŃA, I. - Adenosine deaminase in body fluids: a useful diagnostic tool in tuberculosis. Clin. Biochem.,22: 141-148, 1989.

[12] 12. SINGH, M.M.; BHARVAVA, A.N. & JAIN, K.P. - Tuberculous peritonitis. An evaluation of pathogenetic mechanisms, diagnostic procedures and therapeutic measures. New Engl. J. Med., 281: 1091-1014, 1969.

[13] 13. SMITH, G.H. - Treatment of infections in the patient with Adquired Immunodeficiency syndrome. Arch. intern. Med., 154: 949-973, 1994.

[14] 14. VOIGT, M.G.; KKALVARIA, I. & TRAY, C. - Diagnostic value of ascites adenosine deaminase in tuberculous peritonitis. Lancet, 8: 751-753, 1989.