Abstract
This cross sectional study was carried out in the department of gastroenterology, BIRDEM, Dhaka from January 2010 to May 2011 to determine the role of ascitic fluid ADA and serum CA-125 in the diagnosis of clinically suspected tubercular peritonitis. Total 30 patients (age 39.69 ± 21.26, 18M/12F) with clinical suspicion of tuberculosis peritonitis were included in this study after analyzing selection criteria. Laparoscopic peritoneal biopsy with 'histopathological diagnosis' was considered gold standard against which accuracics of two biomarkers (ADA & CA-125) were compared. Cut off value of ADA and CA-125 are 24 u/l, 35 U/ml respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ADA as a diagnostic modality in tuberculos peritonitis were 87.5%, 83.33%, 95.45%, 62.5% and 86.67% respectively where as CA-125 was found to have 83.33% sensitivity, 50% specificity, 86.9% positive predictive value, 42.85% negative predictive value and 76.6% accuracy. Both biomarkers are simple, non-invasive, rapid and relatively cheap diagnostic test where as laparoscopy is an invasive procedure, costly & requires trained staff and not without risk and also not feasible in all the centre in our country. So ascitic fluid ADA and serum CA-125 are important diagnostic test for peritoneal tuberculosis.
Highlights
Bangladesh is a high endemic zone of tuberculosis
The aim of this study is to evaluate ADA and CA-125 as diagnostic tools for tuberculous peritonitis
Suspected cases of tubercular peritonitis presenting with abdominal pain, fever, ascites, weight loss, history of contact of TB patients or past history of TB were included in this study and those admitted in this hospital and those refused to be included in the study, Pregnant or lactating mother, known case of cirrhosis of liver, CKD, heart failure or intra-abdominal malignancy were excluded
Summary
Bangladesh is a high endemic zone of tuberculosis. Tuberculosis can involve any part of the gastrointestinal tract and is the sixth most frequent site of extra-pulmonary involvement. Diagnosis of tuberculous peritonitis is sometimes difficult. The ADA activity is significantly higher in the tuberculous peritonitis. High level of ADA (cut off value 24 U/L) gave the test sensitivity of 93% and specificity 96%.2-4. Ovarian malignancy is must be excluded before diagnosis of peritoneal tuberculosis. High level of CA-125 (cut off value 35 U/ml) gave the test sensitivity of 98.4% and specificity 95.9%.5. There is a significant correlation between ADA & CA-125 in patients with tubercular peritonitis.[6] Both biomarkers are simple, rapid, non-invasive & relatively cheap diagnostic test for tuberculous peritonitis. Establish as a new biochemical marker of ADA and CA-125 are time demanding for the diagnosis of peritoneal tuberculosis. The aim of this study is to evaluate ADA and CA-125 as diagnostic tools for tuberculous peritonitis
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