Abstract
The etiologic diagnosis of pleural effusion is often difficult, requiring invasive investigations to determine it. In Romania, tuberculosis is a frequent cause of pleural effusion, with the diagnosis of certainty being based on the bacteriological or histopathological examination. Adenosine deaminase (ADA) is an enzyme found in T lymphocytes, stimulated by Mycobacterium tuberculosis, which is why it is considered to be an essential marker of etiologic diagnosis in countries where the TB endemic is elevated. A case-control study was conducted in the Clinical Pneumophthisiology Hospital of Constanta, Romania, in patients diagnosed with tuberculous pleural effusion. The primary endpoint was to establish the cut-off value for ADA in supporting the positive diagnosis of TB pleural effusion, and the secondary objective was to identify the differences between TB pleural effusion and other etiologic types of pleural effusion. A cut-off of 55 UI has a good specificity (80%) and good sensitivity (85%). The study confirms other features of tuberculous pleural effusion as younger age, lower levels of white blood cells and neutrophils, increased number of lymphocytes in pleural fluid, low protein serum level, increased values of pleural lactic dehydrogenase (LDH) and pleural ADA.
Highlights
The trend in medical research is to search for biochemical, molecular or immunological markers to support a positive diagnosis of disease by less invasive and less expensive methods
This enzyme is normally found in the cells of the body, but the highest concentrations are found in T lymphocytes because they are stimulated by the presence of TB bacilli in cells
Cases included 114 (25.6%) patients confirmed with TB pleural effusion by bacteriological examination (29.8%), or by histopathological examination (15.9%) or by any other association of pulmonary parenchymal lesions (28.7% %), from which 25.6% were positive in sputum culture for Mycobacterium tuberculosis (MTB) complex
Summary
The trend in medical research is to search for biochemical, molecular or immunological markers to support a positive diagnosis of disease by less invasive and less expensive methods. For diagnosis of TB serositis, as pleural effusion or pericarditis, age, history of the disease including contact with a contagious patient, biochemical, bacteriological and cytological examination of the pleural and pericardial fluid, histopathological examination are taken into account [4].
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