adenosine deaminase activity is a sensitive marker for the diagnosis of tuberculous pleuritis in patients with very low cd4 counts腺苷脱氨酶活性是一个敏感的标记对结核性胸膜炎的诊断患者的cd4计数很低.pdfVIP

Adenosine Deaminase Activity Is a Sensitive Marker for the Diagnosis of Tuberculous Pleuritis in Patients with Very Low CD4 Counts 1,2,3 3 1,4 1,4 Kamaldeen Baba *, Anwar A. Hoosen , Nina Langeland , Anne M. Dyrhol-Riise 1 Institute of Medicine, University of Bergen, Bergen, Norway, 2 Center for International Health, University of Bergen, Bergen, Norway, 3 Department of Microbiological Pathology, University of Limpopo, Limpopo, South Africa, 4 Department of Medicine, Haukeland University Hospital, Bergen, Norway Abstract Background: Adenosine Deaminase Activity (ADA) is a commonly used marker for the diagnosis of tuberculous pleural effusion. There has been concern about its usefulness in immunocompromised patients, especially HIV positive patients with very low CD4 counts. The objective of this study was to evaluate the sensitivity of ADA in pleural fluid in patients with low CD4 counts. Materials and Methods: This was a retrospective case control study. Medical files of patients with tuberculous pleuritis and non-tuberculous pleuritis were reviewed. Clinical characteristics, CD4 cell counts in blood and biochemical markers in pleural fluid, including ADA were recorded. Results: One ninety seven tuberculous pleuritis and 40 non- tuberculous pleuritis patients were evaluated. Using the cut-off value of 30 U/L, the overall sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of ADA was 94%, 95%, 19, and 0.06 respectively. The mean CD4 cell counts among TB pleuritis patients was 29 and 153 cells/microL in patients with CD4 ,50 cells/microL and .50 cells/microL, (p,0.05) respectively. The corresponding mean ADA values for these patients were 7