Adenosine deaminase activity - more than a diagnostic tool in tuberculous pericarditis
Date
2005-06
Authors
Reuter, Helmuth
Burgess, Lesley J.
Carstens, Machteld E.
Doubell, Anton F.
Journal Title
Journal ISSN
Volume Title
Publisher
Clinics Cardiv Publishing
Abstract
Aim: To improve the understanding of factors that
influence adenosine deaminase (ADA) activity in large
pericardial effusions.
Methods: A prospective study was carried out at
Tygerberg Academic Hospital, South Africa. Patients
underwent echocardiographically guided pericardiocentesis.
ADA activity, as well as biochemistry, haematology,
cytology, and in some cases, histology, were determined.
Human immunodeficiency virus (HIV) status
was assessed in all patients.
Results: Two hundred and thirty-three patients presented
to Tygerberg Hospital with large pericardial
effusions requiring pericardiocentesis. Tuberculous pericarditis
accounted for 162 effusions (69.5%). An ADA
cut-off level of 40 U/l resulted in a test sensitivity,
specificity, positive predictive value (PPV), negative
predictive value (NPV) and diagnostic efficiency of
84.0%, 80.0%, 91.0%, 66.0% and 83.0%, respectively.
Pericardial exudates with an ADA activity ≥ 40 U/l were
associated with increased total leukocyte and neutro -
phil counts. Patients with tuberculous pericarditis and
ADA ≥ 40 U/l also had increased lymphocyte counts.
Pericardial ADA activity < 30 U/l was associated with
severe depletion of CD4 cell counts in HIV-positive
patients. ADA levels were higher in cases with histological
evidence of granulomatous inflammation than in
cases with serofibrinous pericarditis.
Conclusions: An ADA cut-off level of 40 U/l results in
best diagnostic test results. ADA production appears
to be influenced by factors associated with the antituberculous
immune response.
Description
The original publication is available at http://www.cvja.co.za/
Keywords
Adenosine deaminase, Tuberculous pericarditis
Citation
Reuter, H., Burgess, L.J., Carstens, M.E. & Doubell, A.F. 2005. Adenosine deaminase activity - more than a diagnostic tool in tuberculous pericarditis. Cardiovasular Journal of South Africa, 16(3), 143-147