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Diagnostic value of ascites gamma interferon levels in tuberculous peritonitis. Comparison with adenosine deaminase
E Ribera1, J M Martínez Vásquez, I Ocaña
1Department of Internal Medicine, Vall d'Hebron General Hospital, Autonomous University of Barcelona, Spain.
Abstract:
The value of ascites gamma interferon concentration and ascites adenosine deaminase activity in distinguishing tuberculosis from other causes of ascites was examined in a prospective study of 86 patients with ascites, including 16 with tuberculous peritonitis. Gamma interferon concentration was higher in tuberculous peritonitis than in the other causes of ascites (p less than 0.0001), and a cut-off between 3 and 9 u/ml reached a sensitivity and a specificity of 100%. The mean (+/- SD) gamma interferon level in tuberculous ascites was 39.3 +/- 18.3 u/ml in patients seronegative for HIV and 14.2 +/- 4.7 u/ml in patients with AIDS (p = 0.01). Adenosine deaminase activity in tuberculous ascites was also higher than in the other causes of ascites (p less than 0.0001), and a cut-off of 40 u/l reached a sensitivity of 100% and a specificity of 97%. The two false positives for adenosine deaminase test were true negatives for the gamma interferon test. There was no significant correlation between gamma interferon concentration and adenosine deaminase activity either in tuberculous ascitis or in any other group. This study suggests that ascites gamma interferon determination may be very useful in the screening of tuberculous peritonitis, but its cost makes it advisable to use adenosine deaminase activity as a routine test, at least in areas where tuberculosis is endemic.
Insights
Ascites gamma interferon and adenosine deaminase activity effectively distinguish tuberculous peritonitis. Gamma interferon offers 100% sensitivity and specificity, while adenosine deaminase activity is a cost-effective routine test for tuberculosis diagnosis.
Area of Science:
- Infectious Diseases
- Biochemistry
- Medical Diagnostics
Background:
- Ascites is a common clinical condition with diverse etiologies.
- Distinguishing tuberculous peritonitis from other causes of ascites is crucial for timely and effective treatment.
- Biomarkers in ascites fluid may aid in differential diagnosis.
Purpose of the Study:
- To evaluate the diagnostic value of ascites gamma interferon concentration and adenosine deaminase activity in differentiating tuberculous peritonitis.
- To determine the sensitivity and specificity of these markers for diagnosing tuberculosis ascites.
Main Methods:
- A prospective study involving 86 patients with ascites, including 16 with confirmed tuberculous peritonitis.
- Measurement of gamma interferon concentration and adenosine deaminase activity in ascites fluid.
- Statistical analysis to assess diagnostic performance and correlations.
Main Results:
- Ascites gamma interferon concentration was significantly higher in tuberculous peritonitis (p < 0.0001).
- A gamma interferon cut-off of 3-9 u/ml achieved 100% sensitivity and specificity.
- Adenosine deaminase activity was also elevated in tuberculous ascites (p < 0.0001), with a cut-off of 40 u/l yielding 100% sensitivity and 97% specificity.
Conclusions:
- Ascites gamma interferon is a highly sensitive and specific marker for tuberculous peritonitis.
- Adenosine deaminase activity is a valuable and cost-effective routine diagnostic test for tuberculosis ascites, especially in endemic areas.
- While gamma interferon is excellent for screening, adenosine deaminase activity is recommended for broader application due to cost considerations.