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A Hospital Based Study on Estimation of Adenosine Deaminase Activity (ADA) in Cerebrospinal Fluid (CSF) in Various
Ashok Kumar Agarwal1, Sonia Bansal2, Vidya Nand3
1Senior Resident, Department of Medicine, Rajendra Institute of Medical Science (RIMS) , Ranchi, Jharkhand, India .
Objective:
Tuberculosis kills 3.70 lakh patients in India every year,out of which 7-12 % are meningeal involvement. Delay in its diagnosis and initiation of treatment results in poor prognosis and squeal in up to 25% of cases. The aim of the present study is to look for a simple, rapid, cost effective, and fairly specific test in differentiating tubercular aetiology from other causes of meningitis. In the present study we measured the adenosine deaminase activity (ADA) in Cerebrospinal Fluid (CSF) of Tubercular Meningitis (TBM) and non-TBM patients.
Methods:
Fifty six patients attending hospital with symptoms and signs of meningitis were selected and divided into three groups: tubercular, pyogenic, and aseptic meningitis, depending upon the accepted criteria. CSF was drawn and ADA estimated.
Results:
Out of 32 tubercular patients, 28 had CSF-ADA at or above the cut-off value while four had below. Out of 24 non-tuberculous patients (pyogenic and aseptic meningitis), two aseptic meningitis (AM) patient had ADA levels at or above the cut-off value while 22 had below this value. RESULTS of our study indicate that ADA level estimation in CSF is not only of considerable value in the diagnosis of TBM, CSF, and ADA level 10 U/L as a cut-off value with sensitivity 87.5% and specificity 83.33% and positive predictive value of the test was 87.5%.and 83.3% negative predictive value.
Conclusion:
It can be concluded that ADA estimation in CSF is not only simple, inexpensive and rapid but also fairly specific method for making a diagnosis of tuberculous aetiology in TBM, especially when there is a dilemma of differentiating the tuberculous aetiology from non-tuberculous ones. For this reason ADA estimation in TBM may find a place as a routine investigation.
Insights
Adenosine deaminase (ADA) levels in cerebrospinal fluid (CSF) can help diagnose tuberculous meningitis (TBM). Measuring CSF ADA is a simple, rapid, and specific test for differentiating TBM from other meningitis types.
Area of Science:
- Neurology
- Infectious Diseases
- Biochemistry
Background:
- Tuberculosis (TB) is a significant cause of mortality in India, with meningeal involvement occurring in 7-12% of cases.
- Delayed diagnosis and treatment of tuberculous meningitis (TBM) lead to poor prognosis and sequelae in up to 25% of patients.
- A simple, rapid, and cost-effective diagnostic test is needed to differentiate TBM from other forms of meningitis.
Purpose of the Study:
- To evaluate the efficacy of adenosine deaminase (ADA) activity in cerebrospinal fluid (CSF) for diagnosing TBM.
- To determine if CSF ADA levels can reliably differentiate tuberculous meningitis from pyogenic and aseptic meningitis.
Main Methods:
- Fifty-six patients with meningitis symptoms were categorized into tubercular, pyogenic, and aseptic groups based on established criteria.
- Cerebrospinal fluid (CSF) samples were collected from all patients.
- Adenosine deaminase (ADA) activity was measured in the CSF samples.
Main Results:
- Out of 32 TBM patients, 28 showed CSF ADA levels at or above the cut-off value (≥10 U/L).
- Among 24 non-TBM patients (pyogenic and aseptic meningitis), only 2 had ADA levels at or above the cut-off.
- The test demonstrated a sensitivity of 87.5%, specificity of 83.33%, positive predictive value of 87.5%, and negative predictive value of 83.3% for diagnosing TBM.
Conclusions:
- CSF ADA estimation is a simple, inexpensive, and rapid method for diagnosing TBM.
- ADA levels in CSF are fairly specific in differentiating tuberculous etiology from non-tuberculous meningitis.
- ADA estimation in CSF may be a valuable routine investigation for TBM diagnosis, especially in cases of diagnostic uncertainty.
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