Volume. 35, No. 2 july. 2011 - The Chest and Heart Association of ...

More documents

Recommendations

Info

Chest & Heart Journal Vol. 35, No.-2, July 2011Table-VResult of different investigations in pulmonary TB patientsBAL fluid Sputum culture BAL fluid BAL fluid MantouxADA level for AFB Culture Smear for test Positive>5.00 U/L Positive forAFB Positive AFB PositiveADA positiven=39 13 (33.3) 29 (74.4) 20 (51.3) 22 (56.4)ADA Negative n=4 3 (75.0) 1 (25.0) 1 (25.0) 3 (75.0)Total n=43 16 (37.2) 30 (69.8) 21 (48.8) 25 (58.1)Figure within parentheses indicates in percentage.for AFB was positive in 51.3% cases, Mantoux testwas positive in 56.4% cases. So, in comparison toother investigations ADA level assay in BAL fluidwas found to be better for diagnosis of pulmonaryTB patients with negative sputum smear for AFB.Discussion:Various workers had tried different biochemicaltests from time to time which might help in earlydiagnosis and confirmation of pulmonarytuberculosis 12 . M. tuberculosis PCR in bronchialaspirates is a rapid diagnostic procedure with ahigh sensitivity (~95%) and specificity (~70%) insputum smear negative pulmonary TB patients 13 .This test is very costly, not so available in ourcountry and the result would be available at 24-48hours. Whereas, although the invasive procedure,BAL fluid ADA seems to be a more cost-effectivediagnostic procedure than PCR test in our country.Moreover, the results of this test are available ina couple of hours and with high sensitivity,specificity, positive predictive value and negativepredictive value. ADA is used for the diagnosis ofTB and there are studies showing high levels ofADA in Bronchoalveolar lavage fluids of pulmonaryTB patients 6 . The reason of high ADA level is that,ADA is an enzyme found in peripheral blood andtissue lymphocytes and is increased in BAL fluidin diseases with lymphocytic reactions 14 .Inflammation due to TB in lung parenchyma is atype of lymphocytic inflammation and is expectedto increase in pulmonary TB patients 15 .In our study, the mean ADA level in BAL fluidwas 6.58 ± 1.31 U/L in pulmonary tuberculosis and4.00 ± 0.93 U/L in non-tuberculous pulmonarydiseases. The difference was statistically significant(p=0.001). By using ROC curve analysis the cut-offvalue of ADA in BAL fluid for diagnosis pulmonaryTB was determined to be 5.0 U/L, at which levelthe sensitivity was 90.7%, specificity was 87.7%,PPV was 84.8%, NPV was 92.6% and accuracywas 89.0%. These statistical results indicate that,the investigation ADA level assay in BAL fluid wasapplicable for the diagnosis of pulmonary TB.A few authors have studied ADA activity in BALfluid for diagnosis of pulmonary tuberculosis.Similar result was found by Halvani and Binesh(2008) and added that, ADA activity in BAL fluid ofpulmonary TB patients was higher than that seenin other diseases. Orphanidou et al (1998)examined the ADA activity in BAL fluid ofpulmonary TB patients and non-TB pulmonarydisease patients and found that ADA level in BALfluids of pulmonary TB patients was significantlyhigher than that of non-TB lung disease patients(p
Adenosine Deaminase Activity in Bronchoalveolar Lavage in PatientsMd. Khairul Anam et al.pneumonia patients and control group was5.02±3.75 U/L, 1.06±0.99 U/L, 0.21±0.43 U/L and0.3±0.51 U/L respectively (p < 0.001).Orphanidou et al. (1998) compared ADA activityand lysozyme levels in BAL fluid of smear negativepulmonary TB patients and non-TB pulmonarydisease patients. They found no significantdifference in lysozyme level of BAL fluids betweentwo groups but the ADA level in BAL fluids ofpulmonary TB patients was (6.0 ± 05.8 U/L)significantly higher than that of non-TB lungdisease patients (P
Page 3 and 4: THE CHEST & HEART ASSOCIATION OF BA
Page 5 and 6: Chest & Heart JournalVol. 35, No. 2
Page 7 and 8: Instruction to Authors About Unifor
Page 11 and 12: Assessment of Diagnostic Value of C
Page 13 and 14: Assessment of Diagnostic Value of C
Page 16 and 17: Chest & Heart Journal Vol. 35, No.-

Volume. 35, No. 2 july. 2011 - The Chest and Heart Association of ...

Create successful ePaper yourself

Delete template?

Save as template?