Comparative analysis of cerebrospinal fluid adenosine deaminase levels in infective meningitis of different aetiologies

Authors

  • Mohsin Rashid Department of Pediatrics, SGRR and SMIH, Patel Nagar, Dehradun, Uttarakhand, India
  • Sheikh Mushtaq Department of Pediatrics, G. B. Pant hospital Government Medical College Srinagar, J&K, India
  • Junaid Manzoor Department of Pediatrics, SGRR and SMIH, Patel Nagar, Dehradun, Uttarakhand, India
  • Javaid Ahmad Bhat Department of Pediatrics, SGRR and SMIH, Patel Nagar, Dehradun, Uttarakhand, India
  • Shilakha Chaman Department of Pediatrics, SGRR and SMIH, Patel Nagar, Dehradun, Uttarakhand, India
  • Abdul Hamid Department of Pediatrics, G. B. Pant hospital Government Medical College Srinagar, J&K, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20170718

Keywords:

Adenosine deaminase, Cerebrospinal fluid, Tubercular meningitis

Abstract

Background: Meningitis can be caused by bacteria, viruses, parasites, and fungi as well as by non-infectious conditions including inflammatory disorders (e.g., systemic lupus erythematosis or Kawasaki disease) and neoplasia (e.g., leukemic meningitis). The objective of this study were to study cerebrospinal fluid (CSF) adenosine deaminase (ADA) levels in infective meningitis of different aetiologies. And to assess the role of cerebrospinal fluids (CSF) adenosine deaminase (ADA) levels in differentiating tubercular from non-tubercular meningitis.

Methods: The study was conducted on 70 patients of meningitis at Postgraduate Department of Paediatrics, in G. B. Pant Hospital, an associated hospital of Government Medical College Srinagar. Out of 70 patients included in the study 27 cases were Aseptic Meningitis (AM), 14 cases partially treated pyogenic -meningitis (PTM), 19 cases pyogenic meningitis (PM), and 10 cases were tubercular meningitis (TBM). ADA activity of CSF was quantified by colorimetry.

Results: In our study we observed a significant high level of ADA 30.0±3.2U/L (20.0, 54.0) among the tubercular meningitis (TBM) patients and its respective level among Aseptic Meningitis (AM), was 8.1±0.3U/L (4.0, 11.5), partially treated pyo -meningitis (PTM) was 7.6±0.4U/L (5.0, 11.0), pyogenic meningitis (PM) was 11.6±0.5U/L (8.0, 14.5). In total Non-TBM ADA level was 9.1±0.3U/L (4.0, 14.5) units/liter. At cut off of > or equal to 10U/L sensitivity was 100% specificity66.67% positive predictive value33.33% negative predictive value of 100% diagnostic accuracy 71.43%. At a higher cut off of > or equal to 12U/L sensitivity was 100% and specificity increased to 81.67% positive predictive value 47.62% negative predictive value100% diagnostic accuracy was 84.29%.

Conclusions: The sensitivity and specificity of CSF ADA activity is markedly high in differentiating TBM from non-TBM. Hence CSF ADA activity may be used as a simple, cost-effective and reliable test for early diagnosis of TBM.

References

Saez-Llorens X, McCracken GH. Bacterial meningitis in children. Lancet. 2003;361:2139-48.

Acute Bacterial Meningitis beyond the Neonatal Period. Nelson Textbook of Pediatrics 19th Edition; 2011:594:1.

Government of India TB India. Revised National TB Control Programme Annual Status Report; 2014:5-7.

Mastroianni CM, Paolotti F, Lichtrer MD, Agostino C, Vullo V, Delia S. Cerebrospinal fluid cytokines in patients with tuberculous meningitis, Clin Immunopathol. 1997;84:171-6.

Tandon PN. Neurotuberculosis: clinical aspects. In: Neurology in Tripica. Chopra, J. S. and Sawhney, I.M.S. (eds.) Churchill Livingstone Ltd; 1999:358-389.

Tuberculosis, Central Nervous System Disease Nelson Textbook of Pediatrics 19th Edition; 2011:996.

Bothamley GH. Serological diagnosis of tuberculosis. Eur Respir J. 1995;8 (Suppl. 20):676-88.

Kennedy DH, Fallon RJ. Tuberculosis meningitis. JAMA. 1979;241:264-8.

Giusti G. Adenosine deaminase. In: Bergmeyer H U, ed. Methods of enzymatic analysis. New York, NY, USA: Academic Press; 1974:1092-6.

Wilson DK, Rudolph FB, Quiocho FA. Atomic structure of adenosine deaminase complexed with a transition-state analog: Understanding catalysis and immunodeficiency mutations. Science. 2010;252:1278-84.

Fox IH, Kelly WN. The role of adenosine deaminase and 2'deoxyadensoine in mammalian cells. Ann Rev Biochem. 1978;47:655-86.

Erel O, Kocyigit A, Gurel MS, Bulut V, Seyrek A. Adenosine deaminase activities in sera, lymphocytes and granulocytes in patients with cutaneous Leishmaniasis. Mem Inst Oswaldo Cruz, Rio de Janeiro. 1998;93:491-4.

Galanti B, Nardiello S, Russo M, Fiorentino F. Increased lymphocyte adenosine deaminase in typhoid fever. Scand J Infect Dis. 1981;13:47-50.

Prasad R, Kumar A, Khanna BK, Mukerji PK, Agarwal SK, Kumar A, et al. Adenosine deaminase activity in cerebro-spinal fluid for diagnosis of tuberculous meningitis. Ind J Tub. 1991;38:99-102.

Baro M, Acevedo L, Lagos ME. Usefulness of adenosine deaminase determination in cerebrospinal fluid for the diagnosis of meningeal tuberculosis; 4 years experience at a public hospital. Rev Med Chill. 1996;124:319-26.

Pettersson T, Klockars M, Weber TH. Diagnostic value of cerebrospinal fluid adenosine deaminase determination. Scand J Infect Dis. 1991;23:97-100.

Corral I, Quereda C, Navas E, Martin-Davila P, Perez-Elias MJ, Casado JL, et al. Adenosine deaminase activity in cerebrospinal fluid of HIV- infected patients: limited value for diagnosis of tuberculous meningitis. Eur J Clin Microbiol Infect Dis. 2004;23:471-6.

Piras MA, Gakis C. Cerebrospinal fluid adenosine deaminase activity in tuberculous meningitis. Enzyme. 1973;14:311-7.

Ribera E, Jose M, Martinez-Vasquez JM, Inma O, Rosa M, Segura RM, et al. Activity of adenosine deaminase in cerebrospinal fluid for the diagnosis and follow-up of tuberculous meningitis in adults. J Inf Dis. 1987;155:603-7.

Baheti R, Laddha P, Gehlot RS. CSF - adenosine deaminase (ADA) activity in various types of meningitis. J Indian Aca Clin Med. 2001;2(4):285-7.

Gupta BK, Bharat V, Bandyopadhyay D. Role of adenosine deaminase estimation in differentiation of tuberculous and non-tuberculous exudative pleural effusions, J Clin Med Res. 2010;2(2):79-84.

Baheti R, Laddha P, Gehlot RS. CSF - adenosine deaminase activity in various types of meningitis. J Indian Aca Clin Med. 2001;2(4):2001.

Rana SV, Singhal RK, Singh K, Kumar L. Adenosine deaminase levels in cerebrospinal fluid as a diagnostic test for tuberculous meningitis in children. Ind J Clin Biochem. 2004;19:5-9.

Kashyap RS, Kainthla RP, Mudaliar AV, Purohit H, Taori GM, Daginawala HF. Cerebrospinal fluid adenosine deaminase activity: a complementary tool in the early diagnosis of tuberculous meningitis. Cerebros Fluid Res. 2006;3:5.

Chotmongkol V, Teerajetgul Y, Chattanong Y. Cerebrospinal fluid adenosine deaminase activity for the diagnosis of tuberculous meningitis in adults. Southeast Asian J Trop Med Public Health. 2006;37(5):948-52.

Bhatnagar S, Beig FK, Malik A. Adenosine deaminase and c-reactive protein in cerebrospinal fluid for differential diagnosis of tubercular meningitis in children; Indian J Clin Biochem. 2008;23(3):299-301.

Gupta BK, Bharat A, Bandyopadhyay D, Haren B. Adenosine deaminase levels in csf of tuberculous meningitis patients. J Clin Med Res. 2010;2(5):220-4.

Karsena H, Koruka ST, Karahocagilb MK, Calisira C, Baranc FC. Comparative analysis of cerebrospinal fluid adenosine deaminase activity in meningitis. Swiss Med Wkly. 2011;141:w13214.

Pan A, Biswas A, Chaterjee A, Kumar R. Evaluation of cerebrospinal fluid adenosine deaminase activity as a complimentary tool in the early diagnosis of tuberculous meningitis in children. J Col Med Sci Nepal. 2012;8(2):17-23.

Sun Q, Sha W, Xiao HP, Tian Q, Zhu H. Evaluation of cerebrospinal fluid adenosine deaminase activity for the differential diagnosis of tuberculous and non tuberculous meningitis. Am J Med Sci. 2012;344(2):116-21.

Malla K, Rao KS, Malla T, Vedamony J, Ghimire P. Role of cerebrospinal fluid - adenosine deaminase level in early diagnosis of various etiologies of meningitis in children. Nepal J Med Sci. 2012;1(2):97-102.

Jasani JH, Bhuva KV, Vachhani AB, Patel VR, Sancheti SM, Patel D, et al. Value of adenosine deaminase level for the differential diagnosis various meningitis. Inter J Biol Med Res. Int J Biol Med Res. 2012;3(2):1644-7.

Chander A, Shrestha CD. Cerebrospinal fluid adenosine deaminase levels as a diagnostic marker in tuberculous meningitis in adult Nepalese patients. Asian Pac J Trop Dis. 2013;3(1):16-9.

Gupta BK, Goel P, Baruah H, Shukla P, Kiran J. Cerebrospinal fluid adenosine deaminase: its evaluation as a marker for diagnosing tuberculous meningitis in paediatric patients. IOSR-JDMS. 2013;4(1):21-4.

Thwaites G, Chau TT, Mai NT. Tuberculous meningitis. J Neurol Neuro Surg Psych. 2000;68:289-99.

Pettersson T, Klockars M, Weber TH. Diagnostic value of cerebrospinal fluid adenosine Deaminas. Scand J Infect Dis. 1991;23(1):97-100.

Eintracht S, Silber E, Sonnenberg P. Analysis of adenosine deaminase isoenzyme-2 (ADA-2) In cerebrospinal fluid in the diagnosis of TB meningitis. J Neurol Neuro Surg Psych. 2000;69:137-8.

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Published

2017-02-22

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