Estimation of Adenosine deaminase and proteinase inhibitory activity and their correlation with tuberculous effusion and other pleural effusion cases

Diagnosis of tuberculous effusion is difficult with the conventional, bacteriological, cytological and histopathological methods in our country. Adenosine deaminase, serum proteins, phospholipids show marked variation in tuberculous exudates.

Twenty cases of pulmonary tuberculosis, 10 cases of malignant effusions and 8 cases of other parapneumonic effusions visiting a tertiary care hospital were included in this study. After collecting blood and pleural fluid samples, Adenosine deaminase, Alpha-1 antitrypsin l, proteinase inhibitor activity, total lipid levels, phospholipid and Lipase activity were estimated.

Serum ADA levels in tuberculous effusion was 21.8+ 9.8 U/L(10–45.08) P <0.05 and that in tuberculous effusions after treatment was 12.2+4.4 U/L(6.2–20)P<0.05. Alpha-1 antitrypsin(mg%) levels in tuberculous effusion was 649.7+ 228.4 (365–949)P <0.05 and that in tuberculous effusions after treatment was 427.5 + 106.6(292–584)P<0.05.

Adenosine deaminase activity in serum and pleural fluid was found to be significantly elevated in pulmonary tuberculosis compared to the normal healthy subjects. ADA activity of serum and pleural fluid of malignant effusion cases(Bronchogenic carcinoma) and other parapneumonic effusions was found elevated compared to normal whereas the elevation in pulmonary tuberculosis was very high. So estimation of ADA in serum and pleural effusions may be a useful parameter for differential diagnosis of pulmonary tuberculosis from that of bronchogenic carcinoma and other parapneumonic effusions. ADA activity was found to be decreased in patients undergoing antituberculous treatment for a period of 6 weeks. So it may also be useful in the prognosis of the disease during treatment.