Use of Adenosine Deaminase as biomarker in diagnosis of suspected tuberculous pleural effusion at tertiary referral hospitals in RWANDA

Abstract

Background: Pleural effusion is a common problem and a number of diseases can cause it. The ineffectiveness of tests and procedures toconfirm pleural fluid etiologycan delay treatment. There is therefore a need for a sensitive and specific test that can differentiate tuberculosis from other causes of pleural effusion. Previous studies have shown that Adenosine Deaminase(ADA) is an accurate test forthe diagnosis of pleural TB, with sensitivity and specificity of up to 100%.[1][2]The use of Adenosine Deaminase as biomarker, with other parameters and tests were helpful in the diagnosis of tuberculous pleurisy. Methods: Study participants were recruited through the Internal Medicine and Accident& Emergency Departments of the two tertiary referral hospitals in Rwanda (CHUK and CHUB). We included patients older than 16 years with pleural effusion who agreed to participate in the study. Patients with pleural effusion of a known cause, which had been previously diagnosed, and who came for pleural fluid evacuation to improve respiratory symptoms, were excluded. Objective: This study tries to see the prevalence of pleural Tuberculosis base on use of AdenosisneDeaminase Results: The majority of the study participants (N=90) were young (≤55years) at prevalence of 71.1%. Sex ratio (M: F) = 1: 0.83. Among 90 pleural fluid samples studied 58 (64.4%) were analyzed for Light‟s criteria and 44 (75.9%) were consistent with the exudative nature of disease, among them 34.1 % (15) had ADA >30 U/L. TB pleural effusion was diagnosed at prevalence of 32.2% (29) by ADA level >30U/l among 90 study participants. Conclusions: In the area with high prevalence of Tuberculosis, the use of Adenosine Deaminase may help for diagnosis of pleural Tuberculosis with other causes of pleural effusion.