Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.5.4.4 (adenosine deaminase)
 5,136 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

When a patient with an undiagnosed pleural effusion is evaluated, the first question to answer is whether the patient has a transudate or an exudate. This is best done using Light's criteria, but these criteria occasionally misidentify a transudate as an exudate. If the patient's pleural fluid meets exudative criteria, but the patient appears clinically to have a transudative effusion, then the serum-pleural fluid albumin gradient should be measured. If this is greater than 1.2 g-dL-1, the patient probably does have a transudative effusion. If the patient has an exudative pleural effusion, additional tests are indicated to determine the aetiology of the effusion. The gross appearance and the odour of the pleural fluid should be noted and samples of all exudates should be sent for bacterial cultures. Laboratory tests that are useful in the differential diagnosis of exudative pleural effusions include: differential white cell count of the pleural fluid; cytology of the pleural fluid; and levels of adenosine deaminase, glucose, amylase and lactate dehydrogenase in the pleural fluid. If pleural tuberculosis is suspected, a needle biopsy of the pleura is indicated. Thoracoscopy is very efficient at diagnosing malignant pleural effusion and tuberculosis pleuritis, but rarely establishes any other diagnosis.
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PMID:Diagnostic principles in pleural disease. 904 52

Tuberculous pleural effusions occur in up to 30% of patients with tuberculosis. It appears that the percentage of patients with pleural effusion is comparable in human immunodeficiency virus (HIV)-positive and HIV-negative individuals, although there is some evidence that HIV-positive patients with CD4+ counts <200 cells x mL(-1) are less likely to have a tuberculous pleural effusion. There has recently been a considerable amount of research dealing with the immunology of tuberculous pleurisy. At present, we have more evidence that activated cells produce cytokines in a complex pleural response to mycobacteria. Intramacrophage elimination of mycobacterial antigens, granuloma formation, direct neutralization of mycobacteria and fibrosis are the main facets of this reaction. With respect to diagnosis, adenosine deaminase and interferon gamma in pleural fluid have proved to be useful tests. Detection of mycobacterial deoxyribonucleic acid (DNA) by the polymerase chain reaction is an interesting test, but its usefulness in the diagnosis of tuberculous pleurisy needs further confirmation. The recommended treatment for tuberculous pleurisy is a 6 month regimen of isoniazid and rifampicin, with the addition of pyrazinamide in the first 2 months. HIV patients may require a longer treatment. The general use of corticosteroids is not recommended at this time, but they can be used in individuals who are markedly symptomatic.
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PMID:Pleural tuberculosis. 915 Mar 38

From 1994 to 1995, 80 cases which belonged to 78 patients were diagnosed. The rate was 56.6 cases/100,000 inhabitants/year in 1994 and 51.2 in 1995. The ratio male/female was 2:1 for the two years. Diagnose in hospital was 73% and in health centre 27%. Acid-fast stain and/or positive culture of M. Tuberculosis (MT) and another mycobacteria were obtained in 82.5% cases. The MT resistances were about 3.6. It was usually placed in lungs in 69.2%. The 5.1% patients were positive for HIV. Only one patient died (1.8%) who suffered from a miliary form. The favorite administered treatment (78.2%) was six months with three drugs. The adenosine deaminase (ADA) was discriminate for 80% of pleuritis. The average stay was 17.6 days. Important differences in each town councils rates.
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PMID:[Tuberculosis epidemiology in the Cervo (Lugo) health area]. 918 11

Throughout the world tuberculosis is associated with poverty, deprivation, and human immunodeficiency virus infection. Abdominal tuberculosis is usually of insidious onset with diverse symptoms and signs. A few present with acute complications of perforation, obstruction, or bleeding. The diagnosis is difficult, especially in areas where the disease is less common, as many patients do not have evidence of pulmonary tuberculosis or a positive skin test. The main differential diagnosis ranges from Crohn's disease in the young and advanced malignancy in the elderly. Delayed diagnosis is common, resulting in high mortality. Many investigations provide findings suggestive but not diagnostic of tuberculosis. With peritoneal tuberculosis, assay of ascitic fluid adenosine deaminase activity is a valuable, simple method of diagnosis that may reduce the need for laparoscopic biopsy. If the clinical suspicion of abdominal tuberculosis is high, a trial of medical treatment is appropriate. Surgery should be reserved for the complications of the disease. All patients require treatment with three antituberculous drugs over a 6-month course.
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PMID:Abdominal tuberculosis. 920 36

We performed diagnostic and therapeutic pericardiostomy with drainage and biopsy in 51 patients with moderate to large pericardial effusions of different etiologies from August 1991 to July 1995. Patients were divided into 4 groups (group 1, tuberculous pericarditis; group 2, suspected tuberculous pericarditis; group 3, acute pericarditis; group 4, malignancy). The pericardial fluid adenosine deaminase level in tuberculosis (87 +/- 10 U/l) was significantly higher than that in malignancy or acute pericarditis (21 +/- 4 U/l, 23 +/- 7 U/l, respectively) (P = 0.0001). The mean pericardial fluid carcinoembryonic antigen level (1.8 +/- 0.3 ng/ml) in benign disease was significantly lower than that (170.7 +/- 46.4 ng/ml) in malignant disease (P = 0.0001). Follow-up study has been done. With a new scoring system (each score 1 for adenosine deaminase > or = 40 U/l, or carcinoembryonic antigen < or = 5 ng/ml) in 25 patients since November 1993, we could diagnose 5 among 7 patients (71%) with tuberculosis, 11 among 13 patients (85%) with malignancy (adenosine deaminase < or = 40 U/l, or carcinoembryonic antigen > or = 5 ng/ml) and 5 among 5 patients (100%) with acute pericarditis (adenosine deaminase < or = 40 U/l, or carcinoembryonic antigen < or = 5 ng/ml), respectively. Our long-term follow-up study suggests that with the new scoring system we can decrease complications or avoid unnecessary procedures or treatments of patients.
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PMID:New scoring system using tumor markers in diagnosing patients with moderate pericardial effusions. 929 26

Recent studies in populations with a high prevalence of tuberculosis and HIV infection report that tuberculous pleurisy occurs in approximately 30% of patients with tuberculosis. However, the fraction of patients with tuberculosis who have tuberculous pleurisy is comparable in HIV-positive and HIV-negative individuals. It appears that tuberculous pleurisy mostly develops in patients with HIV who have CD4 counts above 200/microL. Primary tuberculous pleurisy is thought to occur as a result of a delayed hypersensitivity reaction to mycobacterial antigens. Recent studies highlight the way in which pleural cells become activated and produce cytokines as a response to mycobacteria. Intramacrophage and direct cytotoxic elimination of mycobacteria, granuloma formation, and fibrosis are the main facets of this reaction. Many studies have investigated the usefulness of measuring different parameters in pleural fluid for an early diagnosis of tuberculous pleurisy. It has been shown that the most useful diagnostic tests are the levels of adenosine deaminase and interferon gamma in the pleural fluid. Elevation of either of these compounds in lymphocytic pleural effusions is virtually diagnostic of tuberculous pleurisy. Although theoretically, detection of mycobacterial DNA in the pleural fluid by the polymerase chain reaction would appear to be useful, the usefulness of this test still needs further demonstration. Patients with tuberculous pleurisy must receive antituberculous treatment. The current recommendation for immunocompetent patients is a 6-month regimen of isoniazid and rifampin supplemented in the first 2 months by pyrazinamide. HIV-infected patients should be treated with this same regimen for a longer time period. Serial thoracentesis or corticosteroid treatment are not warranted for the majority of patients.
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PMID:Pleural tuberculosis: incidence, pathogenesis, diagnosis, and treatment. 936 61

We measured the activity of adenosine deaminase (ADA) and the concentration of interleukin-1 beta (IL-1 beta), interleukin-2 (IL-2), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) in the pleural effusions from 28 patients with tuberculosis, 30 with neoplastic diseases, 25 with bacterial infections and 18 with congestive heart failure or liver cirrhosis. The levels of ADA (83.0 +/- 32.1 IU/L) and IFN-gamma (795.0 +/- 666.4 pg/ml) in tuberculous effusions were significantly higher than those in other groups (p < 0.0001). IL-1 beta level in the effusions of bacterial infections (265.2 +/- 379.2 pg/ml) was higher than that in other groups (p < 0.0001). TNF-alpha level in the effusions of tuberculosis (31.7 +/- 36.7 pg/ml) and bacterial infections (69.5 +/- 232.9 pg/ml) was higher than that in other groups. IL-8 level of exudative effusions was higher than that of transudates. IL-2 was only present in 4 effusions from tuberculosis and 1 effusion from bacterial infections. Diagnostic utilities of cytokines and ADA for tuberculous effusion were evaluated using receiver operating characteristics (ROC) curve analysis. The cut-off points of ADA, IL-1 beta, IL-8, TNF-alpha and IFN-gamma determined in this analysis were 54 IU/L, 5.5 pg/ml, 405 pg/ml, 4.5 pg/ml and 28 pg/ml, respectively and the sensitivity and the specificity of them were 88.0% and 95.9%, 19.1% and 74.1%, 57.1% and 63.2%, 81.0% and 77.2%, and 96.2% and 98.5%, respectively. In ADA, TNF-alpha and IFN-gamma, the areas under the curve (AUC) that represent the diagnostic accuracy were 0.968, 0.719 and 0.993, respectively. AUC of IFN-gamma was significantly higher than that of ADA or TNF-alpha. In tuberculous pleural effusion, IFN-gamma was significantly correlated with TNF-alpha, IL-1 beta and ADA. The correlation was also present between TNF-alpha and ADA.
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PMID:[Clinical significance of cytokine measurement in pleural effusion]. 938 55

In the diagnosis of pleural effusion, tuberculous pleurisy should always be considered because the prevalence of tuberculosis in Japan remains high. The measurement of adenosine deaminase (ADA) levels in pleural fluid is useful for the diagnosis of the tuberculous pleurisy because of its high sensitivity and specificity. However, no studies have addressed the post-test probability (= positive predictive value; PPV) of the test. Since the PPV depends on the pre-test probability (= prevalence) of the tuberculous pleurisy that varies with age, we have retrospectively evaluated the PPV in the different age population; the young (-35 years of age), the middle (36-65 years), and the old (66-years). A total of 208 data sets were collected; the tuberculosis (n = 52), malignancy (n = 34), non-specific infection (n = 31), transudates (n = 45), the others (n = 36), and unknown causes (n = 10). It was found that 1) the prevalence of tuberculous pleurisy was decreased with age, (70% in the young, 28.7% in the middle, and 8.5% in the old), 2) the PPV was the lowest in the old (53.8%), while the highest in the young (95.0%), and 3) no significant correlation was found between age and the ADA activity in pleural effusion.
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PMID:[Pleural adenosine deaminase levels in tuberculous pleurisy--its diagnostic performance under the different prevalences in the different age of population]. 951 25

It is often difficult to diagnose tuberculosis (TB) pleural effusion because the search for Mycobacterium tuberculosis in fluid, or the identification of historical alterations in the pleural biopsy are often false negative. The diagnosis, however, must be timely since 43-65% of patients may develop an active pulmonary TB in the next 3-5 years. To determine the age distribution of patients with pleural TB, the authors reviewed the charts of 452 consecutive inpatients from January 1991 to September 1996 hospitalized at Mexico's National Institute of Respiratory Diseases with a diagnosis of the condition. 133 patients were diagnosed with TB pleural effusion of primary origin without parenchymal abnormalities according to chest roentgenogram. These 98 men and 35 women were of mean age 42 years. Pleural granulomas were identified in 87% of subjects while fluid baciloscopy and culture were positive in only 8% and 19%, respectively. The determination of adenosine deaminase (ADA) produced a diagnostic yield of 84%. Based upon their findings, the authors stress that primary TB pleural effusion may also be seen in adults, closed pleural biopsy remains the most effective diagnostic method, and ADA level is a cheap diagnostic method in countries with a high prevalence of TB.
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PMID:Diagnostic methods of primary tuberculous pleural effusion in a region with high prevalence of tuberculosis. A study in Mexican population. 958 Feb 81

In spite of recent advances in diagnosis and chemotherapy of tuberculosis, prognosis of tuberculosis of the central nervous system (CNS) is still poor. We evaluated clinical characteristics of 14 patients with the CNS tuberculosis (10 male and 4 female, 21 to 71 years of age) who were hospitalized at IMCJ from 1988 to 1997. Twelve patients had tuberculous meningitis (2 of them had also intracranial tuberculoma), 1 had intracranial tuberculoma and 1 had spinal cord tuberculosis. For the acid-fast bacilli, the smears of cerebrospinal fluids (CSF) were all negative but the cultures for M. tuberculosis were positive in 5. Using PCR method, M. tuberculosis was identified from CSF specimens in 2 out of 9 culture negative patients, thus suggesting the usefulness of the PCR for the rapid diagnosis of CNS tuberculosis. The adenosine deaminase (ADA) levels in CSF may provide another diagnostic clue because they were elevated in 8 out of 10 cases. It is to be noted that there were three patients who developed clinical manifestations of CNS tuberculosis after the initiation of chemotherapy for pulmonary tuberculosis. In the last five cases, four-drug regimen which included PZA, was used with a good result. The success could be related to the addition of PZA which penetrates blood-brain barrier just as good as INH. Two patients died and one remains unconscious with severe neurological sequelae. The present study indicates that positive CSF culture, hydrocephalus and consciousness disturbance are important factors in determining poor prognosis of the CNS tuberculosis.
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PMID:[Tuberculosis of the central nervous system experienced at the International Medical Center of Japan]. 978 Jun 7


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