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)

A definitive diagnosis of tuberculosis requires the recovery of M. tuberculosis organisms from a patient's secretions, body fluids, or tissues. However, the detection rate of M. tuberculosis is not high in tuberculous pleural effusions. Several studies demonstrated that adenosine deaminase (ADA) level in pleural effusion above 50 IU/L was strongly associated with tuberculosis. ADA has been found to be elevated in serum and several body fluids that are infected by M. tuberculosis. Recently, the simultaneous skin tests of PPDs (M. tuberculosis), PPD-B (M. intracellulare), PPD-Y (M. kansasii) and PPD-F (M. fortuitum), have been reported to be useful in diagnosing mycobacteriosis in the early stage of the disease. Although serodiagnosis of tuberculosis has long been the subject of investigation, no serodiagnostic approach is currently of widespread and clinical utility. At the present time, several serodiagnostic test using enzyme-linked immunosorbent assay (ELISA) for the measurement of IgG antibody to some protein (38-kDa, 30-kDa, 16-kDa and so on) and nonprotein (lipoarabinomannan and cord factor) antigens. Despite an explosion in the techniques of rapid identification of mycobacteria by molecular genetic means, the relative simplicity and low cost of serodiagnosis remain attractive.
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PMID:[Diagnosis of mycobacterial disease by biochemical and immunological parameters]. 988 9

Gastrointestinal tuberculosis and tuberculous peritonitis are still considered a rare disease in Japan. A high index of suspicion must be maintained to make an exact diagnosis. It also must be kept in mind that little evidence of active or healed tuberculosis is detectable on chest x-ray. The jejunoileum and ileocecum are most commonly affected in the gastrointestinal tuberculosis. Abdominal pain and abdominal tenderness are present in most patients. An abdominal mass is often palpable in the right lower quadrant. The most valuable diagnostic study is colonoscopy with biopsies. In tuberculous peritonitis, an abdominal swelling is the most common symptom. Laparoscopy with directed biopsy is an excellent study for diagnosis. The levels of ascites adenosine deaminase are also useful for diagnosis.
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PMID:[Intestinal tuberculosis and tuberculous peritonitis]. 988 20

We describe a fatal case of tuberculous peritonitis and review the literature on the diagnostic modalities available to diagnose this entity. We suspect a delayed diagnosis resulted in the death of our patient. Today, the prompt diagnosis of an unknown ascitic process involves laparoscopy. A patient with unknown large volume ascites is the easiest and safest to laparoscope. Using a mini laparoscope, a bedside procedure with instantaneous return can be done. The newer noninvasive tests like determination of ascites fluid adenosine deaminase activity and polymerase chain reaction may be helpful in the prompt diagnosis of peritoneal tuberculosis. We recommend that patients with clinical presentation suggestive of peritoneal tuberculosis have either an aggressive diagnostic workup using high-yield tests or a trial of antituberculous therapy.
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PMID:Tuberculous peritonitis: fatality associated with delayed diagnosis. 1021 60

We report 2 cases of pseudochylothorax and review 172 published cases. Tuberculosis is by far the most frequent cause of pseudochylothorax, accounting for 54% of all caes, with a remarkable association with previous collapse therapy and long-term effusions. The remaining etiologies, including rheumatoid arthritis, are infrequent. Tuberculous pseudochylothorax is usually sterile. Successful treatment of an acute tuberculous pleurisy does not preclude the development of long-term complications such as pseudochylothorax. We do not recommend pleural biopsy initially because of its low yield for etiologic diagnosis. Currently, adenosine deaminase (ADA) values in pleural fluid are not useful to sustain diagnosis or therapeutic decisions. We advise draining only symptomatic cases and treating patients with positive Ziehl-Neelsen stain or Lowenstein culture, and those with growing effusions of suspected tuberculous origin, with antituberculous chemotherapy. Pulmonary decortication should be the last therapeutic step for recurrent and symptomatic cases.
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PMID:Pseudochylothorax. Report of 2 cases and review of the literature. 1035 51

The diagnostic value of serum adenosine deaminase (ADA) activity was evaluated in childhood pulmonary tuberculosis. Serum ADA levels were measured in 20 children diagnosed with pulmonary tuberculosis (group 1) and 150 children (group 2) including 128 with tuberculosis infection (Mantoux test positive) and 22 healthy children. In group 1, the mean serum ADA activity was 74.06 +/- 18.5 U/l, which was significantly (p < 0.001) higher than that of group 2 (40.36 +/- 12.0 U/l). A serum ADA level of > or = 53.76 U/l had a sensitivity of 100 per cent, specificity of 90.7 per cent, positive predictive value of 58.8 per cent, and a negative predictive value of 100 per cent in children with tuberculosis disease. To conclude, measurement of serum ADA activity was a useful diagnostic tool in childhood pulmonary tuberculosis.
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PMID:Adenosine deaminase in childhood pulmonary tuberculosis: diagnostic value in serum. 1046 40

Three methods in the diagnosis and treatment of tuberculosis have been compared in this study. Serum adenosine deaminase activities of patients with tuberculosis was compared with those of control groups with (+) and (-) PPD (purified protein derivative) results and were found to be higher than the controls. Within the controls the PPD (+) group displayed higher adenosine deaminase activities in comparison to the PPD (-) group. All patients had growth of B. Tuberculosis in the culture medium and all but one had positive polymerase chain reaction (PCR) results. Control patients were negative for culture and PCR. The sensitivity of ADA (adenosine deaminase) assay was 91.7% and specificity was 94.5%, whereas PCR had a sensitivity of 95.8% and a specificity of 100%. The ADA assay may be used in adjunction with other methods in the follow-up of tuberculosis with high sensitivity, specificity, and ease in applicability and specimen collection.
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PMID:The comparison of adenosine deaminase activity values with polymerase chain reaction results in patients with tuberculosis. 1049 28

We analysed the efficacy of pleural adenosine deaminase (ADAp) and the ADA1/ADAp ratio in the diagnosis of pleural tuberculosis in 103 pleural effusions, 27 of which were tuberculosis (TB) and 76 other diagnoses (non-TB). Smears, cultures and pleural biopsies were carried out in all cases, and were used for final diagnosis. The diagnostic yield of the parameters under study were as follows: smears/cultures of mycobacteria in fluid 11.1%/33.3%; biopsy 33.3%/51.8% and tuberculosis granulomas 85.1%. The levels of ADAp and ADA1/ADAp ratio in TB and non-TB groups showed very significant differences (P < 0.00001); in the TB group: ADAp 54.7 +/- 23.5 IU and ADA1/ADAp 0.27 +/- 0.08; in the non-TB group: ADAp 18.3 +/- 43.2 IU and ADA1/ADAp 0.64 +/- 0.14. The assay established ADA levels in pleural fluid > or = 40 IU and an ADA1/ADAp ratio < or = 0.42 as cut-off levels to identify individuals in the TB group, with a sensitivity of 88.8%/100%, a specificity of 92%/98.6%, a positive predictive value (PPV) of 80%/96.4%, a negative predictive value (NPV) of 95.8%/100% and an accuracy of 91.2%/99.02%. The ADAp levels in 27 patients with TB, showed close correlation with the number of monocyte macrophages (P = 0.001), but not with the number of lymphocytes (P = n.s.). The ADA1/ADAp ratio overcomes the limitations of ADAp (false positives and negatives), and is the most useful parameter for diagnosis on account of a high diagnostic yield, low cost and speed of the assay for identifying a pleural tuberculosis diagnosis, when compared with traditional methods.
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PMID:ADA1/ADAp ratio in pleural tuberculosis: an excellent diagnostic parameter in pleural fluid. 1060 31

Serum adenosine deaminase (ADA) activity and lysozyme levels were measured in 51 patients with tuberculosis (21 pulmonary, 15 miliary, 11 neurotuberculoma and four abdominal plus osteoarticular) and 20 healthy controls. The mean serum ADA activity and lysozyme levels were significantly raised in children with different forms of tuberculosis in comparison with controls (p < 0.001). The neurotuberculoma cases had the lowest mean enzyme levels and the differences were significant when compared with other forms of tuberculosis. The cut-off serum ADA activity of > or = 42 IU/l and lysozyme level of > or = 20 U/l were diagnostic of tuberculosis with 100 per cent sensitivity. A significant correlation was observed between the two parameters (r = 0.66; p < 0.001). Thus, with compatible clinical presentation, the raised serum level of either ADA or lysozyme can be used as a supportive diagnostic test.
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PMID:Adenosine deaminase activity and lysozyme levels in children with tuberculosis. 1089 21

The bacillary population described in tuberculous pleuritis is small, and its most likely pathogenetic mechanism is essentially immunologic. This explains why, until now, the diagnostic identification of tuberculous pleuritis (TP) has been based on the presence of granulomas in pleural biopsy. Correcting this diagnostic deficiency through other parameters related to the specific pathogenetic mechanism has been widely studied. The determination of the levels of adenosine deaminase (ADA) in pleural fluid offers high performance in its discriminating capacity to identify TP (sensitivity 87 to 100%, specificity 81 to 97%). Adenosine deaminase expresses the sum of two isoenzymes (ADA1 and ADA2). ADA1 is ubiquitous in all cells, including lymphocytes and monocytes, whereas ADA2 is found only in monocytes. Analysis and determination of these isoenzymes have shown that ADA in TP increases particularly at the expense of ADA2 and that the ADA1 /ADAp activity ratio improves performance in terms of sensitivity, specificity, and efficacy (100%, 92 to 97%, and 98%, respectively) in correcting all false-negative and false-positive results except 1 to 9% of nonlymphoproliferative malignancies. Only the high performance of ADA in the identification of TP allows it to be assumed that pleural biopsy can be obviated, especially in patients aged less than 35 years of age or having a lymphocyte-to-neutrophil proportion of more than 0.75 in regions of high prevalence. Quick determination and low cost justify its routine use in exudates. The ADA1 /ADAp activity ratio improves performance even more and could be used in cases with uncertain diagnoses or in regions with low prevalence of tuberculosis.
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PMID:The use of adenosine deaminase and adenosine deaminase isoenzymes in the diagnosis of tuberculous pleuritis. 1091 30

This review summarizes current strategies in the treatment of patients with pleural effusion. To determine whether a patient has a transudative or exudative pleural effusion, Light's criteria should be applied to measure the concentrations of protein and lactate dehydrogenase (LDH) in the pleural fluid and serum. If the effusion is transudative, therapy should be directed toward the underlying congestive heart failure, cirrhosis, or nephrosis. Consideration should be given to pleurodesis with a sclerosant if patients with recurrent transudative effusion have severe dyspnea due to their effusion. If the effusion is exudative, attempts should be made to define the etiology. The diagnosis of pleural malignancy is most easily established via pleural fluid cytology. If this is negative and the patient is suspected of having pleural malignancy, thoracoscopy is indicated. The concentrations of adenosine deaminase and gamma-interferon in pleural fluid are useful in the diagnosis of pleural tuberculosis. Patients with pneumonia and pleural effusion should undergo therapeutic thoracentesis; the pleural fluid should be Gram-stained and cultured, and the differential cell count, glucose and LDH concentration, and pH should be determined. Indicators of a poor prognosis include the presence of frank pus, a positive Gram-stain, a pleural glucose concentration of less than 2.2 mmol/L, a pH less than 7.00, the presence of pleural loculations, and an LDH concentration greater than three times the upper limit of normal in serum. If the pleural fluid cannot be completely evacuated because of loculations, intrapleural thrombolytic therapy should be considered. If thrombolytics are ineffective, thoracoscopy or thoracotomy with decortication should be performed. Dyspneic patients with malignant pleural effusions whose dyspnea is relieved with therapeutic thoracentesis should be considered for pleurodesis using a tetracycline derivative. Talc is not recommended because it induces acute respiratory distress syndrome in about 5% of patients, with an overall mortality of 1%.
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PMID:Management of pleural effusions. 1092 61


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