Ascitic Fluid Adenosine Deaminase Activity - A Non Invasive Diagnostic Test for Tuberculous Ascites.

Ramkumar, G (2008) Ascitic Fluid Adenosine Deaminase Activity - A Non Invasive Diagnostic Test for Tuberculous Ascites. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Tuberculosis has been declared a global emergency by the World Health Organization and is the most important communicable disease worldwide. The prevalence of extra-pulmonary tuberculosis seems to be rising, particularly due to increasing prevalence of acquired immunodeficiency syndrome (AIDS). In patients with extra pulmonary tuberculosis, abdomen is involved in 11% of patients. Though potentially curable, abdominal tuberculosis continues to be a major cause of morbidity and mortality in India. In the abdomen, tuberculosis may affect the gastrointestinal tract, peritoneum, lymph nodes, and solid viscera. The disease can mimic various other gastrointestinal disorders, particularly inflammatory bowel disease, colonic malignancy, or other gastrointestinal infections. Because of the non-specific symptoms and signs, its diagnosis is often delayed. Autopsies conducted on patients with pulmonary tuberculosis before the era of effective antitubercular drugs revealed intestinal involvement in 55-90 per cent cases, with the frequency related to the extent of pulmonary involvement. About 0.4 million people in India are co-infected with HIV and tuberculosis. Extra- pulmonary forms of tuberculosis which account for 10-15 per cent of all cases may represent up to 50 per cent of patients with AIDS. Tuberculosis of the gastrointestinal tract is the sixth most frequent form of extra-pulmonary site, after lymphatic, genitourinary, bone and joint, miliary and meningeal tuberculosis. Adenosine deaminase (ADA) activity in ascitic fluid is a sensitive and specific marker for tuberculosis. Adenosine deaminase (ADA) is an enzyme widely distributed in mammalian tissues, particularly in T lymphocytes. Increased levels of ADA are found in various forms of tuberculosis making it a marker for the same. The sensitivity and sensitivity of ADA activity are 95 and 98 per cent respectively. In low protein ascites, false negative results are more frequent. In patients with HIV infection and tuberculous ascites, ADA levels may be lower. ADA is particularly useful in developing countries where more sophisticated and expensive tests such as laparoscopy may not be available. AIM OF THE STUDY : The study was conducted with the objective of (i) Evaluating the efficacy of ascitic fluid adenosine deaminase activity in diagnosing tuberculous ascites. (ii) The efficacy of ascitic fluid adenosine deaminase activity in differentiating tuberculous from non-tuberculous ascites. CONCLUSION : In conclusion, measurement of Adenosine deaminase activity (ADA) level in ascitic fluid is a fast and accurate test for diagnosing peritoneal tuberculosis. It has enough discriminatory power to either confirm or rule out the diagnosis of peritoneal tuberculosis in most cases. The beginning of empirical treatment when a patient has a high ADA value in ascitic fluid seems to be a good approach while waiting for the results of mycobacterial cultures or biopsies. However in the presence of cirrhosis, the sensitivity and specificity of adenosine deaminase in confirming peritoneal tuberculosis is low. Ascitic fluid adenosine deaminase can be used as a diagnostic test in centers where laparoscopy is not available. It can also be used in very sick patients who are unfit for laparoscopy. For differentiating tuberculous ascites from non-tuberculous ascites, the optimal cut off value for asctic fluid adenosine-deaminase is 35 U/ L.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Ascitic Fluid ; Adenosine Deaminase Activity ; Non Invasive Diagnostic Test ; Tuberculous Ascites.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:05
Last Modified: 13 Jul 2017 04:05

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