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Adenosine deaminase: A sensitive and cost-effective method for the detection of tuberculous pleural effusion in a developing state like Bihar, India

Background: Tuberculosis remains a worldwide public health hazard even today. To diagnose tuberculosis in exudative pleural effusion still remains a challenge. Tests such as Tuberculin test, direct AFB demonstration by microscope, Acid Fast Bacili (AFB) culture and PCR have low sensitivity in pleural effusion. In a poor state like Bihar (India) a panel of investigations is not possible for the patient. Aim: The aim of this study is to diagnose tuberculous pleural effusion by estimating Adenosine Deaminase in the pleural effusion fluid that is both cost-effective and sensitive. Setting and Design: 100 cases of pleural effusion were studied in Patna Medical College and ADA values were estimated. For tuberculosis, the cut-off value was taken as 40U/L at 37°C. Statistical analysis: The sensitivity and specificity of ADA were 97.05% and 95.83% respectively. Material and Method: Alongwith physical, chemical and microscopical examination of pleural fluid, culture for AFB was also done and ADA was estimated by Galanti and Giusti's colorimetric method. Results: ADA is highly sensitive and specific and its value is significant in detection of tuberculous pleural effusion. Conclusion: ADA is a useful method to diagnose tuberculous pleural effusion among the people in a developing state like Bihar.