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Adenosine deaminase in pleural fluids. Test for diagnosis of tuberculous pleural effusion.

Adenosine deaminase (ADA) activity was studied in 221 patients with pleuroperitoneal effusions. Patients were subdivided into the following six groups: (1) 48 cases of tuberculosis; (2) 46 with malignancies; (3) 30 postpneumonic effusions; (4) 19 cases of several diseases; (5) 18 patients with pleural effusions of unknown origin; and (6) 60 with acellular transudates. Mean ADA activity was 92.43 +/- 29.43 U/L 37 degrees C in group 1; 13.43 +/- 10.69 in group 2; 19.91 +/- 19.64 in group 3; 14.27 +/- 17.47 in group 4; 14.48 +/- 13.92 in group 5; and 2.29 +/- 3.4 in group 6. Comparing the level achieved in group 1 with all others, the difference is significant at the p less than 0.001 level. Specificity (0.97) and sensitivity (1) of the test in tuberculosis is very high, when a value of more than 45 U/L is considered. In patients with pleural tuberculosis, T-lymphocytes predominate in the fluid but their number did not correlate with ADA-activity (p greater than 0.10). Assessment of ADA in pathologic fluids is of great value in the diagnosis of tuberculosis of the pleura.