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. 2010 Jul;17(3):126-30.
doi: 10.5214/ans.0972-7531.1017306.

Diagnostic efficacy of adenosine deaminase levels in cerebrospinal fluid in patients of tubercular meningitis: A comparison with PCR for Mycobacterium Tuberculosis

Fiju Chacko  1 , Manish Modi  1 , Vivek Lal  1 , S Prabhakar  1 , S V Rana  2 , S K Arora  3
Affiliations

Diagnostic efficacy of adenosine deaminase levels in cerebrospinal fluid in patients of tubercular meningitis: A comparison with PCR for Mycobacterium Tuberculosis

Fiju Chacko et al. Ann Neurosci. 2010 Jul.

Retraction in

  • Retraction Statement.
    [No authors listed] [No authors listed] Ann Neurosci. 2018 Dec;25(4):277. doi: 10.1159/000495123. Epub 2018 Dec 13. Ann Neurosci. 2018. PMID: 30587883 Free PMC article.

Expression of concern in

  • Expression of Concern.
    [No authors listed] [No authors listed] Ann Neurosci. 2015 Oct;22(4):251. doi: 10.5214/ans.0972.7531.220415. Ann Neurosci. 2015. PMID: 26527849 Free PMC article. No abstract available.

Abstract

Background: The rapid diagnosis of Tubercular meningitis (TBM) is fundamental to clinical outcome. The key to diagnosis lies in Cerebrospinal fluid (CSF) analysis and radiological investigations. There are numerous lacunae in the confirmation of diagnosis of TBM from CSF.

Purpose: The aim of present study was to compare the efficacy of CSF adenosine deaminase (ADA) level assays and Polymerase chain reaction (PCR) for Mycobacterium tuberculosis (M. tuberculosis) in the diagnosis of TBM.

Methods: Fifty four adult patients with suspected TBM and 37 controls were included in the study and CSF analyzed for ADA and PCR for M. tuberculosis. The cases were subdivided into definite (5), highly probable (22), probable (22) and possible TBM (5) as per previously validated criteria. The first two were grouped as "most likely" TBM (27) and last two as "unconfirmed" TBM (27).

Results: The mean ADA of the "most likely" TBM was 29±24, "unconfirmed" TBM was 21 ± 15 and controls were 4.8±2.2 U/L. The ADA levels correlated with CSF proteins, absolute lymphocyte count and the staging of the disease. Using a cut off level of >L10 U/L, CSF ADA had a sensitivity of 92.5% and specificity of 97%. PCR for M. tuberculosis was positive in 12 out of 27 "most likely" TBM cases, 5 out of 27 "unconfirmed" TBM cases and 3 out of 37 controls. PCR for M. tuberculosis had a sensitivity of 44.5% and specificity of 92% in the "most likely" TBM cases.

Conclusions: ADA is a rapid, inexpensive and sensitive test in the diagnosis of TBM. It is more sensitive than AFB smear and culture. PCR is another rapid test in the diagnosis of TBM with a good specificity, even in those patients already on presumptive anti-tuberculous treatment. However, despite the sensitivity and specificity of CSF ADA, it should be corroborated with AFB smear and CSF PCR.

Keywords: Adenosine deaminase; PCR; Tubercular meningitis.

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References

    1. Prabhakar S, Thussu A. CNS Tuberculosis. Neurology India. 1997;45:132–40. - PubMed
    1. Venkataraman P, Herbert D, Paramasivan CN. Evaluation of BACTEC radiometric method in early diagnosis of TB. Indian J Med Res. 1998;108:120–27. - PubMed
    1. Malan C, Donald PR, Golden M et al. ADA levels in CSF in the diagnosis of TBM. Journal of Tropical Medicine and Hygiene. 1984;87:33–40. - PubMed
    1. Garcia JE, Losada JP, Gonzalez Villaron L et al. Reliability of polymerase chain reaction in the diagnosis of mycobacterial infection. Chest. 1996;110:300–301. - PubMed
    1. Doucet-Populaire F, Lalande V, Carpentier E et al. A blind study of PCR for detection of M. tuberculosis DNA. Tuber Lung Dis. 1996;77(4):358–62. - PubMed

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