Chest Infections |

Diagnostic Role of Serum Adenosine Deaminase in Miliary Tuberculosis: Experience From a Tertiary Care Hospital in North India FREE TO VIEW

Prasanta Mohapatra, MD; Deepak Aggarwal, MD; Rahul Katyal, MBBS; C. Prashanth, MBBS; Deepak Tekke, MBBS; Robin Gupta, MBBS; Kranti Garg, MD
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Government Medical College and Hospital, Chandigarh, India

Chest. 2013;144(4_MeetingAbstracts):264A. doi:10.1378/chest.1701356
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SESSION TITLE: Respiratory Infections Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Miliary tuberculosis is a form of disseminated tuberculosis resulting from lymphohaematogenous spread of mycobacterium tuberculosis. Sputum for acid fast bacilli (AFB) is usually negative. Anti-tuberculosis treatment is given generally on presumptive basis. Radiologically many other diseases can mimic miliary tuberculosis.Pleural fluid adenosine deaminase (ADA) has established role in diagnosis of tubercular pleural effusion. So, serum ADA can be useful in contributing the diagnosis in the patients having miliary shadows in chest radiographs.

METHODS: This study was carried out to estimate the role of serum ADA in miliary tuberculosis and compare it with other diagnostic modalities. We assessed miliary tuberculosis patients diagnosed clinically and radiologically in the outpatient department. The patients after due consent had undergone eye checkup for choroid tubercles, sputum examination for AFB and blood examination for serum ADA by ADA assay kit (on autoanalyzer) and other routine investigations.

RESULTS: Of the 13 subjects(8 males,5 females),only two patients were AFB positive in their sputum. Five patients had choroid tubercles and all the patients had high serum ADA levels.The values of serum ADA were 52.61± 17.73 in miliary tuberculosis, 59.6±23.66 in patients having choroid tubercles,13.75 ±3. 35 in control and 28.8±6.40 in sputum AFB positive patients. All the miliary tuberculosis patients improved with routine anti-tubercular drugs.

CONCLUSIONS: The patients with miliary tuberculosis have raised serum ADA levels in comparision to healthy control and pulmonary tuberculosis. So higher ADA levels in miliary tuberculosis can be surrogate marker of diagnosis of miliary tuberculosis along with miliary shadow in chest radiograph where no definite diagnostic modality is available for confirming tuberculosis.

CLINICAL IMPLICATIONS: Serum ADA can be contributing in diagnosis of patients with miliary tuberculosis. The determination of serum ADA is rapid and cheap. After confirming the same in large multicentric trial, it can be of great value in diagnosis of miliary tuberculosis.

DISCLOSURE: The following authors have nothing to disclose: Prasanta Mohapatra, Deepak Aggarwal, Rahul Katyal, C. Prashanth, Deepak Tekke, Robin Gupta, Kranti Garg

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