J Korean Neurol Assoc.  1998 Jun;16(3):302-306.

Studies on Adenosine Deaminase(ADA) Activity in the Cerebrospinal Fluid of Tuberculous Meningitis(TBM)

• Kim KI
• Lee AY
• Hong YE
• Kim J
• Kim JM

Abstract

BACKGROUND & PURPOSE: Confirmation of etiology in various types of meningitis is the essential step for the treatment with respect to the underlying organism. Although the definite diagnosis of TBM depends on identifying M. tuberculosis in the CSF, the acid fast bacilli are rarely shown in smears of CSF and are cultured in only some patients. Increased levels of ADA in systemic tuberculous effusion have been observed. This study is to evaluate the diagnositc significance & value as a laboratory index of disease activity of ADA in TBM.
METHODS
We assayed the activity of ADA in the CSF of 117 patients with various types of meningitis (tuberculous, viral, and bacterial) from 1995 through 1996 at Chungnam National University Hospital. We established several diagnostic criteria for TBM: characteristic CSF findings, such as lymphocytic pleocytosis, cloudy or ground-glass appearance, increased protein content, and decreased sugar level, positive acid fast bacilli in CSF smear, brain CT or MRI findings compatible with TBM.
RESULTS
The mean ADA value in CSF was higher in TBM(15.5+/-4.6 U/liter) than in other meningitis. The sensitivity of the test for diagnosing TBM was 0.80 and specificity, 0.98. Increased CSF protein in TBM(271.23+/-78.2) showed in parallel with ADA activity in CSF(p<.05). A gradual decline in level of this enzyme was observed during the first two weeks of therapy in concordance with the clinical improvement. The mean interval for normalizing ADA activity was 37.6 days from the onset of treatment.
CONCLUSION
The quantification of ADA in CSF is a rapid and economic test that is useful for early diagnosis of TBM and sensitive as an indicator for disease activity.

MeSH Terms

Adenosine*
Brain
Cerebrospinal Fluid*
Chungcheongnam-do
Diagnosis
Early Diagnosis
Humans
Leukocytosis
Magnetic Resonance Imaging
Meningitis
Sensitivity and Specificity
Tuberculosis
Adenosine