title: The possible role of cerebrospinal fluid adenosine deaminase activity in the diagnosis of tuberculous meningitis in adults.
abstract: We studied an adenosine deaminase (ADA) activity in the cerebrospinal fluid (CSF) of 182 patients with meningitis. The patients were subdivided into four groups, (1) 36 cases of tuberculous meningitis; (2) 130 cases of viral or aseptic meningitis; (3) nine cases of bacterial meningitis; (4) seven cases of cryptococcal meningitis. Mean+/-S.D. ADA activity was 12.76+/-7.53 U/l in group 1; 2.58+/-2.37 U/l in group 2; 7.38+/-3.27 U/l in group 3; 7.42+/-4.38 U/l in group 4. Comparing the ADA activity in each group with the other groups, the difference is significant (P<0.001), except between groups 3 and 4. The sensitivity of the test for group 1 compared with group 2 was 0.83 and the specificity was 0.95 when a cut-off value of 7 U/l was used. When group 1 was compared with groups 3 and 4, the sensitivity was 0.58 and the specificity was 0.89 and 0.71 with groups 3 and 4, respectively, when a cut-off value of 10 U/l was used. Values >15 U/l were not observed in any of the non-tuberculous meningitis patients; therefore, ADA activity >15 U/l could be a strong indication of tuberculous meningitis. We conclude that a determination of CSF ADA can aid in the early differential diagnosis of tuberculous meningitis.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Asan Medical Centre, Ulsan University College of Medicine, 388-1 Pungnap-dong, Songpa-gu, 138-736, Seoul, South Korea
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: In-Gyu
authors.initials: IG
authors.lastname: Bae
authors.forename: Jin-Won
authors.initials: JW
authors.lastname: Chung
authors.forename: Mi Suk
authors.initials: MS
authors.lastname: Lee
authors.forename: Jae Myung
authors.initials: JM
authors.lastname: Kang
authors.forename: Jiso
authors.initials: J
authors.lastname: Ryu
authors.forename: Jun-Hee
authors.initials: JH
authors.lastname: Woo
mesh_terms: D000243:Adenosine Deaminase / Q000134:cerebrospinal fluid / Q000378:metabolism*; D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D002555:Cerebrospinal Fluid / Q000201:enzymology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014390:Tuberculosis, Meningeal / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; D000243:Adenosine Deaminase