Pleural effusion adenosine deaminase (ADA) level and occult tuberculous pleurisy.
BACKGROUND
We investigated the incidence of tuberculous pleurisy among patients with adenosine deaminase (ADA) levels of 50 IU/L or less in a pleural effusion, and without a previous diagnosis of carcinomatous pleurisy or Mycobacterium tuberculosis.


METHODS
Subjects were selected from patients who had undergone pleural biopsy by thoracoscopy at National Hospital Organization Tokyo Hospital from January 1995 to November 2004, and who had ADA levels of less than 50 IU/L in pleural fluid obtained preoperatively by thoracentesis. In all subjects, smear, culture, and polymerase chain reaction for Mycobacterium tuberculosis were negative.


RESULTS
Of 138 patients who underwent thoracoscopic pleural biopsy, a total of 50 had effusions with ADA levels of less than 50 IU/L. Six (12%) of these patients were diagnosed with tuberculous pleurisy after biopsy. Three patients with an effusion ADA level of 35 IU/L or less were diagnosed with tuberculous pleurisy.


CONCLUSIONS
Occult tuberculous pleurisy is significantly common in patients with pleural effusion ADA levels of 50 IU/L or less and who may otherwise be diagnosed with nonspecific pleurisy.
Sakuraba
Motoki
M
Department of Thoracic Surgery, National Hospital Organization Tokyo Hospital, Japan.
Masuda
Kimihiko
K
Hebisawa
Akira
A
Sagara
Yuzo
Y
Komatsu
Hikotaro
H
D000243:Adenosine Deaminase / Q000032:analysis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D004796:Clinical Enzyme Tests; D003951:Diagnostic Errors / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D019152:Paracentesis; D010996:Pleural Effusion / Q000382:microbiology*; D011237:Predictive Value of Tests; D013906:Thoracoscopy; D014396:Tuberculosis, Pleural / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D055815:Young Adult
D015415:Biomarkers; D000243:Adenosine Deaminase