The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

ADENOSINE DEAMINASE ACTIVITY IN BRONCHOALVEOLAR LAVAGE,INDUCED SPUTUM ,GASTRIC LAVAGE AND SERUM IN CHILDHOOD PULMONARY TUBERCULOSIS.

Mohamed M. Farid1, Magda Y. El-Seify1, Tharwat E. Draz1, Eman M. Fouda1 , Maha M. Fathy2, Hatem Y. El-Bawab3



Background: Background: Isolation of Mycobacterium tuberculosis is difficult in children with pulmonary tuberculosis (PTB) .This represent a diagnostic challenges for health professionals, with increased desire for developing new rapid and reliable diagnostic procedures. This study aimed at evaluation of diagnostic value of Adenosine Deaminase Activity( ADA) in childhood pulmonary TB in induced sputa or gastric lavages, bronchoalveolar lavages, and sera.

Methods:


Results:
It included 32 patients [18 males and 14 females] with a mean age of 10.53 ± 4.27 years recruited from the Pediatric Chest Clinic ,Children's hospital, Ain Shams University. 10 healthy children (age and sex matched) were included as control. Patients were subdivided into 3 groups according to tuberculosis clinical scoring system ( Fourie et al.,1998) into: Group (I) "very likely PTB, Group (II) "possible PTB", Group (III) "unlikely PTB ":Studied groups were subjected to full history taking ,thorough clinical examination, Mantoux skin test and chest x-rays. Adenosine Deaminase Activity was measured in serum, sputum samples collected by either induction with nebulised 3% saline or gastric lavage and in BAL fluid collected with flexible fiberoptic bronchoscope (FOB).

Conclusions:
This study showed that serum ADA activity was statistically significantly higher in children with pulmonary tuberculosis (61.96 ± 27.57 IU/L) compared to the control group (22.6 ± 2.23 IU/L) (p<0.05) and in group (I )( 77.12 ± 23.24 IU/L) compared to group (III)( 24.3 ± 6.3IU/L) (p=0.000 ) . Sputum and BAL ADA activity were significantly elevated in groups I(171.5 ± 43.9 IU/L and7.33 ± 0.85 IU/L) compared to group III( 68.4 ± 5.8 IU/Land 3.8 ± 0.56 IU/L) (p=0.000 ). However using ROC curve, ADA activity in serum was the most sensitive and specific, followed by ADA activity in BAL fluid and then ADA activity in sputum. A cut-off value to diagnose PTB in children for serum ADA was ≥ 60 IU/L , for BAL ADA was ≥ 7 IU/L , and for sputum ADA was ≥ 128.75 IU/L .