Medicine - 2 Answers
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1 :
ADA levels are positive predictors of whether a patient has tuberculosis or not. Usually the patient first presents with pleural effusion, and then some of the fluid is withdrawn for analysis. An ADA level of > 40 U/L indicates the patient probably has a tuberculosis infection that is causing pleural effusion.
2 :
Adenosine deaminase (ADA) is involved in the proliferation and differentiation of T lymphocytes. Live intracellular organisms, cause the activation of T lymphocytes. Hence with chronic intracellular organisms, ADA levels in pleural/ ascitic fluid will increase. The sensitivity and specificity for detection of tuberculous pleuritis with the use of ADA as a marker in the pleural fluid are each >90% (Roth BJ. Searching for tuberculosis in the pleural space. Chest 1999; 116:3-5). However, high levels of ADA in pleural fluid could be due to other reasons too. High levels of ADA have been associated with pleural fluid lymphocytosis, including malignant conditions (eg, adenocarcinomas, leukemias, and lymphomas) and collagen vascular diseases (eg, rheumatoid pleuritis and systemic lupus erythematosus. All these things would make the test not too useful in countries with low prevalence of tuberculous pleuritis. Also, high levels of ADA in pleural fluid should not be used per se, to start treatment against tuberculosis. To sum it up, ADA in pleural fluid/ ascitic fluid, is a very good indicator of tuberculous etiology. However, other tests are necessary for the final diagnosis
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