PDF herunterladen
CC BY-NC-ND 4.0 · Journal of Gastrointestinal Infections 2022; 12(01): 057-060
DOI: 10.1055/s-0042-1757402
Evidence-Based Commentary

Evidence-Based Commentary: Ascitic Adenosine Deaminase in the Diagnosis of Peritoneal Tuberculosis

Amol Sonyabapu Dahale
1   Department of Medical Gastroenterology, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil University, Pune, Maharashtra, India
,
Ashok Dalal 
2   Department of Medical Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
› Institutsangaben Funding None.
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

How is Peritoneal Tuberculosis Suspected and Diagnosed?

Peritoneal tuberculosis (TBP) forms a significant proportion of abdominal tuberculosis (TB). Incidence of TBP in literature varies from 39 to 77% of total abdominal TB cases.[1] The myriad clinical presentations, paucibacillary nature of abdominal TB, and fastidious nature of tubercular bacteria make it very difficult to suspect TBP and near impossible to prove by routine microbial analysis. Peritoneoscopy with peritoneal biopsies for histopathology and bacteriological studies may be required if noninvasive methods are unable to clinch the diagnosis.[2] [3] Peritoneoscopy is invasive with a 3% adverse events rate associated with it.[3] Additionally, most of these patients are surgically unfit and de facto high risk like having underlying cirrhosis. Given the higher incidence and limited resources in highly prevalent TB areas, highly sophisticated and invasive investigations may not be within reach of the majority of the population. Adenosine deaminase (ADA) in peritoneal fluid offers a feasible, sensitive, and highly specific test for TBP. Given the varied incidence of TB in developed and developing nations, the utility of ascitic ADA is likely to be more in high TB endemic regions. To add to the confusion, multiple testing methods and different cutoffs have been reported. Evaluation of the ascitic fluid including culture and measurement of ADA are the first line strategy for diagnosis of tuberculous peritonitis.

Ethical Statement

Not applicable.


Author Contributions

Amol Dahale: Initial draft and approval. Ashok Dalal:- Initial draft, revision and approval.


Data Availability Statement

There is no data associated with this work.




Publikationsverlauf

Eingereicht: 16. April 2022

Angenommen: 25. Mai 2022

Artikel online veröffentlicht:
22. September 2023

© 2022. Gastroinstestinal Infection Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Mimidis K, Ritis K, Kartalis G. Peritoneal tuberculosis. Ann Gastroenterol 2005; 18 (03) 325-329
    Google Scholar
  • 2 Sanai FM, Bzeizi KI. Systematic review: tuberculous peritonitis–presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther 2005; 22 (08) 685-700
    CrossrefPubMedGoogle Scholar
  • 3 Bhargava DK, Shriniwas, Chopra P, Nijhawan S, Dasarathy S, Kushwaha AK. Peritoneal tuberculosis: laparoscopic patterns and its diagnostic accuracy. Am J Gastroenterol 1992; 87 (01) 109-112
    PubMedGoogle Scholar
  • 4 Barua R, Hossain MA. Adenosine deaminase in diagnosis of tuberculosis: a review. Anwer Khan Modern Med Coll J 2014; 5 (02) 43-48
    CrossrefGoogle Scholar
  • 5 Boonyagars L, Kiertiburanakul S. Use of adenosine deaminase for the diagnosis of tuberculosis: a review. J Infect Dis Antimicrob Agents 2010; 27 (02) 111-118
    Google Scholar
  • 6 Alrajhi AA, Halim MA, al-Hokail A, Alrabiah F, al-Omran K. Corticosteroid treatment of peritoneal tuberculosis. Clin Infect Dis 1998; 27 (01) 52-56
    CrossrefPubMedGoogle Scholar
  • 7 Pacheco R, Martinez-Navio JM, Lejeune M. et al. CD26, adenosine deaminase, and adenosine receptors mediate costimulatory signals in the immunological synapse. Proc Natl Acad Sci U S A 2005; 102 (27) 9583-9588
    CrossrefPubMedGoogle Scholar
  • 8 Giusti G, Galanti B. Colorimetric method. adenosine deaminase. In: Bergmeyer HU. ed. Methods of Enzymatic Analysis. 3rd ed.. Weinheim: Verlag chemie; 1984
    Google Scholar
  • 9 Slaats EH, Asberg EGMT, van Keimpema ARJ, Kruijswijk H. A continuous method for the estimation of adenosine deaminase catalytic concentration in pleural effusions with a Hitachi 705 discrete analyser. J Clin Chem Clin Biochem 1985; 23 (10) 677-682
    PubMedGoogle Scholar
  • 10 Dahale AS, Puri AS, Kumar A, Dalal A, Agarwal A, Sachdeva S. Tissue Xpert® MTB/RIF assay in peritoneal tuberculosis: to be (done) or not to be (done). Cureus 2019; 11 (06) e5009 DOI: 10.7759/cureus.5009.
    CrossrefPubMedGoogle Scholar
  • 11 Sharma V, Soni H, Kumar-M P. et al. Diagnostic accuracy of the Xpert MTB/RIF assay for abdominal tuberculosis: a systematic review and meta-analysis. Expert Rev Anti Infect Ther 2021; 19 (02) 253-265
    CrossrefPubMedGoogle Scholar
  • 12 Martinez-Vazquez JM, Ocaña I, Ribera E, Segura RM, Pascual C. Adenosine deaminase activity in the diagnosis of tuberculous peritonitis. Gut 1986; 27 (09) 1049-1053
    CrossrefPubMedGoogle Scholar
  • 13 Voigt MD, Kalvaria I, Trey C, Berman P, Lombard C, Kirsch RE. Diagnostic value of ascites adenosine deaminase in tuberculous peritonitis. Lancet 1989; 1 (8641): 751-754
    CrossrefPubMedGoogle Scholar
  • 14 Dwivedi M, Misra SP, Misra V, Kumar R. Value of adenosine deaminase estimation in the diagnosis of tuberculous ascites. Am J Gastroenterol 1990; 85 (09) 1123-1125
    Google Scholar
  • 15 Riquelme A, Calvo M, Salech F. et al. Value of adenosine deaminase (ADA) in ascitic fluid for the diagnosis of tuberculous peritonitis: a meta-analysis. J Clin Gastroenterol 2006; 40 (08) 705-710
    CrossrefPubMedGoogle Scholar
  • 16 Shen YC, Wang T, Chen L. et al. Diagnostic accuracy of adenosine deaminase for tuberculous peritonitis: a meta-analysis. Arch Med Sci 2013; 9 (04) 601-607
    CrossrefPubMedGoogle Scholar
  • 17 Tao L, Ning HJ, Nie HM, Guo XY, Qin SY, Jiang HX. Diagnostic value of adenosine deaminase in ascites for tuberculosis ascites: a meta-analysis. Diagn Microbiol Infect Dis 2014; 79 (01) 102-107
    CrossrefPubMedGoogle Scholar
  • 18 Sathar MA, Simjee AE, Coovadia YM. et al. Ascitic fluid gamma interferon concentrations and adenosine deaminase activity in tuberculous peritonitis. Gut 1995; 36 (03) 419-421
    CrossrefPubMedGoogle Scholar
  • 19 Hillebrand DJ, Runyon BA, Yasmineh WG, Rynders GP. Ascitic fluid adenosine deaminase insensitivity in detecting tuberculous peritonitis in the United States. Hepatology 1996; 24 (06) 1408-1412
    CrossrefPubMedGoogle Scholar
  • 20 Dahale AS, Puri AS, Sachdeva S. et al. Reappraisal of the role of ascitic fluid adenosine deaminase for the diagnosis of peritoneal tuberculosis in cirrhosis. Korean J Gastroenterol 2021; 78 (03) 168-176
    CrossrefPubMedGoogle Scholar
  • 21 Sharma SK, Tahir M, Mohan A, Smith-Rohrberg D, Mishra HK, Pandey RM. Diagnostic accuracy of ascitic fluid IFN-gamma and adenosine deaminase assays in the diagnosis of tuberculous ascites. J Interferon Cytokine Res 2006; 26 (07) 484-488
    CrossrefPubMedGoogle Scholar
  • 22 Sharma SK, Ryan H, Khaparde S. et al. Index-TB guidelines: guidelines on extrapulmonary tuberculosis for India. Indian J Med Res 2017; 145 (04) 448-463
    PubMedGoogle Scholar
  • 23 Dawra S, Sharma V, Sharma A, Dutta U, Chawla MPS, Kochhar R. Survey of practices in managing abdominal TB. Int J Tuberc Lung Dis 2020; 24 (10) 1109-1111
    CrossrefPubMedGoogle Scholar