Studies on Adenosine Deaminase(ADA) Activity in the Cerebrospinal Fluid of Tuberculous Meningitis(TBM)

J Korean Neurol Assoc > Volume 16(3); 1998 > Article

Journal of the Korean Neurological Association 1998;16(3): 302-306.

결핵성 뇌막염 환자의 뇌척수액에서 Adenosine Deaminase(ADA)에 관한 연구

김건익, 이애영·홍양의·김 제·김재문

충남대학교 의과대학 신경과학교실

Studies on Adenosine Deaminase(ADA) Activity in the Cerebrospinal Fluid of Tuberculous Meningitis(TBM)

Keon-Ik Kim, Ae-Young Lee, Yang-Eui Hong, Jei Kim, Jae-Moon Kim

Department of Neurology, College of medicine, Chungnam National University

Abstract

Background & Purpose : Confirmation of etiology in various types of meningitis is the essential step for the treatment with respect to the underlying organism. Although the definite diagnosis of TBM depends on identifying M. tuberculosis in the CSF, the acid fast bacilli are rarely shown in smears of CSF and are cultured in only some patients. Increased levels of ADA in systemic tuberculous effusion have been observed. This study is to evaluate the diagnositc significance & value as a laboratory index of disease activity of ADA in TBM. Methods : We assayed the activity of ADA in the CSF of 117 patients with various types of meningitis (tuberculous, viral, and bacterial) from 1995 through 1996 at Chungnam National University Hospital. We established several diagnostic criteria for TBM: characteristic CSF findings, such as lymphocytic pleocytosis, cloudy or ground-glass appearance, increased protein content, and decreased sugar level, positive acid fast bacilli in CSF smear, brain CT or MRI findings compatible with TBM. Results : The mean ADA value in CSF was higher in TBM(15.5±4.6 U/liter) than in other meningitis. The sensitivity of the test for diagnosing TBM was 0.80 and specificity, 0.98. Increased CSF protein in TBM(271.23±78.2) showed in parallel with ADA activity in CSF(p<.05). A gradual decline in level of this enzyme was observed during the first two weeks of therapy in concordance with the clinical improvement. The mean interval for normalizing ADA activity was 37.6 days from the onset of treatment. Conclusion : The quantification of ADA in CSF is a rapid and economic test that is useful for early diagnosis of TBM and sensitive as an indicator for disease activity.