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Use of pleural fluid levels of adenosine deaminase and interferon gamma in the diagnosis of tuberculous pleuritis

Krenke, Rafał; Korczyński, Piotr

Current Opinion in Pulmonary Medicine: July 2010 - Volume 16 - Issue 4 - p 367–375
doi: 10.1097/MCP.0b013e32833a7154
Diseases of the pleura: Edited by Richard W. Light

Purpose of review: This review aims to define the role of adenosine deaminase (ADA) and interferon gamma (IFN-γ) in the differential diagnosis of pleural effusion with special attention to their source, mechanism of release and methods of measurement in pleural fluid. The diagnostic performance of ADA and IFN-γ is analyzed, and the advantages and limitations of their use in differentiating between tuberculous and nontuberculous pleural effusion are disucussed.

Recent findings: Several potential biomarkers of tuberculous pleurisy have been evaluated, but none have been found to be clearly superior to pleural fluid level of ADA or IFN-γ. The majority of recent studies confirm the high diagnostic utility of pleural fluid ADA and IFN-γ measurement; hence, these markers are included in different diagnostic algorithms for patients suspected of tuberculous pleurisy. Other relatively new tests show a high variability [nucleic acid amplification tests (NAATs)] or are technically demanding, costly and give equivocal results in patients with active tuberculosis [IFN-γ releasing assays (IGRAs)].

Summary: Pleural fluid ADA and IFN-γ are both sensitive and specific biomarkers of tuberculous pleurisy. Their diagnostic accuracy across the different studies shows a smaller variability than that of other tests, for example NAATs. There is also no convincing evidence that IGRAs are superior to pleural fluid ADA or IFN-γ measurement. Hence, the role of ADA and IFN-γ in the differential diagnosis of tuberculous pleurisy is pivotal.

Department of Internal Medicine, Pneumonology and Allergology, Medical University of Warsaw, Poland

Correspondence to Rafał Krenke, Department of Internal Medicine, Pneumonology and Allergology, Medical University of Warsaw, Banacha 1A, 02–097 Warsaw, Poland Tel: +48 225992562; fax: +48 225991560; e-mail: rkrenke@wum.edu.pl; rafalkrenke@interia.pl

© 2010 Lippincott Williams & Wilkins, Inc.