Tuberculous pleuritis (TP) is one of the most common extra-pulmonary tuberculosis form. Because of tuberculous pleurisy is hard to diagnose due to slow course of disease and lack of specificity in symptoms and diagnostic methods. In that reason, we need multidisciplinary approach and efficient biomarkers. Acid-fast bacilli (AFB) staining, cultures and pathophysiological biopsy finding from the majority of patients are positive only in less than 10%. Löwenstein culture results need time about 6-8 weeks what delays diagnosis. Adenosine deaminase (ADA) is biomarker with high sensitivity and specificity (more than 90%) and considered as gold standard of biomarkers in the diagnosis of TP. It is very hard to distinguish malignant from TP with lymphocyte predomination, but in patient with malignant pleural effusion the level of ADA is decreased, opposite from TP. ADA in pleural punctate is a fast, simple, efficient and economical way for clarification the etiology of the pleural effusion as tuberculous pleurisy. Also, many studies have proved the role of ADA in the response to treatment for tuberculosis at follow up period.
Tuberkulozni pleuritis (TP) je jedan od najčešćih oblika vanplućne tuberkuloze. Zbog sporog toka bolesti i nespecifičnosti simptoma i dijagnostičkih metoda teško je dijagnostikovati tuberkuloznu pleuritis. Iz tog razloga NAM je potreban multidisciplinarni pristup i efikasni biomarkeri. Acidoalkoholno rezistentan bacil (AFB), kulture i nalaz patofiziološke biopsije kod većine pacijenata su pozitivni samo kod manje od 10%. Za rezultate Lovenstein kulture potrebno je vreme oko 6-8 nedelja, što odlaže dijagnozu. Adenozin deaminaza (ADA) je biomarker visoke osetljivosti i specifičnosti (vi{e od 90%) i smatra se zlatnim standardom biomarkera u dijagnozi TP. Veoma je teško razlikovati maligni od TP sa dominacijom limfocita, ali kod pacijenata sa malignim pleuralnim izlivom nivo ADA je smanjen, za razliku od TP. ADA u pleuralnom punktatu je brz, jednostavan, efikasan i ekonomičan način za pojašnjenje etiologije pleuralnog izliva kao tuberkuloznog pleuritisa. Takođe, mnoge studije su dokazale ulogu ADA u odgovoru na lečenje tuberkuloze u periodu praćenja.
Keywords: adenosine deaminase; biomarkers; pleural effusion; tuberculosis.
2023 Jelena Janković, Branislav Ilić, Nataša Đurđević, Aleksandar Jandrić, published by CEON/CEES.