ANALYSIS OF 90 CASES OF TUBERCULOUS PLEUR ITIS IN RELATION TO ADENOSINE-DEAMINASE LEVELS IN PLEURAL FLUID

BACKGROUND: TO analize the adenosine deaminase (ADA) pleural levels an d the possibility of a typical pattern of tuberculous pleuritis (TP) i n relation to these values. PATIENTS AND METHODS: We analized 90 conse cutive cases of TP divided into two groups on the basis of the pleural ADA measurements: group I (less than 43 U/l) and group 2 (equal or hi gher than 43 U/l), We compared: age, sex, tuberculous risk factors, cl inical onset and duration, PPD, chest roentgenogram, biochemical (LDH, glucose and proteins) and cytological examination of the pleural flui d, microbiologic studies on sputum, pleural fluid and biopsies, histol ogic findings of the biopsies, evolution and sequelae after the treatm ent. RESULTS: 36 patients in the group 1 (40%) and 54 in the group 2 ( 60%) (p = 0.01), All the parameters were similar in both groups exclud ing LDH pleural levels, that were higher in group 2. In 20 cases of th e group 1, we obtained a second analysis of pleural ADA and we observe d in II cases (55%) an ADA value above 43 U/l. CONCLUSIONS: We confirm ed that ADA pleural level is increased in the majority of our patients with a low initial sensibility of 60%, that can increase with a secon d determination (72%). ADA activity below 43 U/l cannot exclude the tu berculous aetiology of an effusion and can persist negative in other a nalyses. The results suggest a response of different chronology withou t any relation to initial ADA pleural level.