Association of Serum Adenosine Deaminase Levels in Cytologically Suggested Cases of Tubercular Lymphadenitis: The Experience of a Tertiary Care Centre

Abstract

Background: Tuberculosis (TB), a communicable disease, caused by Mycobacterium
tuberculosis requires a simple, rapid test, which can be easily carried out in a laboratory.
Unfortunately, despite a battery of investigations, no definite test is available till date.
Adenosine deaminase (ADA), a biochemical marker has been proposed as a useful
surrogate marker for TB as its levels can be measured in body fluids.
Methods: A one-and-a-half-year prospective study of 154 cases presenting with
lymphadenitis from January 2019 to June 2020 was undertaken. Using cytology,
lymphadenitis subjects were divided into two groups: Tubercular (104 patients) as
a case group and Reactive (50 patients) as a control group. All cases were followed
by serum ADA assay by colorimetric method. Nonparametric tests were performed to
compare the two groups.
Results: The mean age of the participants was 28.99 ± 13.26 years with a F:M ratio
of 1.81:1. Involvement of cervical lymph nodes was most frequent (89.42% cases). The
mean S.ADA level for tubercular and reactive lymphadenitis was 41.71 ± 11.53 U/L and
21.16 ± 4.16 U/L, respectively (P-value < 0.05). The cut-off value calculated was 32.6
U/L. The sensitivity, specificity, PPV, NPV, and accuracy were calculated as 79.81%,
100%, 100%, 70.42%, and 86.36%, respectively.
Conclusion: A statistically significant increase was found in serum ADA levels in
tubercular lymphadenitis cases compared to reactive lymphadenitis. Hence, it can
be used as an adjunct to FNAC and is a fairly sensitive and specific test. Since it is
difficult to always demonstrate AFB in FNAC smears, ADA can be helpful in establishing
a definite diagnosis despite smear negativity.