Skip to main content

Advertisement

SpringerLink
Log in

Adenosine deaminase activity in cerebrospinal fluid of HIV-infected patients: limited value for diagnosis of tuberculous meningitis

  • Article
  • Published:
European Journal of Clinical Microbiology and Infectious Diseases Aims and scope Submit manuscript

Abstract

Adenosine deaminase activity (ADA) determination in cerebrospinal fluid (CSF) is considered a specific test for the diagnosis of tuberculous meningitis. In order to study the variability of this marker in patients with different neurological disorders associated with HIV infection, and its utility for the diagnosis of tuberculous meningitis in these patients, the ADA levels in 417 CSF samples from HIV-infected patients with neurological symptoms were reviewed. HIV infection, HIV-associated neurological disorders, and progressive multifocal leukoencephalopathy were not associated with elevated ADA in CSF. Among patients with meningitis, receiver operating characteristic curve analysis gave an optimal ADA cut-off point of 8.5 IU/l for the diagnosis of tuberculous meningitis, with 57% sensitivity, 87% specificity, and an area under the curve of 0.747 (similar to that for CSF glucose concentration). False-positive results were found in patients with neurological CMV disease and cryptococcal, lymphomatous, and probable candidal meningitis. The results of this study indicate that ADA determination in CSF has limited utility for the diagnosis of tuberculous meningitis in HIV-infected patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Berenguer J, Moreno S, Laguna F, Vicente T, Adrados M, Ortega A, González-Lahoz J, Bouza E (1992) Tuberculous meningitis in patients infected with the human immunodeficiency virus. N Engl J Med 326:668–672

    CAS  PubMed  Google Scholar 

  2. Sánchez-Portocarrrero J, Pérez-Cecilia E, Jiménez-Escrig A, Martín-Rabadán P, Roca V, Ruíz-Yagüe M, Romero-Vivas J, Palau E, Picazo JJ (1996) Tuberculous meningitis. Clinical characteristics and comparison with cryptococcal meningitis in patients with human immunodeficiency virus infection. Arch Neurol 53:671–676

    PubMed  Google Scholar 

  3. López-Cortés LF, Cruz-Ruiz M, Gómez-Mateos J, Jiménez-Hernández D, Jiménez-Mejías E, Pachón J, Castillo J (1995) Adenosine deaminase activity in the CSF of patients with aseptic meningitis: utility in the diagnosis of tuberculous meningitis and neurobrucellosis. Clin Infect Dis 20:525–530

    PubMed  Google Scholar 

  4. Casado JL, Quereda C, Oliva J, Navas E, Moreno A, Pintado V, Cobo J, Corral I (1997) Candidal meningitis in HIV-infected patients: analysis of 14 cases. Clin Infect Dis 25:673–676

    CAS  PubMed  Google Scholar 

  5. John MA, Coovadia YM (2001) Shortfalls in the use of adenosine deaminase in tuberculous meningitis. Trop Doct 31:138–139

    CAS  PubMed  Google Scholar 

  6. Martínez E, Domingo P, Ris J, Sambeat MA, Cadafalch J (1992) Cerebrospinal fluid adenosine deaminase levels in a patient with cryptococcal meningitis. Clin Infect Dis 15:1061–1062

    PubMed  Google Scholar 

  7. Pedro-Botet J, Soriano JC, Miralles R, Rubiés-Prat J (1991) Adenosine deaminase in cerebrospinal fluid of cerebral toxoplasmosis in AIDS. Infection 19:13

    CAS  PubMed  Google Scholar 

  8. Quereda C, Corral I, Laguna F, Valencia ME, Tenorio A, Echeverría JM, Navas E, Martín-Dávila P, Moreno A, Moreno V, González-Lahoz JM, Arribas JR, Guerrero A (2000) Diagnostic utility of a multiplex herpesvirus PCR assay performed with cerebrospinal fluid from human immunodeficiency virus-infected patients with neurological disorders. J Clin Microbiol 38:3061–3067

    PubMed  Google Scholar 

  9. Tenorio A, Echevarria JE, Casas I, Echevarria JM, Tabares E (1993) Detection and typing of human herpesviruses by multiplex polymerase chain reaction. J Virol Methods 44:261–269

    Article  CAS  PubMed  Google Scholar 

  10. Fedele CG, Ciardi M, Delia S, Echevarria JM, Tenorio A (1999) Multiplex polymerase chain reaction for the simultaneous detection and typing of polyomavirus JC, BK and SV40 DNA in clinical samples. J Virol Methods 82:137–144

    Article  CAS  PubMed  Google Scholar 

  11. Blake J, Berman P (1982) The use of adenosine deaminase assays in the diagnosis of tuberculosis. S Afr Med J 62:19–21

    CAS  PubMed  Google Scholar 

  12. Sloats EH, Asberg EG, Van Keipema AR, Kruijswijk H (1985) A continuous method for the estimation of adenosine deaminase catalytic concentration in pleural effusions with a Hitachi 705 discrete analyser. J Clin Chem Clin Biochem 23:677–682

    PubMed  Google Scholar 

  13. Working Group of the American Academy of Neurology AIDS Task Force (1991) Nomenclature and research case definitions for neurologic manifestations of human immunodeficiency virus-type 1(HIV-1) infection. Neurology 41:778–785

    PubMed  Google Scholar 

  14. Cantor SB, Sun CC, Tortolero-Luna G, Richards-Kortum R, Follen M (1999) A comparison of C/B ratios from studies using receiver operating characteristic curve analysis. J Clin Epidemiol 52:885–892

    Article  CAS  PubMed  Google Scholar 

  15. Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843

    CAS  PubMed  Google Scholar 

  16. Corral I, Quereda C, Martín-Dávila P, Gómez-Mampaso E, Fortún J, Muñoz V, Guerrero A (1998) Mycobacterium tuberculosis infection of the central nervous system: an 18 year experience. In: Casal M (ed) Clinical mycobacteriology. Prous Science, Barcelona, pp 357–361

  17. Piras MA, Gakis C (1973) Cerebrospinal fluid adenosine deaminase activity in tuberculous meningitis. Enzyme 14:311–317

    CAS  Google Scholar 

  18. Ribera E, Martínez-Vázquez JM, Ocaña I, Segura RM, Pascual C (1987) Activity of adenosine deaminase in cerebrospinal fluid for the diagnosis and follow-up of tuberculous meningitis in adults. J Infect Dis 155:603–607

    CAS  PubMed  Google Scholar 

  19. Machado LDR, Livramento JA, Spina-França A (1995) Adenosine deaminase in the cerebrospinal fluid of patients with the acquired immunodeficiency syndrome. Arq Neuropsiquiatr 53:755–759

    CAS  PubMed  Google Scholar 

  20. Tortosa A, Rubio F, Reñé R, Peres J (1993) Infiltración progresiva de pares craneales como primera manifestación de un linfoma meníngeo primario. Med Clin 100:137–139

    CAS  Google Scholar 

  21. Corral I, Quereda C, Casado JL, Cobo J, Navas E, Pérez-Elías MJ, Pintado V, Guerrero A (1997) Acute polyradiculopathies in HIV-infected patients. J Neurol 244:499–504

    Article  CAS  PubMed  Google Scholar 

  22. Arribas JR, Storch GA, Clifford DB, Tselis AC (1996) Cytomegalovirus encephalitis. Ann Intern Med 125:577–587

    CAS  PubMed  Google Scholar 

  23. Donald PR, Malan C, Schoeman JF (1987) Adenosine deaminase activity as a diagnostic aid in tuberculous meningitis. J Infect Dis 156:1040–1041

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank J.C. Martínez-Castrillo, from the Neurology Service, and J. Zamora, from the Clinical Biostatistics Unit, Hospital Ramón y Cajal, for their help in the statistical assessment.

Author information

Authors and Affiliations

  1. Neurology Service, Hospital Ramón y Cajal, Carretera de Colmenar km 9.1, 28034, Madrid, Spain

    I. Corral

  2. Infectious Diseases Service, Hospital Ramón y Cajal, Carretera de Colmenar km 9.1, 28034, Madrid, Spain

    C. Quereda, E. Navas, P. Martín-Dávila, M.-J. Pérez-Elías, J.-L. Casado, V. Pintado, J. Cobo & S. Moreno

  3. Clinical Biochemistry Service, Hospital Ramón y Cajal, Carretera de Colmenar km 9.1, 28034, Madrid, Spain

    E. Pallarés & J. Rubí

Authors
  1. I. Corral
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Quereda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Navas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Martín-Dávila
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M.-J. Pérez-Elías
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J.-L. Casado
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. V. Pintado
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Cobo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. E. Pallarés
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. J. Rubí
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. S. Moreno
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I. Corral.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Corral, I., Quereda, C., Navas, E. et al. Adenosine deaminase activity in cerebrospinal fluid of HIV-infected patients: limited value for diagnosis of tuberculous meningitis. Eur J Clin Microbiol Infect Dis 23, 471–476 (2004). https://doi.org/10.1007/s10096-004-1110-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-004-1110-z

Keywords

Search

Navigation