Clinical study of meningitis in children and role of adenosine deaminase in differentiating tubercular from non-tubercular meningitis


  • Deepmala Pandey Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
  • Ankur Yadav Department of Neonatology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India



ADA levels, CSF, Diagnosis, Neck rigidity, Neuroimaging, Tubercular meningitis


Background: In diseases where cell mediated immunity plays an important role like in tuberculosis, CSF (Cerebrospinal fluid) adenosine deaminase (ADA) activity is increased. Hence, this testing is done especially among children with suspected tubercular meningitis. The objective of this was to study role of Adenosine Deaminase in differentiating tubercular from non-tubercular meningitis.

Methods: This was a hospital based cross sectional study was carried out among 50 children of proven meningitis for a period of two years. CSF ADA levels were done for all cases. They were divided into tubercular meningitis and non-tubercular meningitis group and compared.

Results: Incidence of tuberculous meningitis (TBM) was found high in the age group 5-8 years. Male:female ratio was 2.3:1. Fever was present in all cases followed by vomiting and neck rigidity. CSF AFB was positive in 3 cases (6%). Neuroimaging was done in all cases in which 3 patients had basal exudate in which 2 patients had TBM and 1 patient was Non-TBM. 3 patients had hydrocephalus in MRI in which 2 had TBM diagnosed and 1 had non-TBM. As per ADA levels, 10 were diagnosed as TBM out of which 8 patients had ADA level ≥10 IU/L and 2 had ADA level <10 IU/L which was missed by ADA and later confirmed by other modalities.

Conclusions: It was concluded that if ADA level in CSF is ≥10IU/l the diagnosis of TBM should be considered.


WHO reports 2003. Global TB control, surveillance, planning, financing, communicable diseases. Geneva. Available at: Accessed on: 10-08-2016.

Mastroianni CM, Lancella L, Mengoni F, Lichtner M, Santopadre P, D'agostino C, et al. Cerebrospinal fluid cytokines in patients with tuberculous meningitis. Clin Immunopathol. 1997;84(2):171-6.

Tandon PN. Neurotuberculosis: Clinical aspects. In: Neurology in Tropics. Chopra JS, Sawhney IMS, eds. Churchill Livingstone Ltd; 1999: 358-389.

Thweites G, Chan TTH, Mai NTH, Drobniewskic F, McAdamd K, Farrare J. Tuberculous meningitis. J Neurol Neurosurg Psychiatr. 2000;68:289-99.

Garcia-Monco JC. CNS Tuberculosis. In: Neurologic Clinics. Marra CM. 1999;17(4):737-60.

Kashyap RS, Kainthla RP, Satpute RM, Agarwal NP, Chandak NH, Purohit HJ, et al. Significance of 30 KD protein marker as diagnostic marker in CSF of tuberculous meningitis. Ann Indian Acad Neurol. 2001;4(1):197-201.

Kashyap RS, Kainthla RP, Biswas SK, Agarwal N, Chandak NH, Purohit HJ, et al. Rapid diagnosis of tuberculous meningitis using the simple Dot ELISA method. Med Sci Monit. 2003;9(11):123-6.

Kilpatrick ME, Girgis NI, Yassin MW, Abu el Ella AA. Tuberculous meningitis-clinical and laboratory review of 100 patients. J Hyg. 1986;96(2):231-8.

Kashyap RS, Kainthla RP, Satpute RM, Agarwal NP, Chandak NH, Purohit HJ, et al. Differential diagnosis of tuberculous meningitis from partially treated cases of pyogenic meningitis by cell ELISA. BMC Neurol. 2004;4(1):16.

Prasad R, Kumar A, Khanna BK, Mukerji PK, Agarwal SK, Kumar A, Srivastava VM. Adenosine deaminase activity in cerebro-spinal fluid for diagnosis of tuberculous meningitis. Ind J Tub. 1991;38:99-102.

Fox IH, Kelly WN. The role of adenosine deaminase and 2’deoxyadensoine in mammalian cells. Ann Rev Biochem. 1978;47:655-86.

Erel O, Kocyigit A, Gurel MS, Bulut V, Seyrek A, Ozdemir Y. Adenosine Deaminase activities in sera, lymphocytes and granulocytes in patients with cutaneous Leishmaniasis. Mem Inst Oswaldo Cruz. 1998;93(4):491-4.

Galanti B, Nardiello S, Russo M, Fiorentino F. Increased lymphocyte adenosine deaminase in typhoid fever. Scand J Infect Dis. 1981;13(1):47-50.

Malla K, Rao KS, Malla T, Vedamony J, Ghimire P. Role of cerebrospinal fluid-adenosine deaminase level in early diagnosis of various etiologies of meningitis in children. Nepal J Med Sci. 2012;1(2):97-102.

Bindu TH, Reddy RM. Role of cerebrospinal fluid adenosine deaminase activity in the diagnosis of tuberculous meningitis in children. Int J Contemporary Pediatr. 2017;4(2):411-4.

Gupta BK, Goel P, Baruah H. Cerebrospinal fluid adenosine deaminase: its evaluation as a marker for diagnosing tuberculous meningitis in paediatric patients. J Dental Med Sci. 2013;4(1):21-4.

Qamar FN, Rahman AJ, Iqbal S, Humayun K. Comparison of clinical and CSF profiles in children with tuberculous and pyogenic meningitis; role of CSF protein: glucose ratio as diagnostic marker of tuberculous meningitis. J Pak Med Assoc. 2013;63(2):206-10.

Nhu NT, Heemskerk D, Chau TT, Mai NT, Nghia HD, Loc PP, et al. Evaluation of GeneXpert MTB/RIF for diagnosis of tuberculous meningitis. J Clin Microbiol. 2014;52(1):226-33.






Original Research Articles