Role of cerebrospinal fluid adenosine deaminase activity in the diagnosis of tuberculous meningitis in children

T. Hima Bindu, R. Maheshwara Reddy


Background: Early and correct treatment is essential for successful outcome in patients of tuberculous men-ingitis. Adenosine deaminase activity in the cerebrospinal fluid has been found to be a simple and useful investigation in the diagnosis of tuberculous meningitis in children.

Methods: It is a cross sectional observational hospital based study conducted at the Department of Paediatrics, Deccan College of Medical Sciences, Kanchanbagh, Hyderabad, India. Children aged 2 months to 12 years were included in the study during April 2016 to October 2016.

Results: The mean value of adenosine deaminase activity in the cerebrospinal fluid of tuberculous meningitis cases was 13.3±14.49. The mean cerebrospinal fluid adenosine deaminase levels in tuberculous meningitis patients was significantly higher than non-tuberculous meningitis patients with P <0.01.

Conclusions: The mean cerebrospinal fluid adenosine deaminase level was significantly raised in tuberculous meningitis patients.


Adenosine deaminase, Cerebrospinal fluid, Tuberculous meningitis

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Global Tuberculosis control 2015, WHO, Geneva, 2015.Available /tb/ publications /global_ report. Accessed on 19 December 2016.

T.B. India 2016. Revised national TB control programme annual status report. New Delhi 2016. Available at www.tbc Accessed on 19 December 2016.

Murthy J. Tuberculous meningitis: the challenges. Neurol India. 2010;58:716-22.

Bothamley GH. Serological diagnosis of tuberculosis. Eur Respir J. 1995;20:676-88.

Steingart KR, Henry M, Ng V, Hopewell PC, Ramsay A, Cunningham J, Urbanczik R, et al. Fluorescence versus conventional sputum smear microscopy for tuberculosis: a systematic review. Lancet Infect Dis. 2006;6(9):570-81.

Abe C, Hirano K, Wada M, Kazumi Y, Takahashi M, Fukasawa Y, et al. Detection of Mycobacterium tuberculosis in clinical specimens by polymerase chain reaction and genprobe amplified mycobacterium tuberculosis direct test. J Clin Microbiol. 1993;31(12):3270-4.

Sharma SK, Mohan A. Adenosine deaminase in the diagnosis of tuberculosis pleural effusion. Indian J Chest Dis Allied Sci. 1996;38(2):69-71.

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

Jakka S, Veena S, Rao ARM, Eisenhut M. Cerebrospinal adenosine deaminase levels and adverse neurological outcome in pediatric tuberculous meningitis. Infection. 2005;33:264-6.

Malan C, Donald PR, Golden M, Taljaard JJ. Adenosine deaminase levels in cerebrospinal fluid in the diagnosis of tuberculous meningitis. J Trop Med Hyg. 1984;87(1):33-40.

Piras MA, Gakis C. CFS adenosine deaminase activity in tuberculous meningitis. Enzyme. 1972;14:311-7.

Giusti G. Adenosine deaminase. In: Bergmeyer HU. Method of enzymatic analysis. II. Florida: VCH Weinheim. 1974:1072.

Thwaites GE, Hein TT. Tuberculous meningitis: Many questions, too few answers. Lancet Neurol. 2005;4:160-70.

Udani PM, Parekh UC, Dastur DK. Neurological and related syndromes in CNS tuberculous meningitis: Clinical features and pathogenesis. J Neurol Sci. 1971;14:341-57.

Well GT, Paes BF, Terwee CB, Springer P, Roord JJ, Donald PR, et al. Twenty years of pediatric tuberculous meningitis: a retrospective cohort study in the western cape of South Africa. Pediatrics. 2009;123:1-8.

Molavi A, Lefrock JL. Tuberculous meningitis. Med Clin North Am. 1985;69(2):315-31.

Blake J, Berman P. The use of adenosine deaminase assays in the diagnosis of tuberculosis. S Afr Med J.1982;62(1):19-21.

Prasad R, Kumar A, Khanna BK. CSF - ADA for diagnosis of TBM. Ind J Tub. 1991;38:99-102.

Mishra OP, Loiwal V, Ali Z, Nath G, Chandra L, Das BK. Cerebrospinal fluid adenosine deaminase activity and C-reactive protein in tuberculous and partially treated bacterial meningitis. Indian Pediatr. 1995;32(8):886-9.

Rana SV, Singhal RK, Singh K, Kumar L. Adenosine deaminase levels in cerebrospinal fluid as a diagnostic test for tuberculous meningitis in children. Indian J Clinical Biochem. 2004;19(2):5.

Gupta BK, Bharat A, Bandyopadhyay D, Baruah H. ADA levels in CSF of Tuberculous meningitis patients. J Clin Med Res. 2010;2(5):220-4.

Baheti R, Laddha P, Gehlot RS. CSF - adenosine deaminase (ADA) activity in various types of meningitis. Journal, Indian Academy Clinical Medicine. 2001;2(4):285-7.

Ribera E, Vazquez JM, Ocana I, Segura RM, Pascual C. Activity of adenosine deaminase in cerebrospinal fluid for the diagnosis and follow-up of tuberculous meningitis in adults. J Infect Dis.1987;155(4):603-7.