The Role of Isoensyme Levels of Adenosine Deaminase in Broncho Alveolar Lavage Fluid to Evaluate Activity of Pulmonary Tuberculosis

Early diagnosis and treatment is playing very important role on avoiding morbidity of pulmonary tuberculosis. If the agent cannot be isolated, there were used some indirect tools. We measured isoensyme levels of Adenosine Deaminase in Broncho-alveolar lavage fluid in smear(-) tuberculosis patients to evaluate if disease is active or sequelar. We evaluated 26 active and 10 sequelar smear(-) tuberculosis patients between 2002 and 2004 prospectively. Of the active tuberculosis patients, 18 were male, 8 were female with mean age of 24. In the sequelar tuberculosis group, there were 5 male and 5 female with mean age of 38. Fiberoptic bronchoscopy was performed and BALF was taken from all the patients. Total ADA with ADA-1 and ADA-2 levels of BALF were determined. The average levels of groups for ADA and isoensymes were compared with using Student's -t- test. Total ADA, ADA-1 and ADA-2 levels were determined as 6.7U/ml, 2.11U/ml and 4.62U/ml respectively in active tuberculosis group and 1.78U/ml, 0.78U/ml ve 1.0U/ml in sequelar tuberculosis group. The elevation of ADA-1 level in active tuberculosis group were discovered poorly significant(p=0,049) whereas, elevation of total ADA and ADA-2 levels in active tuberculosis group were highly significant(p<0,01). ADA-2 isoensyme and total ADA levels in BALF of active tuberculosis patients is significantly higher from patients who have sequelar tuberculosis. Determination of ADA-2 and total ADA levels in BALF is, effective and rapid method for differentiating smear(-) active tuberculosis patients from sequelar ones, so putting the indication to start antituberculous therapy.