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Adenosine Deaminase (ADA)(Pus)

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No Fasting Required

Details

Less common than ADA in pleural or ascitic fluid but still useful in select clinical scenarios, especially where tuberculosis (TB) is suspected in deep-seated abscesses

₹229₹1,400

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Adenosine Deaminase (ADA) (Pus) - Comprehensive Medical Test Information

  • Why is it done?
    • Adenosine Deaminase (ADA) is an enzyme found in various body fluids and tissues. The ADA test on pus samples is performed to detect elevated levels of this enzyme, which indicates the presence of lymphocytic inflammation and helps in the diagnosis of tuberculosis and other infections.
    • Primary indications for ordering this test:
      • Suspected tuberculosis (TB) infection, particularly when culture results are pending
      • Differentiation between tuberculous and non-tuberculous infections in suppurative lesions
      • Investigation of chronic suppurative lesions with unknown etiology
      • Assessment of lymph node suppuration and drainage
      • Evaluation of patients with persistent purulent discharge from skin lesions
    • Typical timing:
      • Performed when pus is collected from suspected tuberculous lesions or chronic infections
      • Test is ordered urgently when TB is suspected and rapid confirmation is needed
      • Can be performed alongside bacterial culture and sensitivity testing
  • Normal Range
    • Reference values:
      • Normal/Negative: < 10 IU/L (International Units per Liter) in pus samples
      • Borderline: 10-15 IU/L (may warrant repeat testing or clinical correlation)
      • Elevated/Positive: > 15 IU/L (strongly suggestive of tuberculous infection)
    • Units of measurement:
      • IU/L (International Units per Liter) - standard measurement for enzyme activity
      • μmol/min/mL or U/mL - alternative units used in some laboratories
    • Interpretation of results:
      • Negative result: Low ADA levels indicate absence of lymphocytic inflammation; infection is likely non-tuberculous or non-infectious
      • Positive result: Elevated ADA levels strongly suggest presence of mycobacterial infection, particularly tuberculosis, with high sensitivity and specificity
      • Very high levels (>40 IU/L): Almost diagnostic of tuberculosis in appropriate clinical context
  • Interpretation
    • Detailed result interpretation:
      • ADA < 10 IU/L: Indicates low probability of tuberculous infection; consider alternative diagnoses such as bacterial, fungal, or non-infectious etiologies
      • ADA 10-15 IU/L: Equivocal results requiring clinical correlation with patient symptoms, imaging findings, and other diagnostic tests; repeat testing may be warranted
      • ADA 15-40 IU/L: Consistent with tuberculosis; high diagnostic value, especially when combined with positive clinical and radiological findings
      • ADA > 40 IU/L: Highly specific and sensitive for tuberculosis diagnosis; virtually diagnostic when supported by clinical context
    • Clinical significance of different patterns:
      • Progressive increase in ADA levels: May indicate disease progression or worsening infection despite treatment
      • Decreasing ADA levels during treatment: Suggests favorable response to anti-tuberculous therapy
      • Persistently elevated ADA despite treatment: May indicate treatment failure or resistant TB strain
    • Factors affecting interpretation:
      • Sample quality: Contaminated or improperly collected specimens may yield false results
      • Immunocompromised status: May affect ADA levels and interpretation in HIV-positive patients
      • Other lymphocytic infections: Can elevate ADA levels (fungal infections, brucellosis, atypical mycobacteria)
      • Prior anti-tuberculous therapy: May reduce ADA levels even in active disease
      • Laboratory methodology: Different assay methods may produce slightly different reference ranges
  • Associated Organs
    • Primary organ systems involved:
      • Lymphatic system: Primary source of ADA-producing lymphocytes; elevated levels indicate lymphocytic response
      • Immune system: ADA is produced by T-lymphocytes and macrophages; reflects cellular immune response
      • Lymph nodes: Often site of tuberculous infection producing suppurative discharge
    • Common disease associations:
      • Tuberculosis (Extra-pulmonary TB): Scrofula (tuberculous lymphadenitis), TB sinuses, and cold abscesses show markedly elevated ADA
      • Fungal infections: Coccidioidomycosis, histoplasmosis may show moderately elevated ADA
      • Brucellosis: Chronic brucellosis causing chronic suppuration may elevate ADA
      • Atypical mycobacterial infections: MAC (Mycobacterium avium complex), particularly in immunocompromised patients
      • Bacterial abscess: Usually shows lower ADA levels compared to TB
    • Diagnostic value:
      • Sensitivity: 88-100% for tuberculosis diagnosis in pus samples with appropriate cutoff
      • Specificity: 95-98% for differentiating TB from non-tuberculous infections
      • Rapid diagnostic tool: Provides results within 24-48 hours, much faster than culture which takes 2-8 weeks
    • Potential complications if diagnosis delayed:
      • Progressive tissue destruction and scarring if TB remains untreated
      • Dissemination of infection to other organ systems
      • Development of sinus tracts and chronic draining wounds
      • Risk of transmission to contacts if TB diagnosis missed
  • Follow-up Tests
    • If ADA is elevated (suggestive of TB):
      • Mycobacterium culture: Gold standard for TB confirmation; helps with drug susceptibility testing
      • Acid-Fast Bacilli (AFB) smear microscopy: Provides rapid preliminary evidence of mycobacteria
      • GeneXpert MTB/RIF: Rapid molecular test for TB and rifampicin resistance detection within 2 hours
      • Tuberculin skin test (TST) or Mantoux test: Assesses cell-mediated immune response to TB antigen
      • Interferon-Gamma Release Assays (IGRAs): Blood-based test for TB infection assessment
      • Chest X-ray: To evaluate for pulmonary TB and assess disease extent
      • CT scan: For detailed imaging of affected lymph nodes or tissues if clinically indicated
    • If ADA is normal (TB excluded):
      • Bacterial culture and sensitivity: To identify causative organism in pyogenic infections
      • Gram stain: Preliminary identification of bacteria type (Gram positive/negative)
      • Fungal culture and staining: If fungal infection suspected
      • Biochemical analysis of pus: Protein, glucose, and LDH levels for diagnostic clues
      • Cell count and differential: To assess inflammatory cell composition
    • During treatment monitoring:
      • Repeat ADA testing: After 2-4 weeks of treatment to monitor therapeutic response; levels should decline
      • Follow-up AFB smears: To verify bacteriological response during treatment course
      • Repeat imaging: Chest X-rays or ultrasound to assess clinical and radiological improvement
      • Liver and kidney function tests: To monitor for drug-related toxicity during anti-TB therapy
      • Drug susceptibility testing (DST): If treatment failure suspected or multi-drug resistant TB (MDR-TB) likely
    • Recommended monitoring frequency:
      • Initial diagnosis: ADA testing at time of presentation with pus sample collection
      • At 2 weeks of treatment: Repeat ADA if initial result was borderline or for baseline comparison
      • At 8-12 weeks: Comprehensive reassessment with imaging and repeat cultures if needed
      • End of treatment: To confirm resolution of infection and successful therapy
  • Fasting Required?
    • Fasting requirement: NO
      • Adenosine Deaminase (ADA) testing on pus samples does not require fasting as it is a direct examination of the pus fluid itself
      • The test is performed on locally collected pus specimens rather than systemic blood samples
    • Sample collection instructions:
      • Pus is collected using sterile technique directly from the lesion, abscess, or sinus tract
      • Collection should be done before any topical antiseptics or antibiotics are applied to the area
      • Sterile swab or needle aspiration should be used to obtain sufficient quantity of pus (minimum 1-2 mL recommended)
      • Samples should be placed in sterile containers without preservatives or formalin
      • Refrigeration at 2-8°C is recommended if transport to laboratory is delayed (maximum 2-4 hours at room temperature)
    • Medications:
      • No specific medications need to be withheld for this test
      • However, if already on anti-tuberculous therapy, inform the laboratory as ADA levels may be affected
      • Do not apply topical antibiotics, antiseptics, or iodine solutions to the collection site before sampling
    • Other preparation requirements:
      • Patient identification: Ensure proper patient identification and labeling of specimen container
      • Clinical information: Provide relevant clinical history (suspected TB, duration of symptoms, prior treatment)
      • Timing: Collect sample as soon as possible after presentation; fresh sample gives best results
      • Adequate quantity: Ensure sufficient pus volume for all requested tests (ADA, culture, AFB smear)
      • Transport time: Minimize delay between collection and laboratory receipt (preferably within 1-2 hours)

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