Adenosine Deaminase (ADA)(Pus)
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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
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🧪 Adenosine Deaminase (ADA) – Pus Sample
Parameter | Details |
|---|---|
Fasting Required? | ❌ Not required |
Sample Type | Pus or abscess aspirate, typically from cold abscess, lymph nodes, spine, etc. |
Primary Organs Involved | Depends on pus location (e.g., spinal cord, lymph nodes, soft tissues) |
Primary Purpose | Supportive diagnosis of tuberculous abscess or TB lymphadenitis |
🔬 What is ADA in Pus?
- ADA is an enzyme associated with T-cell activation during immune responses.
- In tuberculous abscesses, especially those in lymph nodes or spine, ADA may be elevated in pus.
- ADA in pus is used when AFB smear or culture is negative or awaiting molecular results.
📈 Interpretation of ADA in Pus
ADA Level (U/L) | Clinical Interpretation |
|---|---|
< 30 U/L | Unlikely to be TB; consider pyogenic bacterial abscess |
30–40 U/L | Borderline; interpret with cell count, clinical and imaging data |
> 40–45 U/L | Suggestive of tuberculous origin, especially in endemic settings |
> 60 U/L | Strongly indicative of TB abscess, particularly if other signs support |
✅ Interpretation is best with lymphocyte-predominant, sterile, cold abscess.
🧠 When to Use ADA in Pus?
- When evaluating:
- Cold abscess of spine, chest wall, or muscle
- Lymph node abscesses with granulomatous changes
- Non-healing abscesses in immunocompetent or immunocompromised patients
- Especially in TB-endemic areas or when AFB tests are negative
🔗 Recommended Conjunction Tests
Test | Purpose |
|---|---|
AFB Smear & Culture (from pus) | Direct detection of Mycobacterium tuberculosis |
CBNAAT / GeneXpert (Pus) | Rapid detection of TB DNA and rifampicin resistance |
Gram Stain & Bacterial Culture | Rule out pyogenic infection |
Histopathology (if biopsy) | Detect granulomas and caseation necrosis |
ESR / CRP | General markers of inflammation |
Ultrasound / MRI / CT | Define abscess extent and guide aspiration |
⚠️ Limitations
Factor | Consideration |
|---|---|
ADA not TB-specific | May be elevated in fungal infections, sarcoidosis, or malignancy |
False negatives | Possible in early TB, immunosuppressed patients |
Use with caution in pus | Needs supportive microbiological and radiological correlation |
✅ Summary Table
Test Name | ADA – Pus Sample |
|---|---|
Purpose | Support diagnosis of TB-related abscess |
Useful In | Spinal TB, lymph node TB, cold abscess |
Significant Level | >40 U/L considered suggestive in right clinical context |
Paired With | AFB smear, GeneXpert, culture, imaging, cytology |
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