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A Study on the Diagnostic Value of Cerebrospinal Fluid Adenosine Deaminase Activity in Children with Tuberculous Meningitis

Journal of the Korean Pediatric Society 1992;35(1):88-97.
Published online January 15, 1992.
A Study on the Diagnostic Value of Cerebrospinal Fluid Adenosine Deaminase Activity in Children with Tuberculous Meningitis
Won Kyu Choi, Mee Kyung Namgoong, Hae Yong Lee, Hwang Min Kim, Jae Seung Yang, Jong Soo Kim
Department of Pediatrics, Yonsei University, Wonju College of Medicine, Wonju, Korea
결핵성 뇌막염 환아의 뇌척수액 Adenosine Deaminase 활성도에 대한 연구
최원규, 남궁미경, 이행용, 김황민, 양재승,
연세대학교 원주의과대학 소아과학교실
Tuberculous meningitis is still relatively common infectious disease of central nervous system in korea. The prognosis of tuberculous meningitis is closely related to the state at which treatment if started. Adenosine deaminase (ADA) is an enzyme which irreversibly hydrolyzes adenosine into inosine and ammonia. Recent investigations have suggested that the measurement of ADA activities in cerebrospinal fluid is useful in the diagnosis of tuberculous meningitis. In this study, cerebrospinal fluid ADA activity were measured in 27 cases of tuberculous meningitis, 16 cases of purulent meningitis, 61 cases of aseptic meningitis, 20 cases of other neurologic conditions, and 19 cases of normal control. The reuslts were as follows; 1) The mean cerebrospinal fluid ADA activity in tuberculous meningitis was 13.15¡¾0.45 unit/L, in purulent meningitis 10.35¡¾9.06 unit/L, encephalitis 7.30¡¾7.56, G-B sundrome 2.67¡¾4.92, Reye syndrome 0.93¡¾0.15 and in control 0.57¡¾0.68 unit/L. In the tuberculous meningitis, the mean ADA activity of cerebrospinal fluid was significantly higher than that in other groups exept purulent meningitis(p<0.001). 2) Cerebrospinal fluid ADA activities differentiated tuberculous meningitis from those with aseptic meningitis being higher than 4 unit/L in all tuberculous meningitis, but lower than 4 unit/L in most of aseptic meningitis. 3) In tuberculous meningitis, there was statistically signficiant correlation between cerebrospinal ADA activity and cerebrospinal protein (p<0.05). but in purulent meningitis, there were statistically significant correlation between cerebrospinal ADA activity and sugar as well as cerebrospinal protein 9p<0.05). 4) During the course of antituberculous treatment in tuberculous meningitis, the change of cerebrospinal fluid ADA activities was similar to that of cerebrospinal fluid protein. The mean cerebrospinal fluid ADA activity started to decrease at 10 weeks after therapy and at that time the mean cerebrospinal fluid sugar and leukocte started to increase or decrease respectively. It is suggested that measurement of ADA activity in cerebrospinal fluid is an available test for diagnosis of tuberculous meningitis, exoecially differential diagnosis with aseptic meningitis and for determination of activity of tuberculous meningitis during the course of treatment.
Key Words: Tuberculous meningitis, Cerebrospinal fluid ADA activity

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