All issues > Volume 35(1); 1992

Original Article

J Korean Pediatr Soc. 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 WK Choi¹, Mee Kyung MK Namgoong¹, Hae Yong HY Lee¹, Hwang Min HM Kim¹, Jae Seung JS Yang¹, Jong Soo JS Kim¹

¹Department of Pediatrics, Yonsei University, Wonju College of Medicine, Wonju, Korea

Abstract

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.

Keywords :Tuberculous meningitis, Cerebrospinal fluid ADA activity