Evaluation of usefulness of pleural fluid adenosine deaminase in diagnosing tuberculous pleural effusion from empyema

Pulmonary tuberculosis (PTB) is a contagious bacterial infection which is the highly endemic disease in India that involves the lungs. It spreads to other organs. PTB is caused by the bacteria Mycobacterium tuberculosis[1]. Tuberculosis is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent. Rapid diagnosis and prompt treatment is required to reverse the morbidity and mortality due to tuberculosis. Tuberculous pleural effusion is the commonest manifestation of extra-pulmonary tuberculosis (EPTB). Diagnosis of tuberculous pleural effusion is difficult because of non-specific clinical presentation and insufficient efficiency of traditional diagnostic methods due to paucity of bacteria in pleural cavity. Pleural biopsy is invasive and often requires several attempts to locate the infective loci but has been the gold standard method in diagnosis of tuberculous pleural effusion. Positivity for acid fast bacilli stain and histopathological study of pleura are very low and culture is time consuming. Enzyme linked immunosorbent assay, polymerase chain reaction, interferon assays are expensive tests for the identification of tubercle bacilli[2]. Mycobacterium is naturally resistant to variety of stresses due to their waxy thick wall. Inside the PEER REVIEW ABSTRACT