Pleural Fluid Adenosine Deaminase and Lymphocyte Proportion: Clinical Usefulness In the Diagnosis of Tuberculosis

Adenosine deaminase (ADA) and lymphocyte proportion are known to be independently elevated in tuberculous effusions, but are non-specific, and false positive results are frequent. to overcome this problem the combined use of both parameters was prospectively studied in 276 patients with pleural effusion seen at Porto Alegre, Brazil. Using a cut-off level of 40 U/l at 37°C (method of Giusti¹⁹) for ADA activity and lymphocyte proportion of more than 50%, the correct diagnosis of tuberculosis (sensitivity) was made in 90.7% (CI 87.3–94.1%) of 54 patients. A specificity of 97.7% (CI 95.9–99.5%) was recorded. Five false positive diagnoses of tuberculous effusion were made. Five false negative diagnoses were made: three cases with haematogenous tuberculous dissemination with low ADA levels, and two other patients with low lymphocyte proportion. the combined use of ADA activity determination and lymphocyte proportion is a highly efficient diagnostic strategy of low cost, that merits wider use.     

Concentrations of copper, zinc, manganese, rubidium, and magnesium in thoracic empyemata and corresponding sera

In this study, a number of selected trace elements and clinically relevant parameters were compared between thoracic empyemata and the corresponding sera for a better understanding of the trace element distribution between these two compartments. Serum-empyema pairs were obtained from 13 patients and quantified for selected and essential trace elements, namely copper (Cu), zinc (Zn), manganese (Mn), rubidium (Rb), and magnesium (Mg), by inductively coupled plasma-mass spectrometry (ICP-MS). In addition, the concentrations of the following clinical laboratory parameters were analyzed by standard methods: total protein, leukocyte count, lactate dehydrogenase, glucose, pH, and the C-reactive protein. Individual concentrations of the elements determined in the empyemata were frequently higher than in pleural effusions of any other benign or malignant condition except for Cu. Serum Cu exceeded the normal range (600–1400 μg/kg) in 6 out of 13 patients (median 1410 μg/kg). In the empyemata, Zn concentrations (median 2000 μg/kg) were characteristically higher than in the sera (median 450 μg/kg) and exceeded the upper limit for serum (1200 μg/kg) in 8 of the 13 patients. Manganese concentrations in the empyemata (median 2.7 μg/kg) were also higher compared to corresponding sera, although they stayed within the limits considered normal for serum of healthy adults (upper limit 2.9 μg/kg). Rubidium was also moderately higher in most empyemata (median 290 μg/kg) and exceeded the upper limit for serum (560 μg/kg) in two patients. The median concentration of the essential element magnesium was higher in the empyemata (23 mg/kg) than in the sera (21 mg/kg). However, all serum Mg concentrations except three remained within the normal range (17–22 mg/kg). Removal of large amounts of empyematous fluid may deprive the body of trace elements and can cause suboptimal or deficient trace element status and homeostasis. Recuperation will be accelerated by compensatory supplementation of trace elements. Therefore, selective medication with adequate trace element compounds in patients with thoracic empyema can be generally recommended for zinc. The other elements need not necessarily be monitored or substituted, because of their stable concentrations in the serum. Rb may have a biological impact, but deficiency symptoms in man are not clearly defined. Deceased.     

Serum protein and zinc levels in patients with thoracic empyema

The element Zn is the metal component or activator of many important enzymes. The tissue concentrations and activities of Zn metalloenzymes direct the rate of protein and nucleic acid syntheses, thereby influencing tissue growth and reperative processes. Most of the serum Zn is normally bound to circulating proteins. Low serum Zn concentrations might result from depletion of Zn-binding proteins. Serum protein and Zn concentrations have been reported to be depressed in patients with acute and chronic diseases. We compare the serum protein and Zn values of patients with thoracic empyema (n=20) with those of a control group (n=20). The values obtained in the empyema group were significantly lower than those in the control group before the study. Test group administered 220 mg zinc sulfate (ZnSO₄. 7H₂O) over 20 d and there was a significant increase in the values for serum protein and Zn after the oral administration of the zinc sulfate.