Differential Diagnosis of Cerebral Malaria by CSF ADA, Serum ADS and its Ratio
Authors/Creators
- 1. Department of Paediatrics, Department of Pathology, MLB Medical College, Jhansi (Uttar Pradesh)
Description
A case control study was conducted comparing CSF ADA, Serum ADA and its ratio for differentiating cerebral malaria from viral encephalitis in the Department of Pediatrics, M.L.B. Medical College, Jhansi during January 2010 – October 2011. Patients admitted with history of fever, convulsion and altered sensorium were enrolled in the study and further divided in three groups comprising of Cerebral Malaria, Viral Encephalitis and Control Group. Lumber puncture were performed in all three groups and ADAestimation was done. The statistical analysis was performed by using chi square test to find out the significance of difference. For determination of cutoff value for parameters, coordinates of ROC curve indicating the greatest sensitivity and specificity were chosen. Fifty two patients of cerebral malaria, 56 patients of viral encephalitis and 54 controls were recruited for the study over 2 year period. Patients with cerebral malaria had significantly higher serum ADA, CSF ADA but lower CSF/ serum ADA compared to control (p78.9, CSF ADAof >6.31 and CSF/Serum ADAratio of ≤0.093 were selected as the cutoff value with highest sensitivity and specificity for differentiation between two conditions. ADA estimation in CSF and Serum is a rapid, simple, and reliably specific test to differentiate cerebral malaria from viral encephalitis. Therfore, this test can be used to avoid diagnostic dilemma. ADA estimation in cerebral malaria patients should find place in routine laboratory methodology.
Files
4.pdf
Files
(70.3 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:e559590dd8ffda2885b2e56fd036ebd4
|
70.3 kB | Preview Download |
Additional details
References
- 1. Kounteya Sinha. Encephalitis-hit kids to get special schools. Times of India. Nov 22, 2011.http: //articles.timesofindia.indiatimes. com/2011-11- 22/india/30428249_1_hand-pumps-japaneseen cephalitis-encephalitis-outbreak.
- 2. Jain V, Nagpal AC, Joel PK , Shukla M, Singh M P , Gupta RB, et al. Burden of Cerebral Malaria in Central India (2004–2007). –Am J Trop Med Hyg,2008 Oct; 79(4): 636642.
- 3. Jakka SR, Veena S, Atmakuri RM and Eisenhut M. Cerebrospinal fluid research 2006; 3:8.
- 4. Panagariya A, Jain RS, Gupta S, Garg A, Sureka RK, Mathur V: Herpes simplex encephalitis in North West India. Neurol India 2001, 49:360-365
- 5. Rao BL, Basu A, Wairagkar NS, Gore MM, Arankalle VA, Thakare JP, Jadi RS, Rao KA, Mishra AC: Alarge outbreak of acute encephalitis with high fatality rate in children in Andhra Pradesh, India, in associated with Chandipura virus. Lancet 2003, 364:869-874.
- 6. Gakis C. Adenosine Deaminase (ADA) Isoenzymes ADA1 and ADA2: Diagnostic and Biological role. Eur Respir J 196: 9: 632-633.
- 7. Conway FJ, Cook R The deaminase of adenosine adenylic acid in blood tissue Biochem J. 1939; 33-479.
- 8. Mishra O. P. Loiwal V. Ali Z, Nath G, Chandra L, Das B. K. Cerebrospinal Adenosine Deaminase activity and C-Reactive Protein in tuberculous and partially treated bacterial meningitis. Indian Pediatr. 1995; Aug: 32(8): 886-9.
- 9. Gambhir IS, Mehta M, Singh DS, Khanna HD: Evaluation of CSF adenosine deaminase activity in tubercular meningitis. Journal Assoc Phys India 1999, 47:192-194
- 10. World Health Organization, Communicable Diseases Cluster: Severe falciparum malaria.Trans R Soc Trop Med Hyg 2000,94(suppl 1):S1-S90.
- 11. Malaria and its control in India (Vol. 7) Directorate of National of Health & Family welfare, Govt. of India 1986.
- 12. Whitley RJ, Gnann JW: Viral encephalitis: familiar infections and emerging pathogens. Lancet 2002, 359:507-514.
- 13. Jakka S, Veena S, Rao AR, Eisenhut M: Cerebrospinal fluid adenosine deaminase levels and adverse neurological outcome in pediatric tuberculous meningitis. Infection 2005, 33:264-266.
- 14. Giusti G, Galanti B: Adenosine 5-monophosphate deaminase and adenosine deaminase activity of the blood in experimental and human hepatic pathological conditions. Boll Soc Ital Biol Sper 1965, 41:614-617.
- 15. Armitage P, Berry G, Matthews JNS: Statistical methods in medical research.4th edition. Oxford, United Kingdom, Blackwell Science; 2002:697.
- 16. Greenhalgh T: Papers that report diagnostic or screening tests. BMJ 1997, 315:540-543.
- 17. Thomas G. Tape. Interpreting Diagnostic Tests. University of Nebraska Medical Center. http://gim.unmc.edu/dxtests/roc3.htm
- 18. Mishra OP, Loiwal V, Ali Z, Nath G, Chandra L: Cerebrospinal fluid adenosine deaminase activity for the diagnosis of tuberculous meningitis in children. J Trop Ped 1996, 42:129-132.
- 19. Peter E. Daddona, William P. Wiesmanne, Chris Lambrose, William N. Kelleys and H.Kyle Websterll .Human Malaria parasite Adenosine Deaminase characterization in host enzyme-deficient erythrocyte culture. The Journal of biological chemistry, 1984; Vol. 259, No. 3; Isse 10 Page 1472-1475.
- 20. Ozcan E, Abdurrahim K, Adnan S, Senel A, Necmeddin A: Serum erythrocyte and leukocyte adenosine deaminase activities in patients with vivax malaria in Turkey. J Egypt Soc Parasitol 1997, 27:445- 454.