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Peer-reviewedCC BY-NC-NDJournal of family medicine and primary care

Comparative analysis of adenosine deaminase (ADA) and polymerase chain reaction (PCR/GeneXpert) for diagnosing pleural and peritoneal tuberculosis

  • Aparnna Unnikrishnan Nair1
  • Sanjana Laishram2
  • Shoraf Pascal3
  • Muskan Joshi4
  • Gayathri Pramil Menon4
  • Lakshmi Murugesan5
  • Nithila Sivakumar5
  • Lakshiya Ramamoorthy5
  • Ruchi Kothari6
  • Roshan Prasad7
  • A Prashanth6
7 affiliations
  1. 1General Internal Medicine, Altnagelvin Hospital, Western Health and Social Care Trust, Derry, Northern Ireland, United Kingdom
  2. 2Community Medicine, St. Peter's Medical College, Hospital & Research Institute, Hosur, Tamil Nadu, India
  3. 3Department of Community Medicine, Madha Medical College and Research Institute, Chennai, Tamil Nadu, India
  4. 4International Faculty of Medicine, Tbilisi State Medical University, Tbilisi, Georgia
  5. 5Department of Internal Medicine, Madras Medical College, Chennai, Tamil Nadu, India
  6. 6Department of Physiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
  7. 7Department of Research, Datta Meghe Institute of Higher Education and Research, Sawangi, Maharashtra, India
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Abstract

Context:: Tuberculosis (Tb) is one the most prevalent diseases, with a huge disease burden in various developing countries, such as India. Given the large burden of TB cases, the proportion of extrapulmonary tuberculosis (EPTB) cases has also risen in recent years. The diagnosis of EPTB poses a significant challenge, owing to its atypical characteristics. Adenosine deaminase (ADA) and GeneXpert/PCR (NAAT) are the primary tools for EPTB diagnosis currently in practice. The aim of the study was to contrast and highlight the efficacy of the two tests, investigating the utility of both, alone and in combination.

Methods and Material:: This study was a cross-sectional comparative study with a total of 77 samples included. Every diagnosis was documented to generate the values based on predictive power, which include sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).

Results:: In all the samples, ADA was first compared to GeneXpert in ascitic fluid (sensitivity 75%, specificity 6.9%, PPV 10% and NPV of 66.67%) and in pleural fluid (sensitivity 94.11%, specificity 3.70%, PPV 38.09% and NPV 50%). GeneXpert compared to ADA in ascitic fluid (sensitivity 10%, specificity 66.67%, and PPV 75%, and NPV 6.89%) and in pleural fluid (sensitivity 38.10%, specificity 50%, PPV 94.12% and NPV 3.70%).

Conclusions:: ADA can be used with relative confidence to test EPTB, due to its high sensitivity as well as reliable negative predictive value, in contrast GeneXpert/PCR is strongly recommended in the detection of pre-existing Tb cases, due to its high specificity. Further studies and investigations are required to help health care providers establish the collective use reducing both morbidity and mortality. This study reinforces the use of ADA in cases of EPTB.

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Cite

BibTeXRIS
BibTeX
@article{nair2026comparative,
  title = {{Comparative analysis of adenosine deaminase (ADA) and polymerase chain reaction (PCR/GeneXpert) for diagnosing pleural and peritoneal tuberculosis}},
  author = {Aparnna Unnikrishnan Nair and Sanjana Laishram and Shoraf Pascal and Muskan Joshi and Gayathri Pramil Menon and Lakshmi Murugesan and Nithila Sivakumar and Lakshiya Ramamoorthy and Ruchi Kothari and Roshan Prasad and A Prashanth},
  journal = {Journal of family medicine and primary care},
  year = {2026},
  month = jul,
  doi = {10.4103/jfmpc.jfmpc_1204_24},
  url = {https://europepmc.org/article/PMC/PMC13722222},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Comparative analysis of adenosine deaminase (ADA) and polymerase chain reaction (PCR/GeneXpert) for diagnosing pleural and peritoneal tuberculosis
AU  - Aparnna Unnikrishnan Nair
AU  - Sanjana Laishram
AU  - Shoraf Pascal
AU  - Muskan Joshi
AU  - Gayathri Pramil Menon
AU  - Lakshmi Murugesan
AU  - Nithila Sivakumar
AU  - Lakshiya Ramamoorthy
AU  - Ruchi Kothari
AU  - Roshan Prasad
AU  - A Prashanth
PY  - 2026
DA  - 2026/07/01
JO  - Journal of family medicine and primary care
DO  - 10.4103/jfmpc.jfmpc_1204_24
UR  - https://europepmc.org/article/PMC/PMC13722222
AB  - Context:: Tuberculosis (Tb) is one the most prevalent diseases, with a huge disease burden in various developing countries, such as India. Given the large burden of TB cases, the proportion of extrapulmonary tuberculosis (EPTB) cases has also risen in recent years. The diagnosis of EPTB poses a significant challenge, owing to its atypical characteristics. Adenosine deaminase (ADA) and GeneXpert/PCR (NAAT) are the primary tools for EPTB diagnosis currently in practice. The aim of the study was to contrast and highlight the efficacy of the two tests, investigating the utility of both, alone and in combination.  Methods and Material:: This study was a cross-sectional comparative study with a total of 77 samples included. Every diagnosis was documented to generate the values based on predictive power, which include sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).  Results:: In all the samples, ADA was first compared to GeneXpert in ascitic fluid (sensitivity 75%, specificity 6.9%, PPV 10% and NPV of 66.67%) and in pleural fluid (sensitivity 94.11%, specificity 3.70%, PPV 38.09% and NPV 50%). GeneXpert compared to ADA in ascitic fluid (sensitivity 10%, specificity 66.67%, and PPV 75%, and NPV 6.89%) and in pleural fluid (sensitivity 38.10%, specificity 50%, PPV 94.12% and NPV 3.70%).  Conclusions:: ADA can be used with relative confidence to test EPTB, due to its high sensitivity as well as reliable negative predictive value, in contrast GeneXpert/PCR is strongly recommended in the detection of pre-existing Tb cases, due to its high specificity. Further studies and investigations are required to help health care providers establish the collective use reducing both morbidity and mortality. This study reinforces the use of ADA in cases of EPTB.
SN  - 2249-4863
SN  - 2278-7135
ER  -