High Adenosine Deaminase Level and Erythrocyte Sedimentation Rate of Intestinal Tuberculosis Patients

Nuri Dyah Indrasari, Marcellus Simadibrata, Primariadewi Rustamadji, Yusra Yusra, Aria Kekalih, Suhendro Suhendro, Alida Roswita Harahap, Heri Wibowo, Ida Parwati, Ferry Sandra


BACKGROUND: Currently, laboratory diagnosis of intestinal tuberculosis (ITB) is limited based on clinical manifestations, providing opportunities for alternative laboratory tests to diagnose ITB. At the present time, the role of serum adenosine deaminase (ADA) and hematological tests in ITB patients are not widely known. The objective of this study was to determine the role of ADA and hematological tests in patients suspected with ITB.

METHODS: Subjects that were suspected of ITB were classified as ITB group, while subjects with inflammatory bowel disease, hemorrhoid, and intestinal malignancy were classified as non-ITB group. Colonoscopy, histopathological examinations, and hematological test were performed. ADA measurement was also performed with clinical chemistry analyzer based on enzymatic colorimetry principle.

RESULTS: Out of 143 subjects, 16 (11.2%) subjects were diagnosed with ITB and 127 (88.8%) subjects were classified as non-ITB group. ADA level and erythrocyte sedimentation rate (ESR) of ITB group were significantly higher than the ones of non-ITB group (p<0.05). Cut-off, sensitivity, and specificity of ADA level were 12.56 IU/L, 75%, and 57%, respectively. Cut-off, sensitivity, and specificity of ESR were 32.5 mm/hour, 81%, and 62%, respectively. Colonoscopy of ITB subjects displayed multiple ulcerations, edema, and hyperemic mucosa. Histopathological examination of ITB subjects exhibited granulomatous inflammation, epitheloid cells, giant cells, and lymphocyte aggregates.

CONCLUSION: ADA level and ESR were significantly higher among ITB patients compared with non-ITB patients. Since the sensitivities of ADA and ESR tests were high, the ADA and ESR tests could be considered as a screening test for ITB.

KEYWORDS: intestinal tuberculosis, adenosine deaminase, hematological tests

Full Text:



World Health Organization. Global Tuberculosis Report 2019. Geneva: World Health Organization; 2019, article.

Yunda DK, Witjaksono F, Nurwidya F. Correlation between protein intake, fat free mass, and total lymphocyte count with quality of life in pulmonary tuberculosis patients undergoing intensive phase treatment in Pekanbaru, Riau Province. Mol Cell Biomed Sci. 2020; 4(3): 128-34, CrossRef.

Oto BT, Fauzi A, Syam AF, Simadibrata M, Abdullah M, Makmun D, et al. Colitis tuberculosis. Indones J Gastroenterol Hepatol Dig Endosc. 2010; 11(3): 143-9, CrossRef.

Evans RP, Mourad MM, Dvorkin L, Bramhall SR. Hepatic and intra-abdominal tuberculosis: 2016 update. Curr Infect Dis Rep. 2016; 18(12): 45, CrossRef.

Lapausa MR, Saldana AM, Asensio AN. Extrapulmonary tuberculosis: an overview. Rev Esp Sanid Penit. 2015; 17(1): 3-11. https://doi.org/10, CrossRef.

Murwaningrum A, Abdullah M, Makmun D. Pendekatan diagnosis dan tatalaksana tuberkulosis intestinal. J Penyakit Dalam Indones. 2016; 3(3): 165-73, CrossRef.

Shi XC, Zhang LF, Zhang YQ, Liu XQ, Fei GJ. Clinical and laboratory diagnosis of intestinal tuberculosis. Chin Med J. 2016; 129(11): 1330-3, CrossRef.

Gopalaswamy R, Dusthackeer VNA, Kannayan S, Subbian S. Extrapulmonary tuberculosis—An update on the diagnosis, treatment and drug resistance. J. Respir. 2021; 1(2): 141-64, CrossRef.

World Health Organization. Implementing Tuberculosis Diagnostics: Policy Framework. Geneva: World Health Organization; 2015, article.

Lehman DC. Mycobacterium tuberculosis and nontuberculous mycobacteria. In: Mahon C, Lehman D, Manuselis G, editors. Textbook of Diagnostic Microbiology. 5th ed. Missouri: Elsevier Saunders; 2015. p. 563-88, NLMID.

Jha DK, Pathiyil MM, Sharma V. Evidence-based approach to diagnosis and management of abdominal tuberculosis. Indian J Gastroenterol. 2023; 42(1): 17-31, CrossRef.

Zavialov AV, Gracia E, Glaichenhaus N, Franco R, Zavialov AV, Lauvau G. Human adenosine deaminase 2 induces differentiation of monocytes into macrophages and stimulates proliferation of T helper cells and macrophages. J Leukoc Biol. 2010; 88(2): 279-90, CrossRef.

Iwaki-Egawa S, Yamamoto T, Watanabe Y. Human plasma adenosine deaminase 2 is secreted by activated monocytes. Biol Chem. 2006; 387(3): 319-21, CrossRef.

Varma S, Toppo A. Estimation of serum adenosine deaminase level in patients of pulmonary tuberculosis in a tertiary care hospital in Chhattisgarh. Int J Res Health Sci. 2015; 3(4): 451-6, article.

Salmanzadeh S, Tavakkol H, Bavieh K, Alavi SM. Diagnostic value of serum adenosine deaminase (ADA) level for pulmonary tuberculosis. Jundishapur J Microbiol. 2015; 8(3): e21760, CrossRef.

Guno TH, Putra BA, Kamelia T, Makmun D. Diagnostic and therapeutic approach in intestinal tuberculosis. Indones J Gastroenterol Hepatol Dig Endosc. 2016; 17(2): 134-40, article.

Purnomo A, Bintoro UY, Sedana MP, Ashariati A. Association between Hasford scoring system and hematologic response in chronic and accelerated phase of chronic myelocytic leukemia patient with imatinib for three months. Mol Cell Biomed Sci. 2019; 3(2): 88-94, CrossRef.

Suparmin S, Indrasari ND, Renaldi K, Immanuel S, Yusra Y, Br Pasaribu MM. Diagnostic role of stool TB-PCR in suspected tuberculous colitis patient at Dr Cipto Mangunkusumo National Central General Hospital: A cross-sectional study. Pan Afr Med J. 2022; 42: 262-71, CrossRef.

Stevanovic G, Pelemis M, Pavlovic M, Lavadinovic L, Dakic Z, Milosevic I, et al. Significance of adenosine deaminase serum concentrations in the diagnosis of extra-pulmonary tuberculosis. Journal IMAB. 2011; 17(1): 130-4, CrossRef.

Pandey R, Tamrakar D, Jaiswal S, Sharma A, Koju S, Duwal S, et al. Serum adenosine deaminase: A novel biomarker tool for the diagnosis of tuberculosis. Biosci Biotechnol Res Asia. 2016; 13(1): 551-6, CrossRef.

Abay F, Yalew A, Shibabaw A, Enawgaw B. Hematological abnormalities of pulmonary tuberculosis patients with and without HIV at the University of Gondar Hospital, Northwest Ethiopia: A comparative cross-sectional study. Tuberc Res Treat. 2018; 2018: 5740951, CrossRef.

Rees CA, Pineros DB, Amour M, Munseri P, Said J, Magohe A, et al. The potential of CBC-derived ratios (monocyte-to-lymphocyte, neutrophil-to-lymphocyte, and platelet-to-lymphocyte) to predict or diagnose incident TB infection in Tanzanian adolescents. BMC Infect Dis. 2020; 20(1): 609, CrossRef.

Sulastri N, Alisjahbana B, Livia R, Sahiratmadja E. Higher neutrophil-lymphocyte ratio in TB/HIV co-infection compared to pulmonary tuberculosis. Indones Biomed J. 2021; 13(4): 375-82, CrossRef.

Adane T, Melku M, Ayalew G, Bewket G, Aynalem M, Getawa S. Accuracy of monocyte to lymphocyte ratio for tuberculosis diagnosis and its role in monitoring anti-tuberculosis treatment: Systematic review and meta-analysis. Medicine. 2022; 101(44): e31539, CrossRef.

Bashir AB, Ageep Ali K, Abufatima AS, Mohamedani AA. Reactive thrombocytosis and erythrocyte sedimentation rate in patients with pulmonary tuberculosis. J Med Lab Diagn. 2020; 5(3): 29-34, CrossRef.

Khalil MM, Halim HAA, Abdelazeem MS. C-reactive protein versus erythrocyte sedimentation rate in monitoring multidrug-resistant tuberculosis. Egypt J Chest Dis Tuberc. 2020; 69(3): 458-65, CrossRef.

Chong VH. Differences in patient profiles of abdominal and pulmonary tuberculosis: A comparative study. Med J Malaysia. 2011; 66(4): 318-21, PMID.

DOI: https://doi.org/10.18585/inabj.v15i4.2406

Copyright (c) 2023 The Prodia Education and Research Institute

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


Indexed by:






The Prodia Education and Research Institute