Cerebrospinal fluid adenosine deaminase level as a diagnostic marker in adult tuberculous meningitis: a study conducted in a tertiary care hospital of Eastern India

Biswajit Biswas, Balaram Ghosh, Arpan Mandal, Dipan Saha


Background: Tubercular meningitis is one of the highly prevalent form of meningitis in the world and is a significant cause of morbidity and mortality in developing countries like India. Lack of early and timely diagnosis and subsequent initiation of treatment makes the fatality rate even higher. Cerebrospinal fluid (CSF) analysis is most important aspect of lab diagnosis in tuberculous meningitis (TBM) worldwide. The objective of this study was to study the cerebrospinal fluid CSF adenosine deaminase (ADA) levels in TBM and non-TBM meningitis cases and to determine its diagnostic significance as a biochemical marker of TBM infection.

Methods: The study population comprised three different patient groups. TBM (n=36), pyogenic meningitis (n=17) and aseptic meningitis group (n=12). Total 75 subjects were enrolled consecutively in the study and CSF specimens were collected from them. ADA and other cytological and biochemical estimation were carried out using standard protocol.

Results: ADA level in TBM in compare to non-TBM was more and mean ADA level of TBM, AM and PM are 26.423±3.8, 2.602±0.5 and 6.29±0.3 respectively. There are highly significant differences between the TBM and non-TBM groups and also in compare with individual groups.

Conclusions: CSF ADA levels are elevated in the TBM cases as compared to the non-TBM - meningitis cases.  Results are statistically significant. It is a simple and inexpensive diagnostic adjunctive test in the rapid and early diagnosis of TBM.


Tuberculosis, Meningitis, ADA

Full Text:



Udwadia ZF, Mehra C. Tuberculosis in India. BMJ. 2015: 1-2.

Lee JY. Diagnosis and Treatment of Extrapulmonary Tuberculosis. Tuberculosis Respiratory Diseases. 2015;78(2):47-55.

Daniel BD, Grace GA, Natrajan M. Tuberculous meningitis in children: Clinical management and outcome. Indian J Med Res. 2019;2:117-30.

Marx GE, Chan, ED. Tuberculous Meningitis: Diagnosis and Treatment Overview. Tuberculosis Res Treatment. 2011: 1-9.

Segura RM, Pascual C, Ocana I. Adenosine deaminase in body fluids: a useful diagnostic tool in tuberculosis. Clin Biochem. 1989;22:141-8.

Sullivan J, Osborne WRA, Wedgwood RJ. Adenosine deaminase activity in lymphocytes. Br J Haematol. 1977;37:157-8.

Thwaites GE, Caws M, Chau TT. Comparison of conventional bacteriology with nucleic acid amplifi cation (Amplified Mycobacterium Direct Test) for diagnosis of tuberculous meningitis before and after inception of anti-tuberculosis chemotherapy. J Clin Microbiol. 2004;42:996-1002.

Thwaites GE, Chau TT, Mai NT. Tuberculous meningitis. J Neuro Neurosurg Psychiatry. 2000;68:288-99.

Prabhakar S, Thussu A. CNS Tuberculosis. Neurology India. 1997;45:132-40.

Siddiqi Z, Siddiqi MS, Fatma J, Karoli R, Singhal V, Gupta M. Cerebrospinal Fluid Lactate in Tubercular Meningitis: Diagnostic or Prognostic Marker. JAPI. 2018;66:18-21.

Rashid M, Mushtaq S, Manzoor J, Bhat JA, Chaman S, Hamid A. Comparative analysis of cerebrospinal fluid adenosine deaminase levels in infective meningitis of different aetiologies. Int J Contemporary Pediatrics. 2017;4(2):608-14.

Baheti R, Laddha P, Gehlot RS. CSF - adenosine deaminase (ADA) activity in various types of meningitis. J Indian Aca Clin Med. 2001;2(4):285-7.

Rana SV, Singhal RK, Singh K, Kumar L. Adenosine deaminase levels in cerebrospinal fluid as a diagnostic test for tuberculous meningitis. Ind J Clin Biochem. 2004;19:5-9.

Kashyap RS, Kainthla RP, Mudaliar AV, Purohit HJ, Taori GM, Daginawala HF. Cerebrospinal fluid adenosine deaminase activity: A complimentary tool in the early diagnosis of tuberculous meningitis. Cerebrospinal Fluid Res. 2006;3(1):1-6.