The Role of Gene Xpert in Diagnosing TB Pleura

Oct 13, 2025 by wbrum.org 119 views

Characteristics of Patients with Pleural TB Who Are Examined by Adenosine Deaminase (Exist) and Gene Xpert at H. Adam Malik Medan Hospital

Introduction

Tuberculosis (TB) pleura is one of the most common forms of extrapulmonary TB, and it poses a significant challenge for medical personnel in establishing a diagnosis. The difficulties in diagnosing TB pleura often result in serious complications, such as pleural effusion. Therefore, effective diagnostic aids are needed to support the diagnosis of TB pleura. Two methods that are often used to support the diagnosis of TB pleura are the examination of adenosine deaminase (ADA) and Gene Xpert. This study aims to explore the characteristics of patients with pleural TB who underwent these examinations at H. Adam Malik Hospital Medan.

The Importance of Adenosine Deaminase (ADA) Examination in Diagnosing TB Pleura

Adenosine deaminase (ADA) examination is a diagnostic tool that has been widely used to support the diagnosis of TB pleura. The ADA examination measures the levels of ADA in the pleural fluid, which can indicate the presence of TB pleura. Elevated levels of ADA are often associated with TB pleura, and this can be an important indicator in helping diagnose the condition. In this study, we found that 64.3% of the samples showed levels above 40 IU/L, which is generally considered to be a higher level of inflammatory activity associated with TB infections.

The Role of Gene Xpert in Diagnosing TB Pleura

Gene Xpert is a diagnostic method that is fast and accurate, and it has been widely used to support the diagnosis of TB pleura. However, Gene Xpert does not always give positive results to all patients. In this study, we found that only 31% of the sample showed positive results on the Gene Xpert examination. This indicates that there are possible cases of pleural TB that are not detected by this method, especially in the initial phase of infection or in patients with disturbed immune responses.

The Characteristics of Patients with Pleural TB Who Underwent ADA and Gene Xpert Examinations

This study involved 42 patients with TB pleural effusion who underwent ADA and Gene Xpert examinations at H. Adam Malik Hospital Medan. The results showed that the diagnosis of pleural TB was obtained through sputum culture or pleural fluid in 33.3% cases, while the remaining 66.7% was diagnosed clinically. In terms of levels, 64.3% samples showed levels above 40 IU/L, while 35.7% had levels below that number. Meanwhile, only 31% of the total sample showed positive results on the Gene Xpert examination.

The Sensitivity of ADA Examination in Diagnosing TB Pleura

The results of this study showed that the ADA examination has a good sensitivity in diagnosing TB pleura, especially when the results of other methods, such as Gene Xpert, are not conclusive. Elevated levels of ADA are often associated with TB pleura, and this can be an important indicator in helping diagnose the condition. Therefore, the ADA examination can be a useful tool in supporting the diagnosis of TB pleura.

The Limitations of Gene Xpert in Diagnosing TB Pleura

Gene Xpert is a diagnostic method that is fast and accurate, but it does not always give positive results to all patients. In this study, we found that only 31% of the sample showed positive results on the Gene Xpert examination. This indicates that there are possible cases of pleural TB that are not detected by this method, especially in the initial phase of infection or in patients with disturbed immune responses.

Conclusion

From the results of this study, it can be concluded that the examination of ADA levels has a greater role in the diagnosis of TB pleura compared to Gene Xpert. Although Gene Xpert offers advantages in the speed of results, there are high levels that can be a stronger clue in identifying patients with pleural effusion due to TB. Therefore, the combination of these two examinations can provide a more comprehensive picture in the management and handling of TB Pleura patients.

Recommendations

Based on the results of this study, we recommend that health workers use the ADA examination as a diagnostic tool to support the diagnosis of TB pleura. The ADA examination can be a useful tool in identifying patients with pleural effusion due to TB, especially when the results of other methods, such as Gene Xpert, are not conclusive. Additionally, we recommend that health workers use the combination of ADA and Gene Xpert examinations to provide a more comprehensive picture in the management and handling of TB Pleura patients.

Future Directions

This study highlights the importance of using the ADA examination as a diagnostic tool to support the diagnosis of TB pleura. Future studies can explore the use of ADA examination in other forms of TB, such as TB meningitis or TB pericarditis. Additionally, future studies can investigate the use of Gene Xpert in diagnosing TB pleura in patients with disturbed immune responses.

Limitations of the Study

This study has several limitations. The sample size was relatively small, and the study was conducted at a single hospital. Therefore, the results may not be generalizable to other populations or settings. Additionally, the study did not investigate the use of other diagnostic methods, such as PCR or culture, in diagnosing TB pleura.

Conclusion

In conclusion, this study highlights the importance of using the ADA examination as a diagnostic tool to support the diagnosis of TB pleura. The ADA examination has a good sensitivity in diagnosing TB pleura, especially when the results of other methods, such as Gene Xpert, are not conclusive. Therefore, the combination of these two examinations can provide a more comprehensive picture in the management and handling of TB Pleura patients.
Frequently Asked Questions (FAQs) About TB Pleura and Adenosine Deaminase (ADA) Examination

Q: What is TB Pleura?

A: TB Pleura, also known as pleural tuberculosis, is a form of extrapulmonary tuberculosis that affects the pleura, which is the thin membrane that surrounds the lungs and lines the chest cavity. TB Pleura can cause symptoms such as chest pain, cough, and shortness of breath.

Q: What is Adenosine Deaminase (ADA) Examination?

A: Adenosine deaminase (ADA) examination is a diagnostic test that measures the levels of ADA in the pleural fluid. ADA is an enzyme that is produced by the body's immune system in response to infection. Elevated levels of ADA in the pleural fluid can indicate the presence of TB Pleura.

Q: How is ADA Examination Performed?

A: ADA examination is performed by collecting a sample of pleural fluid through a procedure called thoracentesis. The sample is then sent to a laboratory for analysis, where the levels of ADA are measured.

Q: What are the Benefits of ADA Examination in Diagnosing TB Pleura?

A: ADA examination has several benefits in diagnosing TB Pleura, including:

High sensitivity: ADA examination has a high sensitivity in detecting TB Pleura, especially when the results of other methods, such as Gene Xpert, are not conclusive.
Rapid results: ADA examination can provide rapid results, which can help healthcare providers make timely decisions about treatment.
Non-invasive: ADA examination is a non-invasive procedure that does not require surgery or other invasive procedures.

Q: What are the Limitations of ADA Examination in Diagnosing TB Pleura?

A: ADA examination has several limitations in diagnosing TB Pleura, including:

False negatives: ADA examination can produce false negative results, which can lead to delayed diagnosis and treatment.
False positives: ADA examination can produce false positive results, which can lead to unnecessary treatment and anxiety.
Limited availability: ADA examination may not be widely available in all healthcare settings.

Q: What is Gene Xpert and How Does it Relate to TB Pleura?

A: Gene Xpert is a diagnostic test that uses molecular biology techniques to detect the presence of Mycobacterium tuberculosis, the bacteria that causes TB. Gene Xpert is a rapid and accurate test that can provide results in a matter of hours. However, Gene Xpert may not always detect TB Pleura, especially in the early stages of the disease.

Q: Can ADA Examination and Gene Xpert be Used Together to Diagnose TB Pleura?

A: Yes, ADA examination and Gene Xpert can be used together to diagnose TB Pleura. The combination of these two tests can provide a more comprehensive picture of the disease and help healthcare providers make more accurate diagnoses.

Q: What are the Treatment Options for TB Pleura?

A: The treatment options for TB Pleura depend on the severity of the disease and the individual patient's needs. Treatment typically involves a combination of antibiotics, such as isoniazid, rifampicin, and pyrazinamide, which are taken for several months. In some cases, surgery may be necessary to remove the affected pleura.

Q: Can TB Pleura be Prevented?

A: TB Pleura can be prevented by taking steps to prevent TB infection, such as:

Getting vaccinated with the BCG vaccine
Avoiding close contact with people who have TB
Practicing good hygiene, such as washing hands regularly
Getting regular check-ups with a healthcare provider

Q: What are the Complications of TB Pleura?

A: TB Pleura can cause several complications, including:

Pleural effusion: a buildup of fluid in the pleural space
Pleural thickening: scarring of the pleura
Respiratory failure: failure of the lungs to expand and contract properly
Death: in severe cases, TB Pleura can be fatal if left untreated.