Study of biochemical profile in tubercular pleural and peritoneal effusion in the sub-himalayan region patients

Tuberculosis (TB) is a dangerous infection affecting about one third of the world population, despite the availability of affordable and effective chemotherapy, remaining one of the major causes of death from a single infectious agent worldwide. Here the measurement of ADA, LDH, protein and glucose has been advocated to help diagnose tuberculous pleural and peritoneal effusions in TB patients. Although considered defi nitive, microbiological tests have limited sensitivity and culture has to be prolonged for several weeks before being reported negative, in diagnosing tubercular pleural and peritoneal effusions and have more sensitivity and specifi city as compared to pleural fl uid culture and biopsy, and by estimation of values of these tests could be a useful tool for diagnosing tubercular pleural and peritoneal effusion. Thus a biochemical test is potentially useful, although high diagnostic accuracy is necessary. Research Article Study of biochemical profi le in tubercular pleural and peritoneal effusion in the subhimalayan region patients Kiran Gupta1#, Ashraf Ali Khan2#, Tariq Masood1 and Waseem Feeroze Bhat2* 1Shri Guru Ram Rai Institute of Medical & Health Sciences and Shri Mahant Indiresh Hospital Patel Nagar, Dehradun (U.K) 248001, India 2Goverment Medical College Doda, Jammu and Kashmir -182202, India #Equal contribution towards the article Received: 30 September, 2020 Accepted: 12 October, 2020 Published: 13 October, 2020 *Corresponding author: Dr. Waseem Feeroze Bhat, Government Medical College Doda, Jammu and Kashmir 182202, India, Tel: Tel No: +919797130949; E-mail:


Introduction
Tuberculosis is (TB) highly contagious bacterial infection caused by bacteria called Mycobacterium tuberculosis (MTB), affecting about one third of the world population and remaining one of the major causes of deaths worldwide [1].
MTB infection can spread through the air from one person to another and causes active disease or latent infection [2]. MTB infection is preventable via Bacillus of Calmette and Guérin (BCG) vaccination and curable with antituberculous drugs.
The clinical manifestations of tuberculosis are dependent on a number of factors: age, immune status, co-existing diseases, immunization status to the bacillus Calmette-Guerin (BCG); virulence of the infecting organism and hostmicrobe interaction [3]. If a TB infection does become active, it most commonly involves the lungs (in about 90% of cases). Symptoms may include chest pain and a prolonged cough producing sputum [4]. Tuberculosis may occur in any location from the mouth to the anus, although lesions proximal to the terminal ileum are unusual. The abdomen is the most common site of extrapulmonary tuberculosis, with peritoneal disease being the commonest form within the abdomen. Tuberculous ascites, one of the clinical signs of abdominal TB, implies accumulation of fl uid in the abdomen, a swollen abdomen, and slightly raised tubercles of 1-2 mm all over the peritoneum [5].
The most common sites of extrapulmonary tuberculosis are the bones and joints, lymph nodes, abdomen, spinal cord, brain and pleura [2]. Among these sites the pleura provide useful information about the etiology of pleural effusion. Pleural effusions result from excessive fl uid formation and its accumulation in the pleural space. The pleural effusion is likely a manifestation of paucibacillary mycobacterial infection within the pleural space [6]. Tuberculous pleural effusion (TPE) results from Mycobacterium tuberculosis infection of the pleura and is characterized by an intense chronic accumulation of fl uid and infl ammatory cells in pleural space [7]. In the context of present study different investigation have done in the tubercular pleural and peritoneal effusion to analyze the levels of ADA, total proteins, glucose and lactate dehydrogenase and comparison between tubercular pleural and peritoneal effusion in TB patients.

Materials and methods
The present study was conducted in 20 patients of tubercular pleural effusion (test group) and 40 patients of non-tubercular pleural effusion (control group) in the department of biochemistry and pulmonary medicine ward and 20 patients of peritoneal effusion (test group) and 40 patients of non-tubercular peritoneal effusion (control group) in the department of biochemistry and gasteroenterology ward of shri guru ram rai institute of medical and shri mahant indiresh hospital, dehradun during 2016 to 2018. The various biochemical investigations of these patients were assessed and compared to the normal controls. The pleural and peritoneal fl uid was confi rmed positive for mycobacterium tuberculosis during TB-PCR. Also the pleural and peritoneal fl uid showed positive for Mycobacteria tuberculosis in Acid-Fast Bacillus (AFB) testing culture. The age groups of all the persons from 3-88 years were taken. Both the gender was taken.

Methods
Different tests were performed by employing various methods.

Test for glucose
VITROS Chemistry products glucose (GLU) slides quantitatively measure glucose concentration in serum, urine, and fl uids using VITROS 250 AND 5, 1 FS Chemistry Systems and the VITROS 5600 Integrated Systems.

Test for LDH
The VITROS LDH slide method is performed using the VITROS LDH Slides and the VITROS Chemistry Products Calibrator Kit 3 on VITROS Chemistry Systems. The VITROS LDH Slide is a multilayered, analytical element coated on a polyester support.
A drop of patient sample is deposited on the slide and is evenly distributed by the spreading layer to the underlying layers. Lactate dehydrogenase catalyzes the conversion of pyruvate and NADH to lactate and NAD + . The oxidation of NADH, which is monitored by refl ectance spectrophotometry is used to measure lactate dehydrogenase activity.

Observations and results
The various biochemical investigations of these patients were assessed and compared to the normal controls.

Comparison of pleural fl uid ADA, glucose, protein and LDH levels in the test group and control group
Pleural fl uid serves a physiologic function in respiration, while also being a useful measure to diagnose and assess disease, TB, and other abnormalities. Many conditions can cause problems within the pleural cavity and in the pleural fl uid [8]. Fluid analysis can determine the cause of the effusion and abnormalities.
In the context of present study pleural fl uid analysis in the  Table 2 and Figure 2.
The difference of ADA, protein and LDH in the test group and control group was found to be highly signifi cant.

Comparison between pleural fl uid and peritoneal fl uid of ADA, glucose, protein and LDH levels in the test group
Finally the above determined parameters were compared in the pleural and peritoneal fl uids of the test groups. As determined from the above data the observed mean±SD of ADA, glucose, protein and LDH in tubercular pleural effusion   [13]. In both cases pleural and peritoneal fl uids ADA and protein were raised as compared to control groups but in case of peritoneal fl uid both ADA and protein was increased as compared to pleural fl uid.
In the present study the level of ADA was found to be highly cirrhosis. The ascitic/blood glucose ratio is a useful test in differentiating TB peritonitis from other causes of ascites [15].   in early clinical decision-making for the management of these patients, as it could lead to a better prognosis and avoidance of potential adverse consequences. Further work is necessary to identify the best (and simplest) combination that will be most useful in clinical practice.