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IS CA-125 A RELIABLE SERUM MARKER FOR DIAGNOSIS OF TUBERCULOSIS?

Coney Island Hospital, Brooklyn, NY

PURPOSE: CA-125 levels have been shown to be elevated in patients with pelvic-peritoneal tuberculosis (TB) with ascites. There are few case reports of raised CA-125 levels in patients with pulmonary and extra pulmonary TB. The aim of our study was to determine the usefulness of CA-125 in the diagnosis of TB (both pulmonary and extra pulmonary) in the patients admitted with a clinical suspicion for TB.

METHODS: Prospective study of 50 patients who were admitted with a clinical suspicion for TB from July 2003 to March 2004. In all 50 patients CA-125 was done on admission. Patients who had other diseases that could cause high CA-125 such as benign or malignant gynecologic tumors, pelvic inflammatory disease, peritonitis and cirrhosis were excluded from the study. A positive culture for Mycobacterium Tuberculosis (MTB) was used to establish the diagnosis of TB.

RESULTS: The following results obtained.

CONCLUSION: Raised levels of CA-125 are useful in the diagnosis of pulmonary and extra pulmonary TB with high sensitivity and specificity and a very high negative predictive value. The levels seems to correlate with the bacillary burden, being highest in miliary and cavitary pulmonary TB. In patients with TB lymphadenitis CA-125 was normal.

CLINICAL IMPLICATIONS: In patients suspected to have TB, a raised CA-125 greatly increases the likelihood of tuberculous infection. A normal CA-125 is strong evidence against tuberculous infection except in patients with lymphadenitis. A normal CA-125 level should prompt a search for an alternate diagnosis.
Patient Characteristics

Variables Values (%) Patients No. 50 (100%) Gender Male Female 35 (70%) 15 (30%) Culture MTB positive MTB negative 19 (38%) 31 (62%) Tuberculosis Pulmonary Extra pulmonary 19 (38%) 14 (28%) 5 (10%) Extra pulmonary Tuberculosis Lymph node Meningitis Pleural effusion 5 (10%) 2 (4%) 1 (2%) 2 (4%)

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