| Literature DB >> 19390697 |
Uwe Himmelreich1, Richard Malik, Till Kühn, Heide-Marie Daniel, Ray L Somorjai, Brion Dolenko, Tania C Sorrell.
Abstract
Bacterial meningitis is an acute disease with high mortality that is reduced by early treatment. Identification of the causative microorganism by culture is sensitive but slow. Large volumes of cerebrospinal fluid (CSF) are required to maximise sensitivity and establish a provisional diagnosis. We have utilised nuclear magnetic resonance (NMR) spectroscopy to rapidly characterise the biochemical profile of CSF from normal rats and animals with pneumococcal or cryptococcal meningitis. Use of a miniaturised capillary NMR system overcame limitations caused by small CSF volumes and low metabolite concentrations. The analysis of the complex NMR spectroscopic data by a supervised statistical classification strategy included major, minor and unidentified metabolites. Reproducible spectral profiles were generated within less than three minutes, and revealed differences in the relative amounts of glucose, lactate, citrate, amino acid residues, acetate and polyols in the three groups. Contributions from microbial metabolism and inflammatory cells were evident. The computerised statistical classification strategy is based on both major metabolites and minor, partially unidentified metabolites. This data analysis proved highly specific for diagnosis (100% specificity in the final validation set), provided those with visible blood contamination were excluded from analysis; 6-8% of samples were classified as indeterminate. This proof of principle study suggests that a rapid etiologic diagnosis of meningitis is possible without prior culture. The method can be fully automated and avoids delays due to processing and selective identification of specific pathogens that are inherent in DNA-based techniques.Entities:
Mesh:
Year: 2009 PMID: 19390697 PMCID: PMC2669500 DOI: 10.1371/journal.pone.0005328
Source DB: PubMed Journal: PLoS One ISSN: 1932-6203 Impact factor: 3.240
Figure 11H NMR spectra acquired with a 400 MHz spectrometer equipped with probe for 1 mm sample tubes.
NMR spectra were acquired from the following samples: (A) CSF from a control animal (before initiation of the infection), (B) CSF from an animal five days after injection of S. pneumoniae (animal showed symptoms of meningitis; heavy growth of S. pneumoniae from CSF confirmed streptococcal meningitis), (C) CSF from an animal four days after injection of C. neoformans (animal showed symptoms of meningitis, heavy growth of C. neoformans from CSF confirmed cryptococcal meningitis), (D) CSF heavily contaminated with blood (same animal as C but collected three days after initiation of the infection). Abbreviations refer to 1H NMR signal of the following metabolites: Ac – acetate, Ala – alanine, Cit – citrate, β-glc (H-2) – H-2 resonance of β-glucose, Glc – glucose, Gln – glutamine, Hα AA – resonances of H-α from amino acid residues, Lac – lactate.
Statistical Classification Strategy using NMR spectra of CSF samples.
| (A) SCS analysis with and without blood contaminated CSF samples. | |||
| N | correct [%] | crisp [%] | |
|
| |||
| Control | 52 | 97 | 73 |
|
| 25 | 91 | 88 |
|
| 24 | 95 | 88 |
|
| |||
| Control | 6 | 50 | 67 |
|
| 15 | 64 | 93 |
|
| 15 | 100 | 87 |
|
| |||
| Control | 49 | 96 | 94 |
|
| 34 | 100 | 94 |
|
| 39 | 97 | 92 |
|
| |||
| Control | 12 | 100 | 92 |
|
| 6 | 100 | 100 |
|
| 6 | 100 | 84 |
|
| |||
|
| 5 | 80 | 100 |
|
| 5 | 100 | 80 |
Figure 21H NMR spectra of 100 µl CSF samples from (A) a healthy rat and (B) a human not suffering from meningitis or other infections.
The spectra acquired at 360 MHz using a susceptibility-matched 5 mm NMR tube. Abbreviations refer to 1H NMR signal of the following metabolites: Ac – acetate, Ala – alanine, β-glc (H-2) – H-2 resonance of β-glucose, Cit – citrate, HDO – remaining, partly deuterated water resonance, Glc – glucose, Gln – glutamine, Lac – lactate.