H NMR spectral identification of medication in cerebrospinal fluid of pediatric meningitis.

Exploratory metabolomics studies of cerebrospinal fluid (CSF), using proton nuclear magnetic resonance (H NMR) spectroscopy, hold major potential application in neurodiagnostics. Such studies, however, rely upon established databases of known metabolites. Here we address the 'unknowns' in the H NMR spectra of CSF from treated pediatric meningitis cases. Through knowledge of the clinical information given by the pediatrician and analytical application of H NMR spectroscopy on pure reference compounds of the medication used, we identified four of the previously unknown compounds in the H NMR CSF spectra - the drugs pyrazinamide, isoniazid, acyclovir, and sulfamethoxazole. We report on the one- and two-dimensional H NMR spectral data and chemical information of these four compounds. By expanding our knowledge of H NMR CSF spectra from treated meningitis cases, we are able to bring H NMR closer to the forefront of neurodiagnostics.