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

Exploratory metabolomics studies of cerebrospinal fluid (CSF), using proton nuclear magnetic resonance (1 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 1 H NMR spectra of CSF from treated pediatric meningitis cases. Through knowledge of the clinical information given by the pediatrician and analytical application of 1 H NMR spectroscopy on pure reference compounds of the medication used, we identified four of the previously unknown compounds in the 1 H NMR CSF spectra - the drugs pyrazinamide, isoniazid, acyclovir, and sulfamethoxazole. We report on the one- and two-dimensional 1 H NMR spectral data and chemical information of these four compounds. By expanding our knowledge of 1 H NMR CSF spectra from treated meningitis cases, we are able to bring 1 H NMR closer to the forefront of neurodiagnostics.