Dr. John S. Ford over at California Medicine Man reports how the emerging science of metabonomics shows promise in noninvasive diagnosis of meningitis, and in distinguishing between its viral and bacterial types:
Metabonomics to the rescue. No this isn’t some failed theory of language education. As one definition I got from the internet, metabonomics is:
“The quantitative measurement of the dynamic multiparametric metabolic response of living systems to pathophysiological stimuli or genetic modification”.
Does that clarify things for you? Yeah right!
In the setting of the above article, this means taking medical specimens and acquiring a examining the biological “signature” through the use of proton nuclear magnetic resonance and mass spectroscopy. These are very sophisticated machines that examine the physical properties of these specimens rather than their biological properties such as cell counts, antibody studies or bacterial/fungal cultures.
The authors took a group of lumbar puncture specimens that were drawn from 12 patients with bacterial meningitis, 11 with viral and 27 controls (healthy people). These samples were then subjected to the high tech methods they developed and their signatures are compared statistically with the signatures of known samples. The equipment they used accurately classified every one of the specimens. This corresponds to 100% sensitivity and 100% specificity. Clearly this is the holy grail of clinical testing.
Reportedly, this test can be performed very rapidly, certainly within the time frame of an emergency room evaluation and in theory could accurately classify patients. Decisions can then be made to admit and treat those few patients with true bacterial meningitis and perhaps discharge those with more benign viral disease. The equipment to perform these analyses is currently available and though representing a high capital investment is apparently cheap to maintain and operate making it potentially available to most hospital labs.
If the technique turns out to be successful (it is only in its earliest stages of evaluation) it could make a major contribution to emergency medicine. One can only speculate on other applications of this technology.