Normal Limits

"Chance is the very guide of life"

"In practical medicine the facts are far too few for them to enter into the calculus of probabilities... in applied medicine we are always concerned with the individual" -- S. D. Poisson

November 01, 2005

California Medicine Man - A brand new technology for distinguishing between viral and bacterial meningitis?

California Medicine Man has a post on a fascinating new technology to distinguish bacterial from viral meningitis. When I was on General Pediatric Service, I admitted a number of febrile newborns (a few weeks old). Since bacterial meningitis in neonates cannot be easily ruled out--no matter how unlikely--we generally admitted the babies and performed the-whole-package work-ups which included blood culture, urine culture, and lumbar puncture. These tests take 2 to 3 days to come back, necessitating an inpatient stay for the babies and their families. While all of us wait anxiously for the results, we start empirical antibiotics therapy to cover common bacterial causes of neonatal bacterial meningitis, just in case. There are clnical guidelines for estimating the probability of neonatal bacterial meningitis based on parameters that can be obtained earlier in the course (eg Spanos et al 1989 and Nigrovic et al 2002). While helpful they do not allow us to comfortably send the babies home before all the the test results are finalized...

The unfortunate consequence of this conservatism is a very high cost associated with admitting many patients with viral disease, treating them with expensive, potentially toxic antibiotics and needlessly scaring the bejesus out of them and their families. Wouldn't it be great if there was a highly accurate and very rapid test for discriminating these different disease entities?

Metabonomics using NMR:
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".

Original article by Coen et al 2005 in Clinical Infectious Diseases.

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