Distinguishing between bacterial and viral etiologies in children with Lower respiratory tract infections (LRTIs) is challenging. This study investigates the association between lung Point-of-Care ultrasound (POCUS) characteristics and the etiologic diagnosis of LRTI. This multicenter, prospective, observational study included children admitted with suspected LRTI to three pediatric centers in Italy. Lung POCUS was performed within six hours of clinical diagnosis, alongside collection of clinical, laboratory, microbiological, and radiological data. Patients were stratified into groups based on presumed microbial etiology: bacterial pneumonia (confirmed or probable) and viral pneumonia (confirmed or probable). 162 children were admitted, 90 with viral pneumonia (74 confirmed, 16 probable), and 72 with bacterial pneumonia (15 confirmed, 57 probable). The lung POCUS score was higher in bacterial infections compared to viral ones (mean score of 32 vs. 27.5, p < 0.001). Receiver operating characteristic (ROC) curves showed that models incorporating POCUS (AUC = 0.88) or chest X-ray (CXR) findings (AUC = 0.89), along with a minimal amount of clinical and laboratory findings, were both accurate in establishing the pneumonia etiology. The study indicates that lung POCUS is a valuable tool that can support clinical and laboratory items in the diagnostic process of LRTI. These results also suggest that POCUS can be as effective as CXR in aiding diagnosis, providing solid evidence for a radiation-free alternative.

Background: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality in the pediatric population worldwide. Establishing a definitive etiological diagnosis in children with CAP remains challenging, as clinical, laboratory, and radiologic findings are often insufficient. Consequently, empirical and frequently unnecessary antibiotic treatments are commonly prescribed. Main body: Lung ultrasound (LUS) has demonstrated diagnostic accuracy comparable to chest X-ray (CXR) for CAP, while eliminating radiation exposure. Emerging evidence suggests that LUS may also differentiate the underlying etiologies of CAP. Assuming that distinct CAP etiologies exhibit characteristic LUS features, we aim to design a study protocol to develop a predictive model that integrates a child’s clinical information with their specific LUS patterns to inform individualized treatment strategies. Conclusions: This clinical approach will comprehensively evaluate clinical, laboratory, LUS, and outcome data from pediatric patients with CAP of various causes. If more centers will use the same approach, this will allow to gather in the short time data from large and diverse cohorts to facilitate the optimization and understanding of how LUS can potentially help understanding the etiology of CAP. The integrated data will be used to support tailored management strategies for pediatric CAP.

Aims: To describe lung ultrasound (LUS) features of Mycoplasma pneumoniae pneumonia and their distribution in pediatric age, and to correlate imaging findings with clinical and laboratory data. Methods: This is a multicenter, prospective, pilot study that involved three hospitals. In total, 35 patients aged 1 month to 17 years, admitted with a diagnosis of Mycoplasma pneumoniae infection, were enrolled. History, clinical, microbiological, and ultrasound data were collected. The LUS examination was performed at admission, recording the following features: presence of subpleural consolidation, bronchograms, B lines, or pleural effusion, and their characteristics. The scans were performed using a standardized approach, in which a composite score was obtained by summing the scores of the different parameters. Results: Consolidations were seen in 97% of children (mostly located in basal, posterior, and lateral fields), and 65% of patients had multiple ones. Non-perilesional B lines were found in 43% of cases, principally in the posterior and basal fields. Pleural effusion was found in 37% of children. The univariate logistic regression showed a correlation between the age of the patient and large-sized consolidations. Moreover, increased lymphocyte count was associated with a lower risk of large-sized consolidations. Conclusions: LUS is a low-cost, non-invasive tool that can reveal findings suggestive of Mycoplasma pneumoniae infection and help physicians better manage children with lower respiratory tract infections, supporting a more personalized diagnostic and therapeutic approach, including antibiotic selection. These preliminary findings also indicate that a larger, comparative study involving other bacterial and viral etiologic agents is warranted to confirm whether LUS patterns are pathogen-specific and whether they can predict clinical outcomes.

Background/Objectives: Chronic non-bacterial osteomyelitis (CNO) is a rare autoinflammatory disease characterized by chronic sterile uni- or multifocal osteomyelitis. The treatment of CNO is mostly empirical and the outcome of the disease has not yet been standardized. The aims of this study were to correlate clinically active lesions with radiological signs of inflammation and to evaluate the outcomes in terms of symptoms and radiological signs with Whole Body Magnetic Resonance Imaging (WB-MRI) based on the treatment line used. Methods: A retrospective, observational cohort study of 20 CNO patients, recruited from a single tertiary center in southern Italy, was conducted. Patients included in the study were treated based on the “step-up” approach and were guided by the “treat-to-target” strategy as well as by the response to therapy. The outcome measure was stratified into four different groups, defined by a “Delphy consensus”, depending on the symptoms and the presence of bone lesions in WB-MRI, compared with the therapy carried out. Results: Pain was the most common presenting symptom of the disease. Only 15% of our patients reported long-term complications. WB-MRI was performed for each patient both at diagnosis and during follow-up. At onset, the site most affected by the disease was the tibia. All patients who reached a 5-year follow-up (30%, n = 6) achieved a complete disease remission. Conclusions: The standardized “step-up” treatment approach in our cohort proved effective in disease management with disease control or remission in nearly 90% of patients at one year from diagnosis.