Modified lung ultrasound score and related findings in children with Mycoplasma pneumoniae pneumonia

BACKGROUND: Different pathogens cause pneumonia with overlapping symptoms, labs, and imaging, complicating early diagnosis. The modified lung ultrasound score (MLUS) shows value in lung disease evaluation, but its ability to differentiate pathogens is unclear. This study assessed MLUS for early identification of mycoplasma, viral, and bacterial pneumonia in children. METHODS: We enrolled 186 children with suspected pneumonia (Jan-Dec 2023). Clinical data, labs, lung ultrasound findings (A-lines, B-lines, solid lesions, pleural effusion), and pathogens were recorded. MLUS was assigned. Based on pathogens, cases were grouped into mycoplasma (n=74), viral (n=63), and bacterial (n=49) pneumonia for comparison. RESULTS: 1. The median age of the mycoplasma pneumonia group was 6 (4.58,8) years, greater than that of the bacterial pneumonia group (3 [1.1,4.83] years) and the viral pneumonia group (3.41 [1.16,4.75] years) (P＜ 0.05). The mycoplasma pneumonia group had more febrile symptoms, extensive solid lung lesions, and fewer asthmatic symptoms than the other two pathogen groups (P < 0.05). 2. The median MLUS for mycoplasma pneumonia group was 15 (10,22), significantly higher than the median score of 9 (5,16) in the bacterial pneumonia group and 8 (5,15) in the viral pneumonia group (P < 0.05). 3. Coughing up sputum and small lung solid changes were significantly more common in the mycoplasma pneumonia group than in the bacterial pneumonia group (P < 0.05). CONCLUSIONS: A high modified lung ultrasound score, extensive solid lung lesions, older age, fever, and fewer shortness-of-breath symptoms strongly suggest mycoplasma pneumoniae infection. These findings provide critical evidence for early, targeted clinical management.