Viral Etiology Research Articles

Background: Pericarditis is a rare obstetric complication. Severe pericardial disease may lead to tamponade physiology, jeopardizing both the mother and fetus. We report a case of a 29-year-old woman, G1P0 at 21 weeks gestation, presenting with recurrent pericarditis complicated by early signs of cardiac tamponade. Methods: A 29-year-old (G1P0) female with a history of Graves' disease on methimazole, drug-induced lupus, and recent pericarditis presented to the hospital at 21-weeks gestation due to recurrent chest pain. She was recently admitted for pericarditis and placed on aspirin and colchicine. Transthoracic echocardiogram (TTE) revealed a small pericardial effusion with diastolic inversion. Thyroid function tests were elevated, and methimazole was increased to 20 mg daily. The patient remained home for two weeks until developing recurrent positional chest pain. On admission, the patient was hemodynamically stable. EKG revealed sinus tachycardia. Repeat TTE confirmed recurrence of acute pericarditis, now with pericardial thickening, fibrinous material adjacent to the visceral pericardium, and a large 2-centimeter pericardial effusion (Figure 1). Evidence of RV inversion and a plethoric IVC were present, concerning for early tamponade physiology. Results: Differential diagnosis at the time was broad, including pericarditis of viral etiology or secondary to drug-induced lupus or Graves disease. Given early tamponade physiology and hemodynamic stability, a multidisciplinary team chose medical management over pericardial window due to ongoing pregnancy, suboptimal window for drainage, and procedure-related risks. Aspirin was started at 650 mg twice a day along with 20 mg methylprednisolone and 0.6 mg colchicine. Intravenous fluid resuscitation was provided to maintain preload. Serial TTE was utilized to monitor the progression of the effusion. Methimazole was maintained at 20 mg daily. Viral and autoimmune pericarditis workup was unremarkable. After two weeks of serial echocardiograms, the patient was gradually tapered to aspirin 81 mg daily, prednisone 15 mg daily, and colchicine 0.6 mg daily and discharged. The rest of her pregnancy was uncomplicated, and she delivered a healthy baby at 38 weeks gestation. Conclusion: This case highlights the complexities of managing pericarditis in pregnant patients with autoimmune conditions. Medical management and serial TTE were useful in managing early tamponade while minimizing risks to both the mother and fetus.

To report the diagnostic results, treatments, and outcomes in 13 dogs with suspected canine infectious respiratory disease complex (CIRDC)-associated pneumonia and Mycoplasma cynos-positive polymerase chain reaction (PCR). Retrospective and prospective case series. Emergency and referral hospital. Thirteen client-owned dogs with suspected CIRDC-associated pneumonia and a positive PCR. None. All dogs with history, clinical signs, and radiographs consistent with CIRDC-associated pneumonia and a positive upper respiratory PCR that presented during a cluster from August 15, 2023, to September 9, 2023, were retrospectively and prospectively included in the series. Among the 13 dogs included, M. cynos was the sole pathogen detected in the airways of eight dogs, while M. cynos and Bordetella bronchiseptica were detected in five dogs. No viral etiologies were detected in this sample. Doxycycline, amoxicillin-clavulanic acid, and fluoroquinolones were frequently prescribed for ≥2weeks. Follow-up was performed until 1week after resolution of cough, evidence of radiographic resolution, or death of the dog. Twelve dogs survived, and one was euthanized. Mycoplasma cynos was detected as the sole or co-occurring infection during this 3-week period, indicating it may be an important agent in some CIRDC clusters.

Aim: Hepatocellular carcinoma (HCC) displays both shared and ethnicity-specific molecular characteristics. Using transcriptomic data from The Cancer Genome Atlas (TCGA), we compared gene expression profiles between Asian and Caucasian HCC patients. Methods: Gene expression profiles were analyzed using the PyDESeq2 implementation of DESeq2, applying size factor normalization and dispersion estimation. Differentially expressed genes (DEGs) were identified with thresholds of false discovery rate (FDR) of < 0.05 and |log2FC| ≥ 1.0. Gene annotation, visualization, and pathway enrichment were conducted using Sanbomics, seaborn, and gene set enrichment analysis (GSEA) via the GSEApy package. Results: A total of 387 and 250 genes were commonly upregulated and downregulated, respectively, in both populations, including the upregulations of GPC3 and PLVAP and the downregulations of FCN3 and OIT3, indicating their potential as universal HCC markers. Conversely, 16 genes were upregulated in Asians but downregulated in Caucasians, and 25 showed the reverse pattern. Asian-specific upregulation of AKR1B10, UBE2C, and S100P suggests links to viral etiology and immune modulation, while MDK, LCN2, and NQO1 were upregulated in Caucasians, implicating proliferative and metabolic roles. Functional enrichment analysis revealed distinct immune and metabolic pathways. Asians showed elevated ubiquitin ligase activity and suppressed inflammatory responses, while Caucasians exhibited enhanced cytokine signaling, complement activation, and xenobiotic metabolism. Conclusions: These findings highlight key molecular differences in HCC across ethnicities and emphasize the value of TCGA data for identifying both shared targets and population-specific therapeutic strategies. Understanding these differences is crucial for advancing precision oncology and developing tailored interventions.

Genomic profiling in hepatocellular carcinoma: a real-world retrospective analysis.

Acute respiratory infections (ARIs) constitute a major cause of pediatric morbidity. Their epidemiological patterns have been significantly altered across COVID-19 pandemic. This study aims to comparatively analyze the epidemiology and viral etiology of ARIs in pediatric inpatients across the pre-, peri-, and post-COVID-19 eras. This retrospective study analyzed electronic health records of patients aged 13 years or younger who were admitted to Kiang Wu Hospital with an ARI diagnosis between January 1, 2018, and December 31, 2023. A total of 14 712 ARIs cases were included, with 6734 (mean [standard deviation] = 281 ± 49/month), 4382 (125 ± 81/month), and 3596 cases (275 ± 143/month) from the pre-, peri-, and post-COVID-19 eras, respectively. Toddlers consistently dominated across all periods, while preschool and school-aged cases declined during the peri-pandemic and rebounded post-pandemic. Variation was in epidemiological shifts among different viral pathogens. Specifically, the peak infection rate of Influenza virus A was 8.9%-11.3% (January-February) in pre-COVID and 12.8%-19.1% (April, September-October) in the post-COVID-19 era, while mostly 0.0% during the peri-pandemic. Respiratory syncytial virus demonstrated a marked seasonality shift from pre-pandemic autumn-winter peaks (August-September: 21.7%-28.0%; December-January: 12.3%-23.7%) to an unprecedented autumn surge (61.2%) during the peri-pandemic, followed by an amplified spring epidemic (49.6%) during the post-pandemic era. Human metapneumovirus experienced a 3-month phase delay in peak activity (pre-pandemic era: March-April, and post-pandemic era: June-July). The study revealed rising viral prevalence, contrasting with U-shaped hospitalization trends, with seasonal and viral differences suggesting varied non-pharmaceutical intervention susceptibility. Shifts toward older children and changing co-infection patterns highlight the need for adaptive surveillance and response systems.

Community-acquired Pneumonia in Children.

Introduction Severe fever with thrombocytopenia syndrome (SFTS), caused by Dabie bandavirus (DBV), is a zoonotic disease characterized by substantial mortality. Hubei Province is an epidemic region with a high incidence rate of SFTS. The clinical manifestations and case fatality rates (CFRs) of SFTS correlate with specific geographic regions and genotypes of DBV. Methods From January to December 2024, serum samples were obtained from 69 patients with suspected DBV infection in northwestern Hubei Province, China. The presence of DBV RNA was used as the diagnostic criterion for SFTS. Demographic characteristics, clinical manifestations, and laboratory findings of confirmed SFTS patients were systematically collected. Phylogenetic analyses of the DBV L, M, and S gene segments were performed using the maximum likelihood method to elucidate the genetic diversity of the viral isolates. Results A total of 19 patients with confirmed SFTS were identified in northwestern Hubei Province in 2024, with a CFR of 31.6% (6/19). Clinical analyses indicated that bleeding, disturbance of consciousness, prolonged activated partial thromboplastin time (APTT), elevated blood urea nitrogen (BUN), and high viral load (≥10 7 copies/mL) were critical prognostic indicators of disease severity. Maximum likelihood phylogenetic analyses of the L, M, and S gene segments demonstrated that genotype F was the predominant lineage circulating in this region. Discussion This study delineates the genomic diversity and genotype distribution of circulating DBV strains, providing insights into viral etiology in northwestern Hubei. Furthermore, specific clinical/laboratory markers may signal adverse outcomes, emphasizing the imperative for symptom recognition and dynamic monitoring of critical laboratory parameters.

Visceral leishmaniasis (kala-azar) is caused by a protozoan parasite of genus Leishmania. India and neighboring countries comprise the largest focus of VL. Moderate to higher degree of fever accompanied by rigor and hepatosplenomegaly is the most typical clinical picture. We present a case of 50 years old male from Bhadohi (Uttar Pradesh) with high grade fever for 2 months without hepatosplenomegaly. On evaluation, there was bicytopenia with hyper-gammaglobulinemia. Work-up for tropical fever, tuberculosis, chronic viral etiologies and multiple myeloma was negative. Further evaluation on lines of fever of uncertain cause showed amastigote forms of Leishmania donovani (LD bodies) in bone marrow aspiration smears. Serology test rk-39 was positive. Thus final diagnosis of visceral leishmaniasis (kala-azar) with the atypical presentation without splenomegaly was made. Fever totally resolved in a week of starting treatment and blood parameters improved at 1 month follow-up. As definite treatment options are available, duration of illness and case fatality rate can be reduced by timely detection of atypical cases.

To describe the clinical profile and the predictors of outcome in children with viral pneumonia. This retrospective study included children (1 to 120months) admitted to the pediatric intensive care unit with severe acute respiratory illness (SARI) of viral etiology confirmed by polymerase chain reaction (PCR) testing of nasopharyngeal swabs or endotracheal aspirates. Out of 180 children admitted with SARI, 160 were screened by PCR testing; 112 had a proven viral etiology; respiratory syncytial virus (RSV) being the commonest (40.2%), followed by rhinovirus (25.9%), and adenovirus (19.6%). 96 required high-flow oxygen support, and 23 needed mechanical ventilation. Adenoviralinfectionsaccountedforall fivedeaths (4.5%) and were significantly associated with need for mechanical ventilation [aOR 9.3 (95%CI 3.1, 30.5)], shock [aOR 12.8 (95%CI 3.9, 47.2)], and multi-organ dysfunction [aOR 15.3 (95%CI 4.4, 60.8)]. The broad impact of adenovirus infections on various organ systems in children underscores the need for thorough surveillance, high suspicion, early detection, and effective management of potential complications.

Background/Objectives: Accurate prognostication of hepatocellular carcinoma (HCC) remains essential for treatment selection and risk stratification. This study aimed to compare the prognostic performance of individual serum biomarkers and composite scoring models, including GALAD, BALAD, BALAD-2, GAAP, ASAP, the Doylestown algorithm, and aMAP, using data from a biobank-based HCC cohort. Methods: This study enrolled 186 patients with confirmed HCC diagnosed between 2019 and 2024. Serum biomarkers (AFP, AFP-L3%, DCP) and composite models were evaluated for their association with overall survival (OS). Prognostic performance was assessed using time-dependent area under the receiver operating characteristic curve (AUROC) at 1-, 2-, 3-, and 5-year intervals and Harrel’s concordance index (c-index). Subgroup analyses were performed based on treatment intent and liver disease etiology. Results: All three biomarkers and composite models were independently associated with OS in multivariate analyses (all p < 0.05). Among all models, BALAD-2 demonstrated the best overall performance (c-index: 0.737), with the highest AUROCs at 1 year (0.827), 2 years (0.846), 3 years (0.781), and 5 years (0.716). BALAD-2 consistently showed superior discrimination in patients treated with curative or noncurative therapies and in the viral etiology subgroup. In the non-viral etiology subgroup, BALAD-2 remained among the top performers, although the GAAP, ASAP, and Doylestown algorithms showed slightly higher metrics. Conclusions: BALAD-2 demonstrated consistent and robust prognostic performance compared with other biomarker-based and clinical models across different patient subgroups, particularly among those receiving curative therapy and viral etiologies. These findings support its integration into clinical risk stratification and decision-making for HCC management.

Meningitis is characterized as an infectious disease caused by bacteria, viruses, fungi, and infections that affect the meninges. A suspected case of meningitis is classified as an individual who has fever, neck stiffness and meningeal irritation due to Kernig’s and Brudzinski’s signs. Among the types of meningitis, bacterial and viral etiologies stand out, with bacterial meningitis being the most frequent, exhibiting greater severity and lethality, and viral meningitis having higher incidence rates. This disease has a high incidence and prevalence rate in the municipality of Porto Velho, as a result of a lack of understanding of the risk factors and epidemiological determinants of the disease, which makes it difficult to plan ideal measures for the prevention of the disease, which makes it difficult to plan ideal measures for the prevention and control of meningitis. This is an observational, retrospective, and descriptive study, based on data obtained regarding the number of reported cases from the Sistema de Informações de Agravos de Notificação (SINAN) and the Departamento de Informática do Sistema Único de Saúde (DATASUS) between 2018 and 2023. A total of 176 cases of meningitis were identified in the region of Porto Velho, with a predominance of males (63.6%), most cases occurring among individuals aged 20 to 39 years (37.5%), and a higher prevalence among individuals self-identified as brown (pardo) (74.4%). Furthermore, an increase in the number of cases was observed in 2023, particularly during the months of June and August. The most common etiology was found to be unspecified bacterial meningitis, alongside a rise in cases of tuberculous meningitis. The overall case fatality rate was 15.3%, with fungal meningitis presenting the highest lethality rate (50%). In summary, meningitis remains a major public health challenge in the municipality of Porto Velho. As highlighted, it is essential to strengthen epidemiological surveillance, ensure early diagnosis, expand vaccination coverage, and especially improve access to treatment in order to reduce the morbidity and mortality associated with the disease.

BackgroundChronic kidney disease of unknown etiology (CKDu) is a major health problem in Sri Lanka. A transient symptomatic episode, characterized by fever, dysuria, and arthralgias, accompanied by kidney dysfunction, has been reported in endemic areas of CKDu. Sym-CKDu has shown with histological features consistent with acute interstitial nephritis and is considered a potential initiating event of CKDu. Among various potential etiologies, viral infections such as Hantavirus, Cytomegalovirus (CMV), and Epstein-Barr virus (EBV) have been implicated in the causation of CKDu.MethodsHere, we performed a prospective observational cohort study of symptomatic patients presenting with at least three of symptoms - i.e. arthralgia, myalgia, fever, back pain or feeling unwell an outpatient clinic in a CKDu-endemic region of Sri Lanka. Between June 2018 and November 2021, a cohort of 151 patients presenting with a feverish syndrome to an outpatient clinic in a CKDu endemic region in Sri Lanka were included in this study, and 85 patients returned for follow-up. serum creatinine, CRP, cystatin C and dipstick proteinuria were determined. Serum samples (n = 32) were screened for antibodies against known human pathogenic viruses using the VirScanTM-Pipeline. Kidney biopsies (n = 19) were analyzed for the presence of viral pathogens using a PAN-Hanta-PCR and next-generation sequencing (NGS).ResultsThe prevalence of reduced eGFR at initial presentation was high, especially in men. After a median follow-up of 2.3 years, 16 patients had lost ≥ 4 ml/min/1.73m2 eGFR per year and their eGFR was < 90 ml/min/1.73m2 at the last follow-up. Patients who experienced a loss of eGFR clustered geographically. Virome screening did not identify any antibody reactivity in the group with loss of eGFR. NGS evaluation and Hanta-PCR of 19 kidneys biopsies did not detect viral pathogens.ConclusionA significant proportion of patients in a CKDu endemic region presenting with a feverish syndrome developed a substantial loss of eGFR over the following years. No evidence of a viral etiology was found.Trial registrationNot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12882-025-04527-z.

Acute respiratory infections and other infectious diseases causing acute febrile syndrome are major public health concerns in Colombia, particularly among vulnerable populations such as the Wayuu Indigenous community in Manaure, La Guajira. To investigate their viral etiology, 55 nasopharyngeal swabs and 58 serum samples were collected from febrile Wayuu individuals in Manaure. RT-qPCR screening identified Coronavirus, Enteroviruses, Adenovirus, and Influenza A/B in respiratory samples, while no arboviruses were detected in serum. Sixteen representative samples underwent metatranscriptomic next-generation sequencing (mtNGS) using the Chan-Zuckerberg ID (CZ-ID) platform. This analysis confirmed RT-qPCR findings and additionally revealed six viral contigs related to Orthopicobirnavirus hominis. Sequencing coverage enabled the reconstruction of a consensus RdRp segment, which was phylogenetically compared with sequences from diverse hosts. The virus clustered within genogroup 1, alongside Colombian isolates linked to severe acute respiratory infection. The absence of strict host-specific clustering suggests possible interspecies transmission. These findings underscore the complementary roles of targeted and unbiased approaches: RT-qPCR detected common respiratory viruses, whereas mtNGS uncovered a virus previously unreported in this community. Overall, mtNGS emerges as a powerful tool to support viral surveillance and provide baseline evidence in indigenous populations, emphasizing the need to decentralize advanced molecular diagnostics and strengthen public health capacity in Colombia.

Infectious respiratory diseases of cattle are multifactorial; they usually have a viral or viral-bacterial etiology and can spread rapidly among productive animals. Consequently, controlling respiratory infections in cattle is a major challenge for the livestock industry worldwide. Purpose of the study is improvement the “Associated vaccine against IRT, VD-BS, PG-3 and bovine chlamydiosis, inactivated emulsion” by expanding the antigenic spectrum of the chlamydial antigen.The sterility of the vaccines was evaluated according to "OFS 1.2.4.0003.15 General Pharmacopoeia article. Sterility" (section 2.3) by direct inoculation. Safety was assessed in accordance with State Standard 31926. Tolerability was monitored for the first 10 days after immunization. The tolerance of vaccines was judged by the absence of a local and general reaction of animals to the introduction of the biological product. PG-3specific antibody titers were determined by hemagglutination inhibition test (HIT). Specific antibodies to the IRT and VD-BS viruses were determined in ELISA. Anti-chlamydial antibodies were quantified by complement fixation test (CFT). Vaccine immunogenicity was evaluated in an acute experiment with white mice.All vaccine batches proved sterile and safe for laboratory animals. Both vaccine formulations were well tolerated by rabbits. Altering the chlamydial antigen composition did not impair antiviral humoral immunity. Rabbits receiving the improved vaccine developed higher anti-chlamydial antibody titers than those vaccinated with the standard formulation. The protection index in white mice immunized with the improved vaccine was 1.3-fold higher than in mice receiving the standard vaccine.Modifying the chlamydial antigen composition in the “Associated vaccine against IRT, VD-BS, PG-3 and bovine chlamydiosis” did not adversely affect the development of antiviral humoral immunity. Inclusion of two additional chlamydial strains enhanced the humoral response to chlamydial antigen and increased overall vaccine immunogenicity by 1.3-fold.

This article is devoted to the search for methods of treatment of viral enteritis of geese in the late stages of its development (more than two days) in the conditions of a farm in the Central Federal District. The text describes the positive effect of the use of serum-reconvalescents for goslings of five-nine days of age, as a result of which the death rate decreased by 44,0%. The results obtained expand the knowledge about the treatment of the highly contagious disease under consideration and contribute to the effective fight against this pathogen.

Elucidating the outpatient burden of lower respiratory tract infections due to RSV and other viruses in children under 2 years of age: clinical presentation, medical treatment, and family impact (Germany, 11/2022-10/2024).

Acute and chronic rhinosinusitis (ARS and CRS) are common conditions with a significant impact on health-related quality of life and disease-related costs. ARS is predominantly of viral aetiology and self-limiting, while bacterial ARS is rare and overdiagnosed. CRS is a persistent inflammatory disease, categorised histopathologically by type of inflammation, with therapeutic strategies varying by severity and endotype. Recent advancements have improved outcomes for patients with severe CRS. This review finds that future research aims to refine biomarkers and personalise treatment for even more favorable outcomes.

Background: Hepatocellular carcinoma (HCC) is a prevalent malignancy with high mortality, often arising in the context of chronic liver diseases. Heme oxygenase-1 (HO-1), an inducible enzyme involved in heme degradation, has been implicated in both hepatoprotection and tumor progression. This study evaluates the expression of HO-1 in HCC and its association with clinicopathological features and patient survival. Materials and Methods: We retrospectively analyzed 58 HCC cases diagnosed between 2018 and 2023 at “Sf. Spiridon” Emergency County Hospital, Iasi. HO-1 expression was assessed immunohistochemically and quantified using a semi-quantitative immunoreactivity score (IRS). Statistical correlations between HO-1 expression and clinical, pathological, and survival parameters were evaluated using univariate analysis, ROC curves, and Kaplan–Meier survival models. Results: High HO-1 expression (IRS > 1) was significantly associated with hepatitis C virus etiology (p = 0.004, V = 0.381), vascular invasion (p = 0.019, V = 0.309) and perioperative anticoagulant therapy (p = 0.007, V = 0.352). However, HO-1 expression did not correlate with overall survival (OS). In contrast, solid growth pattern (p = 0.030) and serum α-fetoprotein levels of 10–99 ng/mL (p = 0.022) were negatively associated with OS. Conclusions: HO-1 expression in HCC was found to be associated with vascular invasion, but not with overall survival. While this may indicate a potential link to certain aggressive tumor features, the overall role of HO-1 in HCC biology remains unclear. These findings suggest that HO-1 should be considered an exploratory rather than definitive prognostic marker, and further research is warranted to clarify its function and potential utility, including investigation of its detectability in biological fluids for non-invasive monitoring.

Rapid multiplex point-of-care (POC) PCR tests may reduce unnecessary antibiotic prescribing by quickly identifying viral etiologies in patients with acute respiratory infections (ARI). We evaluated the impact of a rapid (~15 min) multiplex PCR test on antibiotic prescribing, provider confidence, patient satisfaction, and emergency department (ED) length of stay (LOS). We conducted a prospective, single-center study (March 2024-January 2025) enrolling adults presenting to an urban academic ED with ARI symptoms. Participants underwent rapid multiplex PCR testing (BIOFIRE SPOTFIRE Respiratory Panel), with results provided to clinicians in real time. Antibiotic prescribing, provider and patient perceptions, and ED LOS were assessed through surveys and electronic health record review. A propensity-matched control cohort was used to compare antibiotic prescribing and LOS. The primary outcome was antibiotic prescribing among patients with a confirmed viral etiology; secondary outcomes included overall antibiotic prescribing, ED LOS, and provider-and patient-reported measures. A total of 200 patients were enrolled (mean age 43 years; 56.5% female). Common presenting symptoms included cough (80%), congestion (65%), and sore throat (55%). Patients with confirmed viral infections were significantly less likely to receive antibiotics than those with no detected pathogen (6.5% vs. 20.2%; OR 0.28; 95% CI 0.10-0.68; p = 0.009). Overall antibiotic prescribing rates were similar between experimental and control cohorts (14.9% vs. 12.0%; p = 0.392), but median ED LOS was significantly shorter in the experimental group (4.3 vs. 6.5 h; OR 0.66; 95% CI 0.59-0.74; p < 0.001). Provider diagnostic confidence was high (76%), and most patients reported high satisfaction with testing (92%). Rapid multiplex PCR testing was associated with reduced antibiotic prescribing for viral infections, shorter ED LOS, high provider confidence, and high patient satisfaction. These findings support the value of ultra-rapid diagnostics for antimicrobial stewardship and patient-centered care in the ED.

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.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-19040-4.