<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0872-0754</journal-id>
<journal-title><![CDATA[Nascer e Crescer]]></journal-title>
<abbrev-journal-title><![CDATA[Nascer e Crescer]]></abbrev-journal-title>
<issn>0872-0754</issn>
<publisher>
<publisher-name><![CDATA[Centro Hospitalar do Porto]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0872-07542021000300179</article-id>
<article-id pub-id-type="doi">10.25753/birthgrowthmj.v30.i3.17089</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Difficult management of pediatric acute Q fever]]></article-title>
<article-title xml:lang="pt"><![CDATA[Febre Q pediátrica. Um caso de difícil abordagem]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Figueiredo]]></surname>
<given-names><![CDATA[Rafael Costa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Monteiro]]></surname>
<given-names><![CDATA[Diana R.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rebelo]]></surname>
<given-names><![CDATA[Ana Isabel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Azevedo]]></surname>
<given-names><![CDATA[Ana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Oliveira]]></surname>
<given-names><![CDATA[Sara Freitas de]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Tavares]]></surname>
<given-names><![CDATA[Susana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Hospitalar Universitário do Porto Centro Materno-Infantil do Norte Department of Pediatrics]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Centro Hospitalar de Entre Douro e Vouga Department of Pediatrics ]]></institution>
<addr-line><![CDATA[Santa Maria da Feira ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>09</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>09</month>
<year>2021</year>
</pub-date>
<volume>30</volume>
<numero>3</numero>
<fpage>179</fpage>
<lpage>182</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S0872-07542021000300179&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S0872-07542021000300179&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S0872-07542021000300179&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  Q fever, a zoonosis caused by Coxiella burnetti, is relatively rare in the pediatric population. The disease is often asymptomatic or with mild clinical presentation in children.  Case report:  A four-year-old boy with persistent fever, severe anemia, and positive IgM for Coxiella burnetti was treated with trimethoprim-sulfamethoxazole and azithromycin, with no improvement. After polymerase chain reaction confirmation, he completed 14 days of doxycycline, with good response. After eleven months, the child remains asymptomatic.  Discussion:  Despite having a usually mild presentation, the severe clinical progression and lack of response to initial antibiotic therapy in this case prompt the use of doxycycline, a non-consensual drug in younger ages, with good results. New recommendations endorse the use of this drug for short periods at any age.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  A febre Q, uma zoonose causada por Coxiella burnetti, é relativamente rara em idade pediátrica. Em crianças, a doença é frequentemente assintomática ou com apresentação clínica ligeira.  Caso clínico:  Uma criança do sexo masculino de quatro anos de idade com febre persistente, anemia grave e IgM positiva para Coxiella burnetti foi medicada com trimetoprim-sulfametoxazol e azitromicina, sem melhoria. Após confirmação da infeção por polymerase chain reaction, completou 14 dias de doxiciclina, com boa resposta. Onze meses depois, a criança permanece assintomática, sem sinais de doença.  Discussão:  Apesar de ser habitualmente uma doença ligeira, a evolução clínica grave e falta de resposta à antibioterapia inicialmente instituída neste caso levaram à utilização de doxiciclina, um fármaco não consensual em idades mais jovens, com bons resultados. Novas recomendações sustentam o uso de doxiciclina por curtos períodos em todas as faixas etárias.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[acute Q fever]]></kwd>
<kwd lng="en"><![CDATA[doxycycline]]></kwd>
<kwd lng="en"><![CDATA[pediatric Q fever]]></kwd>
<kwd lng="pt"><![CDATA[doxiciclina]]></kwd>
<kwd lng="pt"><![CDATA[febre Q aguda]]></kwd>
<kwd lng="pt"><![CDATA[febre Q pediátrica]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Anderson]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Bijlmer]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Fournier]]></surname>
<given-names><![CDATA[PE]]></given-names>
</name>
<name>
<surname><![CDATA[Graves]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Hartzell]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Kersh]]></surname>
<given-names><![CDATA[GJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diagnosis and management of Q fever-United States, 2013: recommendations from CDC and the Q Fever Working Group]]></article-title>
<source><![CDATA[MMWR Recomm Rep]]></source>
<year>2013</year>
<volume>62</volume>
<page-range>1</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Slok]]></surname>
<given-names><![CDATA[EN]]></given-names>
</name>
<name>
<surname><![CDATA[Dijkstra]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[de Vries]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Rietveld]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Wong]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Notermans]]></surname>
<given-names><![CDATA[DW]]></given-names>
</name>
<name>
<surname><![CDATA[van Steenbergen]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Estimation of acute and chronic Q fever incidence in children during a three-year outbreak in the Netherlands and a comparison with international literature]]></article-title>
<source><![CDATA[BMC Res Notes]]></source>
<year>2015</year>
<volume>8</volume>
<page-range>456</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Maurin]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Raoult]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Q fever]]></article-title>
<source><![CDATA[Clin Microbiol Rev]]></source>
<year>1999</year>
<volume>12</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>518-53</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Maltezou]]></surname>
<given-names><![CDATA[HC]]></given-names>
</name>
<name>
<surname><![CDATA[Raoult]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Q fever in children]]></article-title>
<source><![CDATA[Lancet Infect Dis]]></source>
<year>2002</year>
<volume>2</volume>
<page-range>686-91</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kampschreur]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
<name>
<surname><![CDATA[Dekker]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Hagenaars]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Lestrade]]></surname>
<given-names><![CDATA[PJ]]></given-names>
</name>
<name>
<surname><![CDATA[Renders]]></surname>
<given-names><![CDATA[NHM]]></given-names>
</name>
<name>
<surname><![CDATA[de Jager-Leclercq]]></surname>
<given-names><![CDATA[MGL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Identification of risk factors for chronic Q fever, the Netherlands]]></article-title>
<source><![CDATA[Emerg Infect Dis]]></source>
<year>2012</year>
<volume>18</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>563-70</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Santos]]></surname>
<given-names><![CDATA[AS]]></given-names>
</name>
</person-group>
<source><![CDATA[Febre Q: Do Diagnóstico à Investigação Ecoepidemiológica de Coxiella Burnetii no Contexto da Infeção Humana]]></source>
<year>2015</year>
<publisher-name><![CDATA[Instituto Nacional de Saúde Doutor Ricardo Jorge IP]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Santos]]></surname>
<given-names><![CDATA[AS]]></given-names>
</name>
<name>
<surname><![CDATA[Bacellar]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[França]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Febre Q revisão de conceitos]]></article-title>
<source><![CDATA[Rev Port Med Interna]]></source>
<year>2007</year>
<volume>12</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>90-9</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="book">
<collab>Direção Geral da Saúde</collab>
<source><![CDATA[Doenças de declaração obrigatória 2012-2015. Volume I - Portugal]]></source>
<year>2016</year>
<publisher-loc><![CDATA[Direção Geral da Saúde ]]></publisher-loc>
<publisher-name><![CDATA[Lisboa]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Raoult]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<source><![CDATA[Treatment and prevention of Q fever]]></source>
<year>2018</year>
<publisher-loc><![CDATA[Waltham, MA ]]></publisher-loc>
<publisher-name><![CDATA[UpToDate Inc]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Todd]]></surname>
<given-names><![CDATA[SR]]></given-names>
</name>
<name>
<surname><![CDATA[Dahlgren]]></surname>
<given-names><![CDATA[FS]]></given-names>
</name>
<name>
<surname><![CDATA[Traeger]]></surname>
<given-names><![CDATA[MS]]></given-names>
</name>
<name>
<surname><![CDATA[Beltrán-Aguilar]]></surname>
<given-names><![CDATA[ED]]></given-names>
</name>
<name>
<surname><![CDATA[Marianos]]></surname>
<given-names><![CDATA[DW]]></given-names>
</name>
<name>
<surname><![CDATA[Hamilton]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[No visible dental staining in children treated with doxycycline for suspected Rocky Mountain Spotted Fever]]></article-title>
<source><![CDATA[J Pediatr]]></source>
<year>2015</year>
<volume>166</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>1246-51</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pöyhönen]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Nurmi]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Peltola]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Alaluusua]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Ruuskanen]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[Lähdesmäki]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Dental staining after doxycycline use in children]]></article-title>
<source><![CDATA[J Antimicrob Chemother]]></source>
<year>2017</year>
<volume>72</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>2887-90</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gaillard]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Briolant]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Madamet]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Pradines]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The end of a dogma the safety of doxycycline use in young children for malaria treatment]]></article-title>
<source><![CDATA[Malar J]]></source>
<year>2017</year>
<volume>16</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>148</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kimberlin]]></surname>
<given-names><![CDATA[DW]]></given-names>
</name>
<name>
<surname><![CDATA[Brady]]></surname>
<given-names><![CDATA[MT]]></given-names>
</name>
<name>
<surname><![CDATA[Jackson]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Long]]></surname>
<given-names><![CDATA[SS]]></given-names>
</name>
</person-group>
<source><![CDATA[Red Book: 2018 Report of the Committee on Infectious Diseases]]></source>
<year>2018</year>
<publisher-name><![CDATA[American Academy of Pediatrics]]></publisher-name>
</nlm-citation>
</ref>
</ref-list>
</back>
</article>
