<?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>0873-2159</journal-id>
<journal-title><![CDATA[Revista Portuguesa de Pneumologia]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Port Pneumol]]></abbrev-journal-title>
<issn>0873-2159</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Pneumologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0873-21592009000200014</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[Tuberculose miliar e febre Q em doente imunocompetente]]></article-title>
<article-title xml:lang="en"><![CDATA[Miliary tuberculosis and Q fever in an immunocompetent Patient]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Simões]]></surname>
<given-names><![CDATA[Sandra]]></given-names>
</name>
<xref ref-type="aff" rid="A01"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Santos]]></surname>
<given-names><![CDATA[Arsénio]]></given-names>
</name>
<xref ref-type="aff" rid="A01"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Vaio]]></surname>
<given-names><![CDATA[Teresa]]></given-names>
</name>
<xref ref-type="aff" rid="A01"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Leitão]]></surname>
<given-names><![CDATA[Sara]]></given-names>
</name>
<xref ref-type="aff" rid="A01"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Santos]]></surname>
<given-names><![CDATA[Rui M]]></given-names>
</name>
<xref ref-type="aff" rid="A01"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Costa]]></surname>
<given-names><![CDATA[Nascimento]]></given-names>
</name>
<xref ref-type="aff" rid="A01"/>
</contrib>
</contrib-group>
<aff id="A01">
<institution><![CDATA[,Hospitais da Universidade de Coimbra Serviço de Medicina III ]]></institution>
<addr-line><![CDATA[Coimbra ]]></addr-line>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>03</month>
<year>2009</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>03</month>
<year>2009</year>
</pub-date>
<volume>15</volume>
<numero>2</numero>
<fpage>325</fpage>
<lpage>329</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S0873-21592009000200014&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S0873-21592009000200014&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S0873-21592009000200014&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[A tuberculose miliar é a forma de doença progressiva resultante da disseminação hematogénea maciça do Mycobacterium tuberculosis (MT). Afecta imunodeprimidos e idosos e tem manifestações clínicas insidiosas e inespecíficas. O caso clínico descrito refere-se a um homem adulto, sem imunodeficiência, com infecção simultânea por Coxiella burnetti e MT. A raridade desta associação e a sua forma de apresentação sublinham a necessidade de alto grau de suspeição clínica para a formulação dos diagnósticos, sendo este o segundo caso descrito na literatura.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Miliary tuberculosis is a progressive disease resulting from the massive hematogeneous dissemination of Mycobacterium tuberculosis. Immunocompromised and elderly patients are the most affected. A case of an immunocompetent 45 year old man, with miliary tuberculosis and a simultaneous infection by Coxiella burnetti is presented. The clinical presentation demands a high awareness for the presence of tuberculosis. The rarity of this association, only one case reported in literature, appears to be a fortuity coincidence.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Tuberculose miliar]]></kwd>
<kwd lng="pt"><![CDATA[febre Q]]></kwd>
<kwd lng="pt"><![CDATA[tratamento]]></kwd>
<kwd lng="en"><![CDATA[Miliary tuberculosis]]></kwd>
<kwd lng="en"><![CDATA[Q fever]]></kwd>
<kwd lng="en"><![CDATA[treatment]]></kwd>
</kwd-group>
</article-meta>
</front><body><![CDATA[ <p><b>Tuberculose miliar e febre Q em doente imunocompetente</b></p>      <p><b><i>&nbsp;</i></b></p>      <p><b>Sandra Simões <a href="#1">1</a><a name="top1"></a></b></p>      <p><b>Arsénio Santos <a href="#2">2</a><a name="top2"></a></b></p>      <p><b>Teresa Vaio <a href="#3">3</a><a name="top3"></a></b></p>      <p><b>Sara Leitão <a href="#2">2</a></b></p>      <p><b>Rui M Santos <a href="#4">4</a><a name="top4"></a></b></p>      <p><b>Nascimento Costa <a href="#5">5</a><a name="top5"></a></b></p>      <p><b>&nbsp;</b></p>     <p>&nbsp;</p>      ]]></body>
<body><![CDATA[<p><b>Resumo</b></p>      <p>A tuberculose miliar é a forma de doença progressiva resultante da disseminação    hematogénea maciça do <i>Mycobacterium tuberculosis </i>(MT). Afecta imunodeprimidos    e idosos e tem manifestações clínicas insidiosas e inespecíficas. O caso clínico    descrito refere-se a um homem adulto, sem imunodeficiência, com infecção simultânea    por <i>Coxiella burnetti </i>e MT.</p>      <p>A raridade desta associação e a sua forma de apresentação sublinham a necessidade    de alto grau de suspeição clínica para a formulação dos diagnósticos, sendo    este o segundo caso descrito na literatura.</p>     <p><b>Palavras-chave: </b>Tuberculose miliar, febre Q, tratamento.</p>     <p>&nbsp;</p>     <p>&nbsp;</p>      <p><b>Miliary tuberculosis and Q fever in an immunocompetent Patient</b></p>      <p><b>Abstract</b></p>      <p>Miliary tuberculosis is a progressive disease resulting from the massive hematogeneous dissemination of <i>Mycobacterium tuberculosis</i>. Immunocompromised and elderly patients are the most affected. A case of an immunocompetent 45 year old man, with miliary tuberculosis and a simultaneous infection by <i>Coxiella burnetti </i>is presented.</p>      <p>The clinical presentation demands a high awareness for the presence of tuberculosis.    The rarity of this association, only one case reported in literature, appears    to be a fortuity coincidence.</p>      ]]></body>
<body><![CDATA[<p><b>Key-words: </b>Miliary tuberculosis, Q fever, treatment.</p>      <p>&nbsp;</p>     <p>&nbsp;</p>      <p>Texto completo dispon&iacute;vel apenas em PDF.</p>     <p>Full text only available in PDF format.</p>     <p>&nbsp;</p>     <p>&nbsp;</p>     <p><b>Referências</b></p>      <p>1. Dye C. Global epidemiology of tuberculosis. Lancet 2006; 367:938-40</p>      <p>2. Pina J, <i>et al. </i>A tuberculose no virar do milénio. 1.ª ed. Lisboa, Lidel, 2000; 3-575</p>      ]]></body>
<body><![CDATA[<!-- ref --><p>3. Salvado G, <i>et al. </i>Tuberculose miliar. Revisão de casos internados numa unidade de tuberculose. Rev Port Pneumol 2002;8 (4):315-327&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;[&#160;<a href="javascript:void(0);" onclick="javascript: window.open('/scielo.php?script=sci_nlinks&ref=000033&pid=S0873-2159200900020001400001&lng=','','width=640,height=500,resizable=yes,scrollbars=1,menubar=yes,');">Links</a>&#160;]<!-- end-ref --><p>4. Basgoz N. Clinical manifestations, diagnosis and treatment of miliary tuberculosis.    UptoDate on line, 2007</p>     <p>5. Kim J, Langston A, Gallis H. Miliary tuberculosis: epidemiology, clinical    manifestations, diagnosis and outcome. Rev Infect Dis 1990; 12(4):583-90 </p>      <p>6. Raoult D. Clinical features, diagnosis, treatment and prevention of Q fever. UptoDate on line, 2007</p>      <p>7. Walker DH, Dumler S, Marrie T. Q fever. In Dennis L Kasper, Dan L Longo, Eugene Braunwald, Stephen L Hauser, J Larry Jameson (Eds.). Diseases caused by <i>Ricket tsiae, Mycoplasmas </i>and <i>Chlamydiae, </i>Harrisson´s Principals of Internal Medicine. New York, McGraw-Hill 2008;1066-67.</p>      <p>8. Maartens G, Willcox P, Benatar S. Miliary tuberculosis: rapid diagnosis, hematologic abnormalities and outcome in 109 treated adults. Am J Med 1990; 89: 291-96</p>      <p>9. Corbett E, <i>et al. </i>The growing burden of tuberculosis, global trends and interactions with the HIV epidemic. Arch Intern Med 2003; 163: 1009-21</p>      <p>10. Optican R, Ost A, Ravin C. High-resolution computed tomography in the diagnosis of miliary tuberculosis. Chest 1992;102(3):941-43</p>      <!-- ref --><p>11. Garcia J, <i>et al. </i>Hepatic granulomatosis caused by Q fever: a cause of erroneous tuberculosis diagnosis. Na Med Interna 1993; 10(12):595-8&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;[&#160;<a href="javascript:void(0);" onclick="javascript: window.open('/scielo.php?script=sci_nlinks&ref=000041&pid=S0873-2159200900020001400002&lng=','','width=640,height=500,resizable=yes,scrollbars=1,menubar=yes,');">Links</a>&#160;]<!-- end-ref --><p>12. Watanabe A. Clinical manifestation of Q fever and tuberculosis, similarly caused by intracellular parasites. Kekkaku 2006; 81(8):543-9</p>      ]]></body>
<body><![CDATA[<p>13. Sumida Y, <i>et al. </i>A case of military tuberculosis complicating acute    Q fever. Nippon Shokakibyo Gakkai Zasshi 2006; 103(12):1377-83.</p>     <p>&nbsp;</p>     <p>&nbsp;</p>     <p><a name="1"></a><a href="#top1">1</a> Interna do Internato Complementar de    Medicina Interna</p>     <p><a name="2"></a><a href="#top2">2</a> Assistente Graduado(a) de Medicina Interna</p>     <p><a name="3"></a><a href="#top3">3</a> Assistente de Medicina Interna</p>     <p><a name="4"></a><a href="#top4">4</a> Chefe de Serviço de Medicina III e Professor    Auxiliar da Faculdade de Medicina da Universidade de Coimbra</p>     <p><a name="5"></a><a href="#top5">5</a> Director de Serviço de Medicina III e    Professor Catedrático da Faculdade de Medicina da Universidade de Coimbra</p>     <p>Servi&ccedil;o de Medicina III &#8211; Hospitais da Universidade de Coimbra    &#8211; Coimbra</p>     <p>&nbsp;</p>     ]]></body>
<body><![CDATA[<p>&nbsp;</p>     <p>Recebido para publica&ccedil;&atilde;o/<i>received for publication</i>: 08.10.01</p>     <p> Aceite para publica&ccedil;&atilde;o/<i>accepted for publication</i>: 08.12.12</p>       ]]></body><back>
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<person-group person-group-type="author">
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</person-group>
<article-title xml:lang="pt"><![CDATA[Tuberculose miliar. Revisão de casos internados numa unidade de tuberculose]]></article-title>
<source><![CDATA[Rev Port Pneumol]]></source>
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<person-group person-group-type="author">
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<article-title xml:lang="en"><![CDATA[Hepatic granulomatosis caused by Q fever: a cause of erroneous tuberculosis diagnosis]]></article-title>
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</back>
</article>
