Difficult management of pediatric acute Q fever

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.