When Q Fever Strikes Twice; Meningoencephalitis and Hepatitis B Reactivation in the Setting of Advanced HIV Infection: A case report and review of the literature

Background Q fever is an emerging zoonotic disease caused by Coxiella burnetii. Its unique structure allows it to survive environmental stress as well as the intracellular acidic environment. C. burnetti also evades the immune system further contributing to it’s virulence. Human infection occurs following inhalation of fomites or contact with body fluids from infected animals. Q fever manifest in various clinical forms, with acute presentations often involving nonspecific febrile illness, hepatitis, or pneumonia. Meningioencephalitis is rare and associated with increased mortality. Case Presentation We present a 30-year-old male who presented with an altered mental status, fever, and acute hepatitis, found to have a new diagnosis of advanced HIV infection and hepatitis B. Q fever serologies were consistent with acute Q fever and he was treated for Q fever aseptic meningioencephalitis with Doxycyline with significant improvement in fever and mental status. Conlusion The findings in this case highlight the interplay of Q fever with HIV infection and its possible role in hepatitis B reactivation. Infection with C. burnetti results in CD4 cell activation and cytokine release, an effect that is impaired in patients with advanced HIV/AIDS. In this review, we explore the pathophysiology, diagnostic challenges, and management of Q fever in advanced HIV and how that interplays with hepatitis B co-infection. Further research is needed to explore the relationship between Q fever, HIV, and hepatitis B.