First Report of <i>Coxiella Burnetii</i> Meningitis in Iran

Introduction: Coxiella Burnetii is the primary agent of Q fever, a zoonotic disease transmitted through contact with animals or via arthropod vectors. More than a quarter of Iranian ranchers are seropositive for C. burnetii infection. To the best of our knowledge, this is the first report of Q fever meningitis in Iran. Case Presentation: A 23-year-old male soldier with livestock interaction was admitted with headache, fever, and meningismus for two weeks, unresponsive to outpatient treatment. Cerebrospinal fluid (CSF) analysis showed mild pleocytosis, high protein concentration, hypoglycorrhachia, and negative results for common bacterial and viral infections by molecular and bacteriological methods, as well as for the serology of brucellosis. After failing to respond to empirical treatment with ceftriaxone, vancomycin, and acyclovir, we requested serology and PCR testing for C. burnetii, which showed negative PCR results but a positive serology for C. burnetii antibodies type 1 (1:256) and type 2 (1:512). We diagnosed Q fever meningitis and started doxycycline 100 mg twice daily, which resulted in dramatic improvement. We continued doxycycline for one year, leading to complete recovery. Conclusions: This case is the first report of Q fever meningitis in Iran. We recommend providing access to antibodies and PCR tests for C. burnetii, and requesting these tests for cases of unexplained meningitis.