BRUCELLOSIS TODAY

In France, human brucellosis decreased significantly between the 70's (800 annual cases) and 1992 (102 cases), the result of the veterinary fight against animal disease. Bovin brucellosis is almost eradicated e xcept into Massif Central, Pyrenees and Alpes, where goats and sheep a re always responsible for the contamination of cows. B. melitensis 9/1 1 biovar 3 is the more frequent contaminant. Clinical features of huma n disease are unchanged but skeletal and visceral focalisations become less frequent than previously - Blood cultures - too often left - and seroagglutination remain classical means of diagnosis. I.I.F. and ELI SA are more precise because recognition of specific IgM and IgA which are good evidence of recent or persistent infection. In vitro antibody production - assay (IVAP) is more sophistical; its value should be as sessed. Today antibiotherapy for acute or subacute forms is based on a ssociations : Tetracyclin (2 g/d) or better Doxycyclin (200 mg once da yly for 45 d) are always associated with either Streptomycin (1 g dail y for 21 days) or Rifampicin (900 mg once daily for 45 d). The first r egimen is probably more efficient than the second one because relapses occur more often (5 - 10 %) with Doxycyclin-Rifampicin than with Doxy cyclin-Streptomycin (relapses: 4 - 5 %). In pregnant women Cotrimoxazo le-Rifampin is efficient enough and atoxic if the treatment is stopped 7 days before delivery. The same regimen is recommended in children l ess 8 years of age. Veterinary action should be going on in spite of i ts cost. Individual measures (gloves, antiseptic solution for shoes, b oiled milk...) are always necessary. Specific immunization (vaccin Mer ieux, France) oftenseems efficient despite a few light adverse effects ; its use is recommended in farmers, veterinary and bacterlogic worker s.