RETROSPECTIVE STUDY ON 59 CASES OF HUMAN BRUCELLOSIS IN AQUITAINE - CLINICAL, LABORATORY, AND THERAPEUTIC ASPECTS

Brucellosis is an infection found worldwide, the incidence of which ha s diminished in recent years in France. The authors report a retrospec tive study on 59 cases of brucellosis occuring between 1980 and 1996 i n the University hospitals of Bordeaux, in internal medicine, infectio us diseases, and rhumatology units. Fifty-nine patients (45 men, 14 wo men) mean age 44 years (7 to 83), were diagnosed with brucellosis. 68% had a predisposing factor (risk profession, consumption of dairy prod ucts). 31 presented an acute form with fever that tended to be irregul ar and vesperal (31), sweating (25), marked asthenia (16), weight loss (9), arthralgias (9), splenomegaly (7), and/or hepatomegaly (6), 26 h ad a localized form, mainly osteoarticular (10 spondylitis with discit is, 5 coxitis, 4 sacroiliitis, 1 arthritis of the knee, 1 arthritis of the ankle), but also genital (1 orchitis, 1 salpingitis), cardiac (1 endocarditis, 1 myocarditis), neurological (1 meningoencephalitis), an d splenic (1 patient had multiple splenic abscesses). Two patients pre sented clinical signs consistent with a chronic brucellosis. Moderate hepatitis was noted in 29. Blood cultures were positive in 23, 10 amon g the localized forms (B. melitensis 10 cases, B. abortus 3 cases, B. suis 2 cases, 8 cases remained unidentified). The pathogen was isolate d 8 times by guided specimen collection. Serologic tests were positive in all cases. The melitin skin test was positive in both patients pre senting a chronic form. Treatment mainly relied upon the association o f rifampin and doxycycline. Seven patients were managed by monotherapy (ofloxacin or doxycycline). Fever subsided an average of 7 days after beginning treatment (from 2 to 30 days), hepatic cytolysis in less th an a month, while a low neutrophil count sometimes persisted up to 3 m onths. Eight patients initially presenting an acute form underwent a l ocalized relapse.