BRUCELLOSIS IN IRAN: THE FARS PROVINCE EXPERIENCE

Over a 10-year period, l30 consecutive cases of brucellosis were encountered and were prospectively treated and followed. Twenty-one cases were children and the remainder were adults. There were 93 males and 37 females with a male: female ratio of 2.5 to one. The age range of the patients was from 2 to 74 years with a mean of 30 years. Fifty-five percent of cases were from rural areas and the rest from major cities of the Fars province. The disease was most frequently seen during spring and summer. Although it was seen in ranchers and farmers who usually deal with small ruminants in our country, it was also frequently seen in those with other professions. Animal contact was common (33%) as well as consumption of raw unpasteurized milk and fresh cheese which was seen in almost half of the cases. Fever and sweating were the most common complaints and arthritis and splenomegaly were the most frequent physical findings. Bilateral sacroiliac joint involvement was the most common arthritic disorder and was exclusively seen in adults. Knee and ankle joint involvement was commonly seen in children. They were unilateral and monoarticular in their presentation. Seven cases had orchitis and one pregnant lady developed second trimester abortion. Treatment with conventionally recommended antibiotics was successful in all except two cases who had relapse secondary to an inadequate course of drug therapy. The two, however, responded to another course of full term antibiotic therapy with full recovery. In contrast to western countries were cattle and swine are the most frequent sources for human brucellosis, sheep and goats are the most common source of infection in our country. Here, the disease is not an exclusively occupational one for young adult males and an indirect oral route of disease transmission is quite frequent. Brucellosis, therefore, affects both children and adults of either sex, with a wide age range. Prohibition of ingestion of raw milk: and fresh cheese as well as control of Brucella melitensis infection in sheep and goats can significantly reduce the burden of disease in our country.