[Current aspects of brucellosis].

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 except into Massif Central, Pyrénées and Alpes, where goats and sheep are always responsible for the contamination of cows. B. melitensis 9/11 biovar 3 is the more frequent contaminant. Clinical features of human 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 ELISA 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 assessed. Today antibiotherapy for acute or subacute forms is based on associations: Tetracycline (2 g/d) or better Doxycycline (200 mg once daily for 45 d) are always associated with either Streptomycin (1 g daily for 21 days) or Rifampicin (900 mg once daily for 45 d). The first regimen is probably more efficient than the second one because relapses occur more often (5-10%) with Doxycycline-Rifampicin than with Doxycycline-Streptomycin (relapses: 4-5%). In pregnant women Cotrimoxazole-Rifampin is efficient enough and atoxic if the treatment is stopped 7 days before delivery. The same regimen is recommended in children less 8 years of age. Veterinary action should be going on in spite of its cost. Individual measures (gloves, antiseptic solution for shoes, boiled milk...) are always necessary. Specific immunization (vaccin Mérieux, France) often seems efficient despite a few light adverse effects; its use is recommended in farmers, veterinary and bacteriologic workers.