The epidemiological features and clinical manifestations of adult cases of brucellosis admitted to the Department of Infectious Diseases, Babol Medical University, Iran from 1997 to 2002 were investigated. Of 469 cases, 267 (56.9%) were males. The mean age of cases was 36.9 +/- 15 years. Most (60.8%) were from rural areas. Two thirds of cases (306, 66.3%) presented during spring or summer. Fresh cheese (22.4%), animal husbandry (11.3%), laboratory worker (8.1%) and veterinary profession (1.5%) were the main risk factors. Forty-five families (9.6%) had two cases. Sweating, fever, and arthralgia were the most frequent clinical symptoms. Complications were documented in 105 males (39.5%) and 41 females (20.3%, P=0.0001). Peripheral arthritis was seen in 24 (9%) males and 19 (9.4%) females, with knees and hips being the most common sites of infection. Sacroiliitis and spondylitis were seen in 28 (6%) and 32 (6.8%) cases respectively with spondylitis more common in males (P=0.023). Epididymo-orchitis was seen in 29 (10.9%) males. There were three cases each of endocarditis (0.6%) and neurological complications (0.6%). Most patients with brucellosis did not have any of the known risk factors for brucellosis. Thus consumption of unsafe dairy products could be the main route of infection. The disease manifested with a diversity of clinical manifestations and complications. Complications were more frequent in males than females.

This prospective study was conducted on 111 children with brucellosis, who attended the Department of Infectious Diseases, Babol, Iran, from September 1999 to March 2003. Fever (73.9%), sweating (67.6%), artheralgia (49.5%) and splenomegaly (18%) were common findings. The disease was acute and sub-acute in 97.3% and chronic in 2.7% of cases. Peripheral arthritis was seen in 35 (31.5%) of cases, which was monoarticular in 29 patients, most involving the knees and hips. Sacroilitis was seen in six (5.4%) cases.

Introduction: Duration of treatment for brucellar spondylitis in endemic regions is controversial. This study describes the outcome of treatment in 50 cases of brucellar spondylitis in Iran. Methodology: From April 2001 to September 2010, we treated 20, 13, 11 and 6 cases with doxycycline plus rifampin (DR), streptomycin plus doxycycline plus rifampin (SDR), cotrimoxazole plus doxycycline plus rifampin (CDR), and gentamicin plus doxycycline plus rifampin (GDR), respectively. Gentamicin and streptomycin were administered for 14 days and the other agents for 3 months. When complete clinical response was not achieved, therapy was continued. All patients were followed for one year. The Kaplan Meier method and the log rank test were used to compare the duration of therapy between SDR plus GDR patients with those treated with CDR or DR. Results: Eight (45%), 10 (76.9%), 7 (63.3%) and 6 (100%) cases treated for three months were cured with DR, SDR, CDR and GDR, respectively. Nine (45%), 4 (36.4%) and two (22.2%) were cured after four months with DR, CDR and SDR, respectively. Mean duration of therapy in the SDR plus GDR, CDR and DR was 3.26±0.17, 3.36±0.15 and 3.9±0.23 months, respectively (p=0.49 and p=0.015, respectively). Three cases with epidural or paravertebral abscesses recovered after six months. Relapse occurred in one (9.1%) and two (10%) cases treated with CDR and DR, respectively. Conclusions: Brucellar spondylitis could be treated using different combinations of antimicrobials especially with a regimen containing aminoglycoside for four months; patients with epidural or paravertebral abscesses require longer treatment times.

SAT and 2-ME may be found in significant titers in less than 5% of clinically treated cases after two years. Serologic cure for both tests with lower titers were higher than with higher titers.

The results show that the efficacy of gentamicin for 5 days plus doxycycline for 8 weeks is not superior to that of streptomycin for 2 weeks plus doxycycline for 45 days.