THE DIAGNOSIS AND MANAGEMENT OF BRUCELLOSIS

Abstract

The author''s prediction of a decade ago, that brucellosis would become recognized as a major public health problem, has been fulfilled. Of the 248 cases of brucellosis in human subjects studied by the author, all but 52 occurred prior to the passage of a universal pasteurization ordinance in 1931. The consumption of raw milk or unpasteurized dairy products elsewhere, usually while vacationing, has been responsible for the occurrence of the disease in Dayton since 1931. The only procedure which definitely establishes diagnosis is cultivation and identification of the organism. Agglutination and skin tests are important in diagnosis of acute brucellosis, but are notoriously inadequate in cases of chronic brucellosis. A positive agglutination test, particularly of low titer, and a positive skin test do not indicate that the patient is necessarily suffering from brucellosis when the tests are made. Both the agglutination test and the skin test yield negative results in an appreciable number of persons from whose blood Brucella has been recovered. In our hands, the opsonocytophagic test has yielded a high proportion of inconsistent results. This test has proved to be of little value as a diagnostic procedure or as a guide to therapeutic response. Since it is now well established that brucellosis is caused most frequently by the ingestion of raw milk containing Brucella, the most important consideration in the control of the disease is adequate, controlled pasteurization of all milk and other dairy products.