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Staphylococci were isolated from rural and urban populations in Iraq, which were not known to be exposed to either heavy metals or antibiotics. The antibiotic and heavy metal resistance patterns of these strains were analyzed in both mannitol-fermenting and nonfermenting strains. Over 90% of the strains were resistant to at least one of the following antibiotics: penicillin, chloramphenicol, erythromycin, tetracycline, cephalothin, lincomycin, or methicillin. In general, mannitol-fermenting strains were resistant to penicillin and cupric ions. Mannitol-negative strains were more frequently associated with mercuric ion and tetracycline resistance. Although resistance to penicillin and tetracycline can coexist, the combination of penicillin resistance and tetracycline resistance usually occurred in mannitol-negative strains. The possibility of selection of heavy metal-resistant strains due to exposure to toxic levels of methylmercury was examined. No significant increase in mercuric ion-resistant strains of staphylococci or Escherichia coli were detected in exposed populations as compared to control groups. The possible reasons for this result are discussed.The current interest in subtle effects of environmental contaminants on ecosystems has resulted in a renewed emphasis on the interactions of pollutants with microorganisms. As man further contaminates his own environment, he alters the milieu of those organisms for whom he is the host. For example, selection of antibiotic-resistant strains in human patients (4,8,19) and live stock (18) is a well recognized phenomenon. There is also evidence to indicate that there may be a correlation between the emergence of resistance to antibiotics and heavy metals. Thus the exposure of industrial workers to metallic mercury or inorganic mercury has been shown to be associated with an increased colonization by antibiotic-or mercury-resistant staphylococci in the nasal passages (7). Even in populations that had not been known to have been exposed to mercury, there is a high correlation between certain types of antibiotic resistance patterns and resistance to heavy metals.Recent studies have demonstrated an association between resistance to penicillin, copper ions, and the production of coagulase, whereas resistance to mercury was more commonly noted in strains that were resistant to tetracycline and coagulase negative (6; D. Groves and F.. Young, manuscript in preparation). 6Because there was an increased incidence of intercurrent infections leading to death in patients poisoned with methylmercury at Minimata (14), it was considered particularly relevant to determine the effects of exposure to toxic amounts of heavy metals on resistance patterns in microorganisms. In the period from September 1971 to mid-January 1972, a severe epidemic of methylmercury poisoning of farmers and their families occurred in Iraq, due to the consumption of home-made bread prepared from seed grain treated with a methyl mercurial fungicide. A total of 6,530 cases were admitted to hospitals, and there...

SUMMARY The clinical features of 21 episodes of skeletal brucellosis in 17 Iraqi patients are reported. Six had monarthritis of a large joint, six had spondylitis, and five had spondarthritis. Brucellosis remains a major health problem in Iraq. The disease is transmitted to man through the ingestion of unpasteurised milk or milk products but can also be acquired through physical contact.Key words: Brucella abortus, monarthritis, spondylitis, spondarthritis. Patients and methods ResultsSeventeen consecutive patients attending our rheumatology clinic with skeletal manifestations considered to be due to brucellosis were studied. In addition to obtaining a history, physical examination, and x rays, the following investigations were performed: haemoglobin and leucocyte count, erythrocyte sedimentation rate (ESR), urine examination, latex fixation test for rheumatoid factor, antistreptolysin 0 titre, antinuclear factor, lupus erythematosus cell preparation, C reactive protein, serum uric acid, rose bengal test using a concentrated suspension of Brucella abortus (Weybridge strain) stained with rose bengal (BioMerieux), and an agglutination test with Brucella abortus antigen (Burroughs-Wellcome). HLA typing was done using the microlymphocytotoxicity technique only for the young patients in the spondylitic and spondarthritic groups. A blood culture for brucella was carried out in 12 patients and synovial fluid culture in three. A tuberculin test was done only in one patient with spondylitis. All cases were followed up for one year. In cases of relapse the ESR, leucocyte count, rose bengal and brucella agglutination tests were performed. The diagnosis of brucellosis was made on the basis of suggestive history in association with the finding of a positive rose bengal screening test and a positive agglutination titre (3,>1/320).