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112 Allergenicity to Allergens like Prosopis Juliflor and Date Tree Pollens in Saudi Arabia June 2011 antibodies to Prosopis juliflora, where a higher level of these pollens maybe found. However, in a test conducted by Novey et al [2] , it was concluded that mesquite pollen is a potent allergen capable of causing immediate hypersensitivity reactions in a susceptible population remotely from the plant source. Sensitivity to one or more aeroallergens is common in patients, indicating high level of aeroallergen sensitization in patients with airway allergy residing in the Riyadh region [13] . Some progress on the biochemical aspect of Prosopis allergen has been made, e.g., Prosopis juliflora pollen allergen extract has been fractionated by sephadex (G-100 gel filtration) [14] . Six different fractions were obtained, which were confirmed by sodium dodecyl sulphatepolyacrylamide gel electrophoresis [15] . A fraction called E (MW 20,000 kd) consisted mainly of allergenic molecules [16,17] . However, it appears that no other species of Prosopis has been studied in relation to antigenic properties or compared with Prosopis juliflora. Consequently, characterized and purified antigens from Prosopis spp., as per WHO reference, have not yet emerged. In addition, humoral and cellular crossreactivity between Prosopis pollen and Phaseolus seed allergens has been shown recently [17,18] . CONCLUSION The findings documented suggest that Prosopis pollen is a sensitizing factor for allergic patients in Saudi Arabia, with a considerable number of positive reactions. As they are and will be introduced by the millions as roadside ornamentation individuals in these locations might be sensitized with Prosopis juliflora. The sensitizing effect may take place at any region where a higher level of this pollen may be found. However, further studies and / or investigation are needed to draw conclusions of prosopishypersensitivity in many multiple sensitive patients and we might consider Prosopis as one of the major allergens in Saudi Arabia. ACKNOWLEDGMENTS Authors convey their sincere thanks to National Center for Allergy, Asthma and Immunology Management and all technicians who participated in this study. Authors deeply appreciate Dr Mohammed Alsaeed and Amany S. Emara from National Hospital, for proof reading and their valuable comments to improve this manuscript. REFERENCES 1. Al Frayh AR, Shakoor Z, Gad El Rab MO, Hasnain SM. Increased prevalence of asthma in Saudi Arabia. Ann Allergy Asthma Immunol 2001; 86:292-296. 2. Rahal EA, Halas Y, Zaytoun G, Zeitoun F, Abdelnoor AM. Predominant airborne pollen in a district of Beirut, Lebanon for the period extending from March 2004 to August 2004. Lebanese Sci J 2007; 8:29-37. 3. Tan TN, Shek LP, Goh DYT, Chew FT, Lee BW. Prevalence of asthma and comorbid allergy symptoms in Singaporean preschoolers. Asian Pac J Allergy Immunol 2006; 24:175-182. 4. Futamura N, Kusunoki Y, Mukai Y, Shinohara K. Characterization of genes for a pollen allergen, Cry j2, of Cryptomeria Japonica. Int Arch Allergy Immunol 2007; 143:59-68. 5. Halwagy MH. Concentration of airborne pollen at three sites in Kuwait. Grana 1988; 27:53-62. 6. Malik P, Singh AB, Babu CR, Gangal SV. Headhigh airborne pollen grain from different areas of Metropolitan Delhi. Allergy 1990; 45: 298-305. 7. Thakur IS. Prosopis juliflora pollen allergen induced hypersensitivity and anaphylaxis studies in guinea pigs. Biochem Int 1986; 13:915-925. 8. Chakraborty P, Mandal J, Sarkar E, Chowdhury I, Gupta-Bhattacharya S. Clinico-immunochemical studies on airborne Areca catechu L. pollen, a probable risk factor in emergency asthma hospitalization from eastern India. Int Arch Allergy Immunol 2009;149:305- 314. 9. Howarden D, Baker S, Toerien A, Prescott R, Leaver R, Potter PC. Derman W, Katelaris CH. Aero-allergy in South African olympic athletes. S Afr Med J 2002; 92:355-356. 10. Sajwani A, Farooq SA, Pazelt A, Eltayeb EA, and Brynt VM, Melissopalynological studies from Oman. Palynology 2007; 31:63-79. 11. Dhyani A, Arora N, Gaur SN, Jain VK, Sridhara S, Singh BP. Analysis of IgE binding proteins of mesquite (Prosopis juliflora) pollen cross-reactivity with predominant tree pollens. Immunobiol 2006; 211:733- 740. 12. Misra A, Prasad R , Das M , Dwivedi PD . Prevalence of legume sensitization in patients with naso-bronchial allergy. Immunopharmacol and Immunotoxicol 2008; 30: 529-542. 13. Almogren A. Airway allergy and skin reactivity to aeroallergens in Riyadh. Saudi Med J 2009; 30:392-396. 14. Choudhary SA. Acacia and other genera of Mimosoidaeceae in Saudi Arabia. National Herbs in Regional Agriculture and Water Research Centre, Ministry of Agriculture and Water, Riyadh, Saudi Arabia. 1983; 73-81. 15. Hasnain SM, and Al-Frayh AR. Prevalence of allergenic Amaranthus viridis pollen in seven different regions of Saudi Arabia. Ann Saudi Med 2007; 27:259-263. 16. Assarehzadegan MA, Sankian M, Jabbari F, Noorbakhsh R, Varasteh A.. Allergy to Salsola Kali in a Salsola Incanescens-rich area: Role of extensive cross allergenicity. Allergology International 2009; 58:261- 266. 17. Alsaeed AH. Sensitization to allergens among patients with allergic rhinitis in warm dry climates. Bahrain Med Bull 2007; 29:8-11. 18. Dhyani A, Arora N, Jain V K, Sridhara S, Singh B P. Immunoglobulin E (IgE)-mediated cross-reactivity between mesquite pollen proteins and lima bean, an edible legume. Clin Exp Immunol 2007; 149:517- 524.
June 2011 KUWAIT MEDICAL JOURNAL 113 Original Article Pregnancy Associated with Brucellosis and Acute Viral Hepatitis: Course and Outcome (Co-infections in Pregnancy) Serda Gulsun 1 , Vedat Dorman 2 , Selda Aslan 3 , Talip Gul 4 1 Department of Infectious Diseases and Clinical Microbiology, Diyarbakir State Hospital, Diyarbakir, Turkey 2 Diyarbakir Provincial Health Directorate, Diyarbakir, Turkey 3 Department of Infectious Diseases and Clinical Microbiology, Av. Cengiz State Hospital, Gaziantep, Turkey 4 Department of Medicine, Divison of Gynecology and Obstetrics, Dicle University, Diyarbakir, Turkey ABSTRACT Kuwait Medical Journal 2011; 43 (2): 113-117 Objective: To assess the outcome and course of pregnancies complicated by Brucellosis (BCS) and acute viral hepatitis (AVH) infections Design: Prospective study Setting: Diyarbakir State Hospital, Turkey Subjects: Eighty-eight pregnant women admitted to Diyarbakir State Hospital, Turkey Intervension: Serum agglutination test (SAT), Coombs anti- Brucella test and / or blood culture system were used in the diagnosis of BCS. Enzyme-linked immunosorbent assays (ELISA) and polymerase chain reaction (PCR) was used in the diagnosis of viral hepatitis. Main Outcome Measures: The clinical course and delivery pattern of 32 healthy pregnant women was compared with that of 32 pregnant women who had BCS and 24 pregnant women who were concurrently infected with BCS and AVH. Results: There was no maternal mortality. Preterm delivery occurred in 18.75% of the 32 pregnant women with BCS and 37.5% of 24 pregnant women with BCS and AVH (p = 0.004). The incidence of low birth weight was also significant between the two groups (p < 0.0001). Antepartum hemorrhage might be a warning sign of the occurrence of complications in pregnant women with BCS and AVH (p < 0.001). An important observation from the present study is that maternal BCS and AVH (even concurrent) had no effect on the incidence of congenital malformations or stillbirths; it did increase the incidence of prematurity and low birth weight over that seen in the general delivery population. Conclusion: In spite of the high complication rates, BCS and AVH in pregnancy are well-tolerated diseases even when they occur together. KEY WORDS: acute viral hepatitis, brucellosis, pregnancy INTRODUCTION Brucellosis (BCS) is rare in pregnancy. There is controversy about the relationship between BCS and the outcome of pregnancy [1] . In Turkey, BCS is common, especially in the Middle, East and Southeast Anatolia regions. According to reports from the Turkish Ministry of Health, 37 cases were reported in 1970, with numbers rising to 18,408 cases in 2004 (incidence rate 25.67 / 100, 000) [2] . According to some authors, it is thought that this increase is a result of improvements in diagnosis and increased reporting, rather than a real increase in the prevalence of the disease [3] . Liver test abnormalities and jaundice are also rare in pregnant women and are seen in 0.3 - 3% of pregnancies [4,5] . Acute viral hepatitis (AVH) is the most common cause of jaundice in pregnancy [6-8] . Opinions differ over the maternal and fetal outcome of pregnancies associated with viral hepatitis. The aim of this study was to answer some key questions regarding BCS and AVH during pregnancy and to investigate if the two endemic diseases occurring concurrently during pregnancy could change the normal course of pregnancy. The effect of antibrucellosis treatment in pregnancy was also assessed in the presence of liver dysfunction possibly caused by AVH. SUBJECTS AND METHODS Study settings Diyarbakir is the largest city in Southeastern Turkey. Situated on the banks of the river Tigris, it is the administrative capital of Diyarbakir province, with a population of almost 1.5 million. Diyarbakir State Hospital is the biggest state hospital serving the region. We studied a total of 88 pregnant women admitted to Diyarbakir State Hospital from July 2003 to May 2010. Address correspondence to: Dr. Serda Gulsun, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir State Hospital, Diyarbakir, Turkey 21100.Tel: +905053848993, E-mail: serdagulsun@gmail.com
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