Presse Med
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AUTOANTIBODY PRODUCTION: The production of autoantibodies can only occur if immune tolerance is circumvented. Thus drug-induced autoimmune hemolytic anemia requires that the drug have an effect on both autoantigens and on the immune system. AN EXAMPLE, METHYLDOPA: Methyldopa is a hypotensive agent which induces major production of anti-Rh IgG anti-erythrocyte autoantibodies, anti-nuclear antibodies and anti-actin antibodies. ⋯ Hemolysis is however exceptional and is only clinically or biologically perceptible in 1 to 2% of the patients who become immunized. Induced lupus has been reported as have been several dozen cases of drug-induced hepatitis with anti-actin autoantibodies. DRUGS INDUCING HEMOLYTIC ANEMIA: Besides methyldopa, other drugs known to induce hemolytic anemia include levodopa used for Parkinson's disease, mefenamic acid, a nonsteroidal antiinflammatory drug, interferon-alpha, used in chronic viral hepatitis, cyclosporin used for the prevention of graft rejection and the treatment of certain autoimmune diseases, and fludarabin, used in chronic lymphoid leukemia.
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OPTIMAL TREATMENT: Myasthenia is an autoimmune disease related to a recognized autoantigen. Treatment is aimed at providing symptomatic relief or a pathophysiological effect. The latter approach, with corticosteroid and immunosuppressor regimens, has proven to be effective, improving functional improvement, but at the cost of prolonged treatment over several years with the risk of major adverse effects. Indications and treatment modalities must be carefully weighed.
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Case Reports
[Human urinary myiasis caused by Fannia canicularis (Diptera, Muscidae) larvae in Algeria].
Human urinary myiasis is caused by fly larvae which complete their entire cycle in the human body. ⋯ Urogenital myiasis is almost always subsequent to conditions of poor personal hygiene. In this case authentic larvae infestation was evidenced. The diagnosis of true urinary myiasis was confirmed by repeated emissions of different larval stages including the nymph.
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Whipple's disease is a diffuse disease with a wide variety of clinical manifestations. Differential diagnoses include chronic enteritis, chronic joint disease, chronic meningoencephalitis and prolonged fever with weight loss, chronic uveitis and endocarditis with negative blood culture. MOLECULAR DIAGNOSIS: Histologically the characteristic lesions contain PAS-positive inclusions. ⋯ AN EMERGING PATHOGEN: Tropheryma whippelii is a recently identified pathogen highly difficult to culture. Since its discovery, it has been a model of emerging pathogens. Clinical observation, microscope studies, molecular and cellular biology, and bacteriology have all contributed to its recent isolation which should lead to the development of indirect diagnostic techniques [abstract corrected]