ACTINOMYCOSIS

Introduction:

Actinomycosis ek chronic bacterial infection hai jo 'Actinomyces' bacteria se hota hai. Ye bacteria filamental, gram-positive hote hain, jo aam taur pe mouth, digestive system, aur female genital tract mein paye jaate hain. Lekin jab mucous membrane damage hoti hai, jaise dental surgery, abdominal injury, ya IUD use karne ke baad, to infection shuru ho sakta hai.

Actinomycosis kaise develop hota hai:

Ye infection dheere dheere tissues mein failta hai aur abscesses aur sinus tracts banata hai. Kabhi kabhi is infection ke discharge mein sulfur granules (chhoti yellow particles) bhi dekhe ja sakte hain. Ye infection alag-alag jagah affect kar sakta hai jaise face (cervicofacial), chest (thoracic), ya abdomen aur pelvis. Isko diagnose karna mushkil hota hai kyunki ye tumors ya tuberculosis jaisi bimariyon jaise lagta hai.

Common types:

1. Cervicofacial Actinomycosis (Lumpy Jaw): Ye sabse common type hai aur aksar poor dental hygiene ya oral surgery se judta hai. Jaw mein swelling hoti hai, fistulas ban jaate hain, aur pus discharge hota hai jisme sulfur granules hoti hain.

2. Thoracic Actinomycosis: Ye lungs ko affect karta hai, aksar bacteria inhale karne ke baad. Chest pain, cough, aur kabhi kabhi chest wall pe sinus tracts bhi ban jate hain.

3. Abdominal aur Pelvic Actinomycosis: Surgery ya abdominal injury ke baad hota hai ya phir women mein IUD use ke wajah se hota hai. Abdominal pain, bowel habits mein changes, aur mass ki tarah feel hota hai, jise galat tareeke se cancer samajh liya jaata hai.

Symptoms:

Cervicofacial Actinomycosis: Jaw mein swelling, skin discoloration, sinus discharge, aur chewing mein dikkat.
Thoracic Actinomycosis: Cough, chest pain, shortness of breath, weight loss, aur fever.
Abdominal Actinomycosis: Abdominal pain, nausea, weight loss, aur abdomen mein mass ka sensation.
Pelvic Actinomycosis: Lower abdominal pain, vaginal bleeding ya discharge.

Diagnosis:

Iska diagnosis karna thoda challenging hota hai. Abscesses ya sinus tract se tissue samples lene padte hain aur sulfur granules discharge mein milte hain to infection ka confirmation hota hai. Imaging tests jaise CT scan mass-like infection dikhate hain jo cancer jaise lag sakte hain. Laboratory tests anemia, elevated inflammatory markers show karte hain aur 'Actinomyces' ko cultures mein detect kar sakte hain.

Treatment for Actinomycosis:

Is infection ka treatment antibiotics ke zariye kiya jaata hai. Penicillin G sabse zyada effective hoti hai. Treatment mein high doses antibiotics ka istamaal kiya jaata hai jo 6 mahine se lekar 1 saal tak chal sakta hai. Severe cases mein antibiotics ke saath surgery bhi zaroori ho sakti hai.

Antibiotic Treatment:

1. Penicillin G (Pfizerpen, Bicillin): Severe cases mein pehle intravenous (IV) Penicillin G diya jaata hai. Phir, oral antibiotics jaise Penicillin VK pe switch kiya jaata hai jab tak treatment complete na ho. Treatment 6 se 12 mahine tak chal sakta hai, ye infection ki severity aur response pe depend karta hai.

2. Alternative antibiotics: Agar kisi ko penicillin se allergy ho, to doosre antibiotics ka istamaal kiya jaata hai jaise:

Doxycycline: Ye bacterial protein synthesis ko rokta hai. Penicillin-allergic patients ke liye use hota hai, lekin pregnant women ke liye avoid kiya jaata hai.
Clindamycin (Cleocin): Penicillin-allergic patients ke liye doosra option. Ye bacterial protein synthesis block karta hai, lekin companion bacteria ko cover nahi kar pata.
Amoxicillin/Clavulanic acid (Augmentin): Mild to moderately severe cases mein use hota hai.
Ceftriaxone (Rocephin): Moderate to severe infections mein use hota hai, jaise cervicofacial aur thoracic actinomycosis.
Imipenem/Cilastatin (Primaxin): Severe abdominal ya pelvic infections ke liye kaafi effective hota hai.

Surgical Treatment:

Jahan antibiotics se kaam nahi hota, wahan surgery zaroori ho sakti hai. Surgery ke zariye bade abscesses drain kiye jaate hain, infected tissue remove kiya jaata hai, aur kuch complications jaise fibrotic lesions ko treat kiya jaata hai. Kabhi kabhi abdominal actinomycosis mein patients ki emergency surgery ki zaroorat hoti hai agar peritonitis ya bowel perforation ho jaaye.

Monitoring During Treatment:

Kyuki treatment kaafi lambe time tak chal sakta hai, regular follow-up zaroori hota hai jaise CT scan ya MRI ke zariye infection ka response monitor karna. Blood tests bhi karaye jaate hain recovery aur side effects dekhne ke liye.

Prevention:

Achhi oral hygiene aur regular dental care important hai, khaaskar oral surgery ke baad. Aur IUD use karne wali women ko pelvic actinomycosis ke risk ko dhyaan mein rakhna chahiye.

Complications:

Agar untreated chhoda gaya, to actinomycosis bone infections, brain abscesses, aur endocarditis (heart infection) jaise serious complications tak le ja sakta hai. Lekin early symptoms ko pehchaankar aur prolonged antibiotics course follow karke zyada tar patients achhe se recover karte hain.