Leech Infestation Research Articles

Cystoscopic Removal of Leeches in the Lower Urinary Tract: Our Experience

The purpose of this study is to describe the experience of managing leech infestation in lower urinary tract from a tropical country. Medical records (January 2002 to December 2010) of children with history of leech infestation in the urinary system, admitted in the Department of Pediatric Surgery, Chittagong Medical College & Hospital, Chittagong, Bangladesh were reviewed. All patients underwent saline irrigation through urethral catheter. When saline irrigation failed, cystoscopic examination was done with removal of leeches by flexible graspers. Follow-up was done 2 weeks later. The study included 117 patients. Age ranged from 4 to 12 years. Male and female ratio was 3.7:1. All patients had per urethral bleeding. 51 (43.6%) patients had suprapubic pain. All children underwent saline irrigation through urethral catheter. Spontaneous expulsion occurred after saline irrigation in 57 (48.7%) patients. The expelled leeches were alive in 11 cases; dead in 46 patients. Cystoscopic removal of leeches was done in 60 patients (51.3%). In the cystoscopic group, 54 of the removed leeches were dead and 6 were alive. Cystoscopic removal can be a useful technique for the removal of leeches from the urinary tract when saline irrigation fails.

Leech Infestation in Children Through Body Orifices: Experience in a Hospital in Bangladesh

Bangladesh harbors many leeches in its vast wetlands. Leeches have a tendency to enter through body orifices with potentially life-threatening consequences. Literature search revealed inadequate description of clinical manifestations and treatment of leech infestations in children. We describe our experience with leech infestations in children. Between January 1, 2004 and December 31, 2010, 17 cases of leech infestation through body orifices in children were managed. This is a retrospective study on age, sex, route of leech entry, investigation and treatment, and outcome. Age ranged from 4.5 to 11 years (mean 6.4 ± 1.8) and females accounted for more than 70 %. The orifices of leech entry include urethra, vagina, and rectum. Leeches could be found in eight cases. Two boys with leeches in the urinary bladder needed suprapubic removal. Leeches were retrieved from the vagina under general anesthesia in three cases, and on three occasions leeches came out from the vagina after normal saline instillation. In nine cases with different routes of entry where leech was not found, instillation of normal saline was sufficient to stop bleeding. Fifteen cases presented with bleeding and transfusion was required in five cases with Hb% <7 gm/dl. Leech infestation through lower body orifices is common in children of rural Bangladesh. Prompt diagnosis is of paramount importance, and application of normal saline is effective in most cases. Sometimes surgical intervention is required.

The anti-leech effect of Peganum harmala L. extract and some anti-parasite drugs on Limnatis nilotica

This experimental trial was designed to evaluate the anti-leech effect of methanolic extract of Peganum harmala L. plant as well as niclosamide, albendasole, pyrvinium, furazolidone and sulfadimidine. In an experimental study the methanolic extract of Peganum harmala L. aerial parts was prepared by maceration method and the amount of total phenolic compounds was determined colorimetrically using the Folin–Ciocalteu reagent. Then the severity effect of the compounds was recorded for 720 min and categorized in 5 groups (1 to 5), based on the time to paralyze or kill the leech. The mean death time of leeches in groups treated with niclozamide, sulfadimidine, furazolidone and pyrvinium were 14.77±3.66, 58.33±22.17, and 137.11±37.84 and 320.44±300 min, respectively. Different doses of P. harmala L. methanolic extracts (300, 600, 900, 1200, 1500 and 1800 mg) were ineffective on leeches in 720 min of experiment. Despite of suggestion in Iranian traditional medicine related to the effect of P. harmala L. on leech infestation, the results of this experiment showed that P. harmala L. was ineffective. The niclozamide, sulfadimidine, furazolidone and pyrvinium might be used per se or as complementary treatment in leeches’ infestation.

The anti-leech effect of Peganum harmala L. extract and some anti-parasite drugs on Limnatis nilotica

This experimental trial was designed to evaluate the anti-leech effect of methanolic extract of Peganum harmala L. plant as well as niclosamide, albendasole, pyrvinium, furazolidone and sulfadimidine. In an experimental study the methanolic extract of Peganum harmala L. aerial parts was prepared by maceration method and the amount of total phenolic compounds was determined colorimetrically using the Folin–Ciocalteu reagent. Then the severity effect of the compounds was recorded for 720 min and categorized in 5 groups (1 to 5), based on the time to paralyze or kill the leech. The mean death time of leeches in groups treated with niclozamide, sulfadimidine, furazolidone and pyrvinium were 14.77±3.66, 58.33±22.17, and 137.11±37.84 and 320.44±300 min, respectively. Different doses of P. harmala L. methanolic extracts (300, 600, 900, 1200, 1500 and 1800 mg) were ineffective on leeches in 720 min of experiment. Despite of suggestion in Iranian traditional medicine related to the effect of P. harmala L. on leech infestation, the results of this experiment showed that P. harmala L. was ineffective. The niclozamide, sulfadimidine, furazolidone and pyrvinium might be used per se or as complementary treatment in leeches’ infestation.

Novel Use of a Hemostatic Dressing in the Management of a Bleeding Leech Bite: A Case Report and Review of the Literature

Persistent bleeding from leech bites is a common occurrence, although little evidence is available to guide management. Detailed here is the case of a 30-year-old American man who presented with two leech bites after a trek through the jungle in Nepal, one of which continued to briskly ooze blood despite standard wound care. The wound was ultimately treated with QuikClot gauze, which allowed for rapid hemostasis without rebleeding. This case report describes the first use of a hemostatic dressing for this purpose, and reviews what is known about hemostatic agents and about leeches in order to discuss how they make us bleed and what to do when a leech bite occurs.

Globus Sensation Due to a Mobile Foreign Body in a 41-year-old Female.

Leech infestation could be associated with wide range of complications including epistaxis, stridor, hemoptysis, globus sensation, hematemesis, and vaginal bleeding. In the present case report. , we introduce a case of leech infestation in a 41-year-old female presenting with chronic globus sensation, stridor, vomiting and dysphagia later diagnosed with leech infestation. Therefore, leech bites might be considered as a differential. Diagnosis of globus sensation in the endemic rural areas where in unhealthy water from natural sources is consumed without taking required hygienic precautions.

A Case of Hirudiniasis with Upper Gastrointestinal Bleeding

Leech infestations can lead to several symptoms, including epistaxis, hemoptysis, hematemesis, vaginal bleeding and anemia. A five-year-old male patient presented to the emergency ward with bilateral bleeding from the nose in the form of leakage with a duration of one month, as well as bloody vomiting and blood in the sputum for two days prior to admission. The patient was pale, the nose and oropharyngeal mucosa were pale with fresh leakagetype bleeding and there was a similar clot in the nasopharynx. Laboratory examinations were normal. Examination of the oropharynx and nasopharynx was repeated to assess for active bleeding, and a leech 4x1 cm in size was found in addition to a clot. The leech was detached from the mucosa following administration of a hypertonic saline solution and removed with forceps. Leech infestation should be considered in cases of bleeding and anemia of unknown etiology in patients from rural areas.

Otorrhagia bleeding due to leech bite

Leeches are blood-sucking hermaphroditic parasites that attach to vertebrate hosts, bite through the skin, and suck out blood. When leeches feed, they secrete an anticoagulant (hirudin), which helps them get a full meal of blood. This is the first report of leech removal from external auditory canal. Previous leech involvement cases were explained in nasopharynx, larynx, pharynx, eye, and gastrointestinal tract. Prominent sign of all cases was active bleeding from the leech attachment site; that stopped with leech removal. A 24-year-old man was presented to Al-Zahra hospital with left otorrhagia and otalgia from 2 days ago. After suction of ear a small soft foreign body was seen in the external ear near the tympanic membrane, then the ear filled with glycerine phenice, the patient explained decreased movement of foreign body. Four hours later the bloody discharge stopped and otalgia decreased. After suction of clots, a leech was extruded from external auditory canal by alligator. Leech infestation is a rare cause of otorrhagia and should be suspected in the endemic region in all of unusual bleeding; it can be diagnosed and treated by exact inspection and removal.

Leech therapy for pain relief: Rational behind a notion

Dear Editor, While practicing Neurosurgery in a society invaded by various cultures and neurosurgical philosophies, one should expect facing different traditional remedies in his/her daily practice. A 34-year-old woman with one-year history of left L5 radiculopathy was referred to our outpatient clinic. In physical examination, there were papules seen behind her lateral malleolus from which she was suffering the worst [Figure 1]. She reminded leech therapy performed a couple of weeks before, by a “traditional healer” at her rural area resulting in temporary pain relief. The patient underwent L4/L5 discectomy and the symptoms recovered completely. Similar traditional ways of treatment for sciatica have been reported by the authors from our community,[6] but the question is: “does newly emerging evidence consider any role for leech (Hirudo medicinalis) therapy in pain relief of sciatica?” Figure 1 Appearance of leech therapy behind the lateral malleolus where the most severe pain was felt by the patient The medicinal leech is one of the few examples of the use of invertebrates in the treatment of human diseases. Leech therapy, mentioned as “Jalaukavacharan” in Ayurveda (Hirudotherapy), was used for medicinal “blood-letting” and “purification”, believed to cure a variety of ailments such as gout, skin diseases, blood disorders, alopecia, filariasis, headaches, etc., The use of leech therapy became less widespread toward the end of 19th century but now has emerged again as a widely useful therapy attracting the researchers all over the world. In Ayurveda, its easy applicability without producing any adverse effects is another reason why leech therapy has been used since ancient times.[3] Although leech therapy is known as a therapeutic option in the traditional medicine, some modern indications for leech therapy have also been proposed by Food and Drug Administration (FDA).[7] The exact mechanisms through which leech therapy may exert analgesic effect(s) are not well understood. Besides of a possible placebo effect, leech therapy may exert some direct anti-inflammatory and pain-killing effects through the components of the leech saliva. Platelet-derived growth factor (PGF) is assumed to play an important role in producing the signals of neuropathic pain in spinal cord and inhibition of its release by intrathecal injection of Hirudin has been reported to suppress thermal hyperalgesia and tactile allodynia in mice.[5] We may also hypothesize that the strong sensory stimulus caused by the pain and burning sensation of the leech bite can alleviate the symptoms of the patient through the “gate theory” as well. Some recent randomized controlled trials have shown leech therapy to be effective in knee and metacarpal osteoarthritis.[4,8] Leech therapy has also been successfully applied to treat severe lumbar pain due to cancer.[2] These local effects can be due to the anti-inflammatory effects of substances in the leech saliva other than Hirudin, such as histamine-like vasodilators, kallikrein and tryptase inhibitors. Also, the role of thrombin in pain-control mechanisms is suggested by some researchers,[1] while Hirudin itself exerts some anti-inflammatory effects by inhibiting thrombin.[1] Considering far advanced methods of treatment available nowadays, this mode of therapy may look redundant. However, in medically high-risk/aged patients and those reluctant to undergo surgery, less aggressive treatments including leech therapy can be assumed as a temporary solution. Further studies to evaluate effectiveness of leech therapy in lumbago and sciatica are warranted.

Allium sativum L.: the anti-immature leech (Limnatis nilotica) activity compared to Niclosomide

This study was carried out to determine the effects of methanolic extracts of Allium sativum L. on Limnatis nilotica compared with Niclosomide. In this experimental study in September 2010, a number of leeches (70 in total) from the southern area of Ilam province were prepared, and the effects of methanolic extract of A. sativum L. with Niclosomide as the control drug were compared and distilled water was evaluated as the placebo group which investigated L. nilotica using anti-leech assay. The average time of paralysis and death of L. nilotica for Niclosomide (1,250 mg/kg) and the methanol extract of A. sativum L. (600 μg/ml) were 6.22 ± 2.94 and 68.44 ± 28.39 min, respectively. Distilled water and garlic tablets at a dose of 400 mg were determined as the inert group. In this research, the attraction time of the leeches’ death among different treatments is significant. In this study, it was determined that Niclosomide, with an intensity of 4+, and methanolic extracts of A. sativum L., with an intensity of 3+, have a good anti-leech effect and can be shown to be effective in cases of leech biting, while distilled water was negative.

Evaluating the anti-leech (Limnatis nilotica) activity of methanolic extract of Allium sativum L. compared with levamisole and metronidazole

This study was carried out to detect the effects of methanolic extracts of Allium sativum L. on Limnatis nilotica. In this experimental study in September 2010, a number of leeches (70 in total) from the southern area of Ilam province were prepared, the effects of the methanolic extract of A. sativum L. with levamisole and metronidazole as the control drugs were compared, and distilled water was evaluated as the placebo group which investigated L. nilotica using anti-leech assay. The average time of paralysis and death of Limnatis nilotica for Metronidazole, methanol extract of Allium sativum L. and Levamisole was 718.77 ± 66.3 min, 5.11 ± 1.76 min and 144.55 ± 57.217 min, respectively. Distilled water and garlic tablets at a dose of 400 mg were determined as the inert group. In this research, the attraction time of death of leeches among different treatments is significant. In this study, it was determined that levamisole, with an intensity of 4+, and methanolic extracts of A. sativum L., with an intensity of 2+, have a good anti-leech effect and can be shown to be effective in cases of leech biting, while metronidazole and distilled water were negative.

Leech (Limnatis nilotica) causing respiratory distress in a pregnant cow in Ilam province in Iran

IntroductionLeeches, a hermaphroditic, blood-sucking parasite arerarely reported in humans and animals as a cause of manyproblems. They vary in color, length and shape, and may beblack, brightly colored, or mottled. The leeches mainlyinhabit in ponds, lakes, and streams. The Limnatis niloticaspecies is a blood-sucking parasite that lives in stagnantwater in ponds and lakes. The strong jaws and muscularsuckers at the anterior and posterior ends of L. nilotica arethe main sign for detection. This species is commonlyfound existing in Southern Europe, North Africa, and theMiddle East including Iran (Bahmani et al. 2006). Theseleeches live in hosts and can cause anemia and may act asvectors of animal pathogens. The main symptoms includehaemoptysis, snoring, dyspnea, cough, dysphagia, andbleeding from the vagina (Bani Ismail et al. 2007;Estambale et al. 1992; Grosser and Pesic 2006; Yaghmaee2000). Hirudiniasis is not common in animal and human,but sporadic reports of leech infestations in humans andanimals are available from the Middle East and adjoiningcountries. In some reports in human beings, leeches as aforeign body and parasite in the respiratory tract havebeen reported, and in animals, leeches infesting the nasalcavity were reported in one camel in Iraq (Al-Ani andAl-Shareefi1995; Cheikh-Rouhou et al. 2000). In this study,a 3-year-old pregnant cow referred to a private clinic in theDehloran suburbs in Iran with acute respiratory distress andinappetite.Case reportA 3-year-old pregnant cow referred to a private clinic in theDehloran suburbs in Iran with acute respiratory distress andinappetite. The history of the case revealed that the mainfeed of the cow had been hay and grazing in pasture, andfor drinking water, a stream and sump were used 48 hprevious to the time of referral; the cow displayed severediscomfort, with little appetite, abnormal breathing, andrespiratory sounds. The case had no background of anydisorder. Examination of the case showed increasingrespiratory rates, bleeding from the mouth, and reluctanceto walk.The temperature, heart rate, and respiratory rate wereincreased slowly. Rectal examination manifested noabnormal signs and the fetus palpated and was alive.The mouth of the cow was fully opened, and the mouthcavity was fully explored. One leech was found attachedto the right-side cheek and tongue (Fig. 1). The leecheswere removed by using forceps carefully without theprescription of any drugs, and after examination, thespecies of leech was identified asL. nilotica.Thestrongjaws and muscular suckers at the anterior and posteriorends, the dark-green color surface with rows of greenspots on the dorsal surface, and yellowish-orange anddark-green bands on either side with a 100-mm lengthwere the main signs for detection of L. nilotica species.Investigations revealed that the animal used to drink waterfrom a nearby pond that had rainwater. The owner of thepresent case was educated not to allow the other animalsto drink water from the infested pond.

Prolonged venous bleeding due to traditional treatment with leech bite: a case report

IntroductionThe medicinal leech, Hirudo medicinalis, has been used in the treatment of many diseases for thousands of years. In Turkey, it is used most commonly in the management of venous diseases of lower extremities.Case presentationA 25-year-old Turkish woman presented to our emergency room with bleeding from her left leg. She had been treated for varicose veins in her lower extremities with leeches about 24 hours before admission to the emergency room. The bleeding was controlled by applying pressure with sterile gauze upon the wound, and she was discharged. She returned after four hours having started bleeding again. Hemostasis was achieved by vein ligation under local anesthesia.ConclusionsLeech bite should be evaluated as a special injury. Prolonged bleeding can be seen after leech bites. In such cases, hemostasis either with local pressure or ligation of the bleeding vessel is mandatory.

Leech Infestation of the Nasopharynx; A Rare Cause of Epistaxis and Hemorrhage

In this case report we present a live leech in the nasopharynx of a 14 years old male that caused symptoms of oral hemorrhage and epistaxis. Habitual drinking of water from spring appeared to cause leech infestation. The leech was removed endoscopically after 4% pantocain and oxmetazolin application. Leech infestation must be kept in mind in the differential diagnosis of unusual respiratory distress, epistaxis, oral hemorrhage and hemoptysis especially on those who are living in rural areas where drinking water from springs is a habit.

Leptospirosis: pulmonary hemorrhage in a returned traveller

A previously healthy 33-year-old man experienced fever and general malaise seven days after returning from northeastern Malaysia. He had trekked in the jungle, swam in fresh water, consumed iodine-purified water and sustained many mosquito and leech bites during his three-week vacation. He had

Chromoblastomycosis after a leech bite complicated by myiasis: a case report

BackgroundChromoblastomycosis is a chronic mycotic infection, most common in the tropics and subtropics, following traumatic fungal implantation.Case presentationA 72 year-old farmer was admitted to Luang Namtha Provincial Hospital, northern Laos, with a growth on the left lower leg which began 1 week after a forefoot leech bite 10 years previously. He presented with a cauliflower-like mass and plaque-like lesions on his lower leg/foot and cellulitis with a purulent tender swelling of his left heel. Twenty-two Chrysomya bezziana larvae were extracted from his heel. PCR of a biopsy of a left lower leg nodule demonstrated Fonsecaea pedrosoi, monophora, or F. nubica. He was successfully treated with long term terbinafin plus itraconazole pulse-therapy and local debridement.ConclusionsChromoblastomycosis is reported for the first time from Laos. It carries the danger of bacterial and myiasis superinfection. Leech bites may facilitate infection.

Nasal leech infestation causing persistent epistaxis

Foreign bodies in the nasal cavity are commonly encountered as a cause of epistaxis; however, nasal leech infestation as a cause of unilateral persistent epistaxis is very rare. Examination of nasal cavity revealed fleshy material in the left nostril, which was identified as leech. The leech was removed with the help of an artery forceps following irrigation of the left nostril with normal saline and adopting wait-and-watch policy. In developing countries, leech infestation as a cause of epistaxis should be suspected in patients with lower socioeconomic status or in those living in rural areas who give history of drinking polluted water from, or bathing in, stagnant ponds and puddles.

Rectal bleeding due to leech bite: a case report

We present herein a case with a four-day history of fresh rectal bleeding due to leech bite. The cause was found to be a leech in the rectum by anoscope. This pathological condition is extremely rare in urban areas. Leech endoparasitism, although rare, may cause serious, even lethal, complications. Suspicion of leech infestation should be kept in mind when faced with intermittent or severe rectal bleeding in humans, and should be investigated surgically as with all other foreign bodies. In the current study, we present a patient who admitted with rectal bleeding due to leech bite. The leech was removed by hand examination (by forceps) without requiring any surgical attempt.

Oropharyngeal Leech Infestation and Therapeutic Options

This is a case report about a rare oropharyngeal foreign body causing oropharyngeal symptoms such as sore throat, dysphagia and hemoptysis. We reported a 7 year-old boy who had ingested a leech from a bottle which had been filled with water and it had attached to the palate within 4 days. The leech was identified as approximately 3 cm in length. Leech was removed under premedication by using monopolar cauterization. Although child infestation by a leech in the upper respiratory tract is very rare, it should be investigated when contaminated liquids are ingested. Electro cauterization should be borne in mind as a therapeutic option in the treatment of leech infestations in the upper respiratory tract under pre-medication in pediatric patients.

A Rare Cause of Epistaxis, Hemoptysis and Anemia: Leech in the Nasopharynx

Leeches are blood-sucking endoparasites that can be seen in different colors and sizes. Leech infestation is endemic in tropical regions like Mediterranean countries, Africa and Asia. Leeches enter the human body when the polluted water is drunk, and they localize in the mucosa of the oropharynx, nasopharynx, tonsils, esophagus or nose but rarely in larynx. Depending on its localisation in the body, the leech which attaches firmly on the mucosa secretes an anticoagulant substance called hirudin and may cause different clinical symptoms such as epistaxis, hemoptysis or hematemesis. A dark colored and moving foreign body in nasopharynx was observed in the endoscopic examination of three cases of 12 to 70 years of age who were applied to our emergency department with complaints of epistaxis, nasal obstruction and hemoptysis lasting for about a month. All three cases were from rural areas and used well water as drinking water . They were treated by immediate removal of the foreign body using forceps, and it was detected to be a species of leech. Following this procedure, all three cases recovered uneventfully. Although leeches are rarely observed in the respiratory system, it may occasionally cause life-threatening complications if it is not accurately diagnosed. Therefore, leech infestation should be considered as a cause of unexplained hemoptysis, epistaxis or anemia in leech-endemic areas. A definitive diagnosis can be made by endoscopic assessment. doi:10.4021/jmc41e