Multiple live leeches from nose in a single patient- a rare entity

Nasal leeches and epistaxis: A case series

Nasal hirudiniasis is uncommon in humans, where a leech invades through the nostrils, adhering to the nasal cavity mucosa. It is rare in urban areas, noted in endemic rural areas, but scarcely documented and, with urbanisation and ecological imbalance has become rarer still. It presents with recurrent epistaxis due to hirudin released by the leech while other symptoms are infinitesimal owing to an analgesic enzyme secreted. A thorough history-taking and examination is of utmost importance as respiratory complications may arise if the leech invades the airways. We present a case series of five patients, within a period of three years.

Esophageal hirudiniasis: an unusual cause of upper gastrointestinal bleeding

Leeches are carnivorous, hermaphroditic, segmented worms mainly found in fresh water. The majority of leech attachments are external and short-lasting. Internal surfaces can be involved. Yet, esophageal attachment is very rare. We report a case of a 59-year-old female who presented with hematemesis, melena and chest pain. Upper gastrointestinal endoscopy revealed a round black foreign body in the mid-third of the esophagus identified as a leech. We carefully extracted the worm with a forceps applied to the middle of its body. The diagnosis of leech infestation should be kept in mind when exploring gastrointestinal bleeding in patients living in rural areas and those with poor living conditions.

First record of infestation by nasal leeches, Limnatis nilotica (Hirudinida, Praobdellidae), from cattle in Italy

In July 2017, twenty cattle of a free-grazing herd were found to be infested with leeches in the mouth. Main signs were bloody sialorrhea and/or a purple-red colour of the lower lip. Leeches, in a variable number (1 to 3) per animal, were found at the lingual frenulum or on the sublingual vestibular mucosa and were morphologically identified as Limnatis nilotica. To the best of our knowledge, this is the first report of cattle infestation by L. nilotica in Italy. Besides recalling the attention to leech infestation and suggesting its inclusion in the differential diagnosis of animals with suggestive signs, this short report also provides practitioners with easy-going morphological keys for proper diagnosis and discrimination among species.

Negative suction approach to remove living leeches from the nasal cavity

OBJECTIVE

To explore a method for removing a living leech from the nasal cavity.

MATERIALS AND METHODS

A total of 5 patients with nasal leech were examined. Nasal endoscopy revealed the presence of a wriggling leech in the nasal cavities of each of these patients. A negative suction tube with an inner diameter of 3 mm and a negative pressure of 30-40 kp was used to remove these leeches. In each case, this suction tube was aimed at the free end of the leech, and the leech was gradually and slowly sucked into the tube. The suckers of the removed leeches were examined to ensure that no leech fragments remained within each patient.

RESULTS

In all 5 cases, the intact leech was successfully removed. No surgical complications occurred.

CONCLUSIONS

The negative suction method can successfully remove nasal leeches.

Epistaxis Due to Leech Infestation in Nose: A Report of Six Cases and Review of Literature

The aim of this study is to report unusual cause of epistaxis due to leech infestation in nose in hilly area and its management. The study was carried out for a period of 4 years (2008-2012) in a secondary level hospital in hilly area of Darjeeling, West Bengal, India with data collected from the OPD and Emergency register of the patients. This retrospective case series consisted of six cases. All the cases presented with unilateral recurrent epistaxis and foreign body nose. Anterior rhinoscopy revealed fleshy greenish brown mobile mass inside the nasal cavity which was removed by forceps. The animate foreign body was identified as leech in all the cases. To conclude, in hilly areas leech infestation can present as animate foreign body in nose and it should be considered as important cause of epistaxis.

Leeches--the good, the bad and the wiggly

Leeches have been making a remarkable come-back in medical practice in recent years, particularly in reconstructive surgery. This paper opens with a brief review of the historical aspects of the medicinal use of leeches and their recent renaissance in modern medical practice. We then embark on a journey through the murky waters of leech infestation and the potentially life-threatening complications arising from close encounters with these extraordinary creatures. Finally, we get to grips with the tricky issue of safely apprehending and removing uninvited hangers-on.

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.

Meta analysis of the leech as a live foreign body: detection, precaution and treatment

Foreign body in the esophagus is a common emergency presentation. Foreign body aspirations comprise the majority of accidental deaths in childhood. Conventional x-ray imaging is usually obtained to aid the diagnosis during the initial evaluation. The decision for surgical intervention is usually based on a suspicious history, physical examination and radiologic findings. Rigid bronchoscopy is very effective procedure for inhaled foreign body removal with fewer complications. Proper use of diagnostic techniques provides a high degree of success and the treatment modality to be used depending on the type of the foreign body is mostly satisfactory. Live foreign body is a rare entity but common emergency presentation. The approach towards a patient with leech infestation comprises a thorough history and systematic examination followed by relevant investigations. However, there is considerable debate over the most appropriate treatment option for such patients. A living foreign body, or parasite, in the oro-or naso-pharynx is rare in Western countries, but in other parts of the world is a fairly common cause of problems. In the past 10 years 28 cases of foreign bodies due to infestation with leeches were treated in our departments. In all patients, 2-70 years old, the complaint was of recurrent episodes of epistaxis, blood-spitting, odynophagia, dysphagia, dyspnea and hemoptysis several days before admission. Examination showed a green-brown mass protruding from different naso- and oro-pharengeal areas, which is in every case, was a blood-engorged leech. Treatment consisted of removing the leech by applying a forceps to the middle of the leech's body and giving a quick pull. Bleeding ceased immediately after removal of the leech. This review aims to develop a comprehensive approach towards patients presenting with foreign body ingestion by developing clinical practice guidelines. These guidelines address not only the initial evaluation of the patient but also the various management alternatives and their advantages, limitations and applicability in various scenarios, based upon a review of the literature.

Nasal leech infestation in children: comparison of two different innovative techniques

OBJECTIVE

The objective of this study is to compare the results of two different techniques in removing nasal leech infestation.

MATERIAL AND METHODS

This prospective study was carried out in 40 patients attending Department of ENT and Head and Neck Surgery, TU Teaching Hospital, Kathmandu, with the history suggestive of nasal leech infestation. Patients enrolled between April 2004 and December 2008 were studied. Patients were arranged randomly into two groups. In the first group of patients, anterior rhinoscopy was done and suction was used to remove the leech from nasal cavity. While in second group, water was poured into the kidney tray and adjusted 1cm below the nasal vestibule. As soon as the leech was seen in the nasal vestibule coming towards the water, they were catched with artery forceps. Both groups were compared in the following items: time taken to remove the leech, bleeding status, pain assessment and patient's/caretaker's satisfaction. Unpaired t test was applied to compare the time taken in removing leeches in both groups.

RESULTS

In the first group of patients using suction, the mean duration of removal of leech was 18.25 min while in second group of patients, it was 30.25 min. Bleeding and pain was present in the first group of patients. All children were not satisfied with this technique in first group of patients. Around 70% of the patients wanted an easier option to remove the leech from nasal cavity.

CONCLUSION

Wait and watch policy (keeping the water in kidney tray just below the nasal vestibule) is a better technique because of less pain and less blood loss with full satisfaction to the patients and caretakers, though it is more time consuming.