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Vargas N, Lieberman B, Hwang L, Badner V. Hirudotherapy for Venous Congestion in an Almost Completely Avulsed Earlobe without Microsurgical Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5030. [PMID: 37250836 PMCID: PMC10219735 DOI: 10.1097/gox.0000000000005030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 04/06/2023] [Indexed: 05/31/2023]
Abstract
Venous congestion is a frequent and challenging complication after re-attachment or replantation of avulsed tissues, body parts, and flaps. It is often the reason for failure. One of the successful therapies to prevent and/or treat venous congestion is the use of medicinal leeches. There is sound evidence for its efficacy in plastic and reconstructive surgery for avulsed body parts or flaps. However, there is not enough evidence for its use in ear reconstruction or replantation, especially regarding the fragile tissue of the earlobes. The current study is the first in the literature to describe the use of hirudotherapy for venous congestion in an almost completely avulsed earlobe without microsurgical blood vessel repair, as a last resort in an otherwise healthy 38-year-old male patient who sustained trauma due to physical assault.
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Affiliation(s)
- Nikoletta Vargas
- From the Department of Dentistry, Albert Einstein College of Medicine, New York, N.Y
- Oral and Maxillofacial Surgery, Jacobi Medical Center, Bronx, N.Y
| | - Benn Lieberman
- From the Department of Dentistry, Albert Einstein College of Medicine, New York, N.Y
- Oral and Maxillofacial Surgery, Jacobi Medical Center, Bronx, N.Y
| | - Lyahn Hwang
- Department of Plastic and Reconstructive Surgery, Montefiore Medical Center, New York, N.Y
| | - Victor Badner
- From the Department of Dentistry, Albert Einstein College of Medicine, New York, N.Y
- Oral and Maxillofacial Surgery, Jacobi Medical Center, Bronx, N.Y
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Vaesken C, Besnier P, Bernardeau C, Garmi R, Malherbe M, Mouet A, Michon J, Muzard A, Isnard C, Bazin I, Saint-Lorant G. Improvement of patient care through hirudotherapy and the management of leeches from their reception to their disposal in France. Eur J Hosp Pharm 2023; 30:e61-e65. [PMID: 35501036 PMCID: PMC10086708 DOI: 10.1136/ejhpharm-2021-003100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/12/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Medicinal leech therapy - known as hirudotherapy (HT) - is an empirical medical technique that has become popular again in reconstructive surgery. However, at each step of leech management there are risks for blood contamination of the caregivers and severe infections for patients. This reduces the success of the treatment. The aim of this study was to improve the management of leeches from ordering to disposal to improve patient care. METHODS First, a review of the literature was performed. Second, we conducted a retrospective study of patients' antibiotic prophylaxis from January 2018 to December 2019. The data we collected were patient characteristics, the specific care unit at the hospital, indication, contra-indication, posology, duration of HT, number of leeches delivered, antibiotic prophylaxis prescribed and microbial organism, if identified. Third, an interdisciplinary meeting was organised to review the entire leech circuit: ordering, maintenance, prescription, dispensing, application and disposal. RESULTS At the end of the literature review, six articles based on practices implemented in France were selected for inclusion. These articles discussed antibiotic prophylaxis, iron supplementation, and leech storage, application and disposal. On the retrospective study performed, antibiotic prophylaxis for HT was performed for 60% (30/50) of patients, 77% (23/30) of the prescriptions followed the recommendations for antibiotic prophylaxis, and 20 patients did not receive antibiotic prophylaxis. The interdisciplinary meeting made it possible to define a collegially validated protocol, containing a computerised antibiotic prophylaxis prescription, including per os ciprofloxacin antibiotic prophylaxis, intravenous iron supplementation and biological monitoring. A leech application protocol was created, and the method of leech disposal was revised. CONCLUSION Despite the absence of clear guidelines and heterogeneous practices, this study reveals the importance of a standard procedure including leech management practices before use, antibiotic prophylaxis and application and disposal guides. The interdisciplinary protocol allows improved patient care management and makes leech management safer for caregivers.
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Affiliation(s)
| | | | | | - Rachid Garmi
- Maxillofacial Surgery Department, CHU Caen, Caen, France
| | | | | | | | | | | | - Isaline Bazin
- Orthopaedic Surgery Department, CHU Caen, Caen, France
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A Novel Aeromonas popoffii Phage AerP_220 Proposed to Be a Member of a New Tolavirus Genus in the Autographiviridae Family. Viruses 2022; 14:v14122733. [PMID: 36560737 PMCID: PMC9780818 DOI: 10.3390/v14122733] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/22/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
Aeromonas popoffii is one of the environmental Aeromonas species. A number of factors of virulence have been described for this species and it has been reported as a causative agent of urinary tract infection. The first A. popoffii bacteriophage AerP_220 along with its host strain A. popoffii CEMTC 4062 were isolated from river water. The phage has a podovirus morphotype, shows a narrow host range and is lytic against the host strain. The AerP_220 genome comprises 45,207 bp and does not contain genes responsible for antibiotic resistance and toxin production. Fifty-nine co-directional putative ORFs were found in the AerP_220 genome. Thirty-three ORFs encoded proteins with predicted functions; the products of 26 ORFs were hypothetical proteins. AerP_220 genome analysis revealed that this phage can be considered a novel species within the Autographiviridae family. Comparative genomic and proteomic analysis revealed that AerP_220 along with the Aeromonas phage vB_AspA_Tola (OM913599) are members of a new putative Tolavirus genus in the family Autographiviridae. The Gajwadongvirus and proposed Tolavirus genera along with Pantoea phage Nufs112 and phage Reminis could form a new Tolavirinae subfamily within the Autographiviridae family.
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McCracken JA, Koehler SM, Sharma R. Rethinking antimicrobial prophylaxis in patients receiving medicinal leech therapy. Am J Health Syst Pharm 2021; 79:e14-e19. [PMID: 34390241 DOI: 10.1093/ajhp/zxab330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE To describe challenges in the management of prophylaxis against infections for patients receiving medicinal leech therapy given changes in antimicrobial resistance patterns in the normal flora of leeches. SUMMARY This article presents a patient case of reconstructive surgery complicated by infection associated with the use of medicinal leeches, as well as a discussion of prophylaxis in medicinal leech therapy, focusing on considerations for choosing a prophylactic agent. CONCLUSION Our case report highlights resistance changes in Aeromonas isolates associated with medicinal leeches and the potential for complications if isolates resistant to chosen prophylactic agents arise. When administering antimicrobial prophylaxis in patients receiving medicinal leech therapy, clinicians should be familiar with the susceptibilities of Aeromonas species but also conscious of evolving antimicrobial resistance given the extent of the consequences of infected surgical grafts.
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Affiliation(s)
- James Andrew McCracken
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Steven M Koehler
- Department of Surgery, University Hospital of Brooklyn, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Roopali Sharma
- Department of Pharmacy, University Hospital of Brooklyn, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Reconstruction of traumatic hand defects with shunt-restricted arterialised venous flaps — a surgical process flow and our experience. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01819-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Palm NM, Wesolowski JC, Wu JY, Srinivas P. Implementation of a Leeches + Antimicrobial Prophylaxis Order Panel to Optimize Medicinal Leech Use at a Tertiary Care Academic Medical Center. J Pharm Pract 2021; 35:427-430. [PMID: 33563061 DOI: 10.1177/0897190021993683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Medicinal leech therapy promotes vascular flow and can be used to salvage grafts. Medicinal leeches have a symbiotic relationship with Aeromonas species and can therefore present a risk of bacterial transmission to patients. Antimicrobial prophylaxis is warranted for the duration of leech therapy, however, an institutional evaluation of 40 patients receiving medicinal leech therapy demonstrated poor adherence with recommendations. An electronic medical record order panel for antimicrobial prophylaxis with medicinal leech therapy was implemented, leading to a subsequent improvement in adherence to prophylaxis use, including significant increases in the ordering of antibiotics and the appropriate timing of initiation in the subsequent 10 patients receiving medicinal leech therapy after panel implementation. Aeromonas infections were rare before and after panel implementation, and developed only in the patient subset with non-optimized prophylaxis.
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Affiliation(s)
- Nicole M Palm
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
| | | | - Janet Y Wu
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
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Masters MC, Gupta AR, Rhodes NJ, Flaherty JP, Zembower TR, Alghoul M, Krueger KM. Multidrug resistant Aeromonas infection following medical leech therapy: A case report and development of a joint antimicrobial stewardship and infection prevention protocol. J Glob Antimicrob Resist 2020; 23:349-351. [PMID: 33137533 DOI: 10.1016/j.jgar.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/13/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Aeromonas sp. infections are a recognized complication of medical leech therapy (MLT). In patients requiring MLT, ciprofloxacin or trimethoprim-sulphamethoxazole are commonly used to prevent such nosocomial infections. After a patient at our institution developed a MLT-associated multi-drug resistant (MDR) Aeromonas infection, we developed and evaluated a joint antimicrobial stewardship and infection prevention protocol for MLT at our institution. METHODS We describe a case of a surgical site infection with MDR Aeromonas following MLT that was resistant to typically prescribed prophylactic antimicrobials, and development of a new leech culture protocol to proactively monitor for antimicrobial resistance among our institution's leech supply. We also report the rates of MLT-associated infections prior to and following implementation of this protocol and the antimicrobial susceptibility profiles detected in leech culture at our institution. RESULTS Between October 2014 and February 2018, 46 patients received MLT at our institution. Other than the case described in this report, no other instances of MLT-related infections were noted during this time period. Culture results from 22 leeches in six batches since February 2018 showed that all were susceptible to ciprofloxacin, TMP-SMX, and ceftriaxone. Since initiation of a leech culture protocol, no further cases of MLT-associated infections have been reported at our institution. CONCLUSIONS In light of increasing antimicrobial resistance and the potentially devastating consequences of MLT-associated infections, institutions offering MLT should be aware of these risks and ensure that protocols are in place to minimize infection risks for patients.
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Affiliation(s)
- Mary Clare Masters
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Aakash R Gupta
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nathaniel J Rhodes
- Department of Pharmacy, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, IL, USA; Pharmacometrics Center of Excellence, Midwestern University Chicago College of Pharmacy, Downers Grove, IL, USA
| | - John P Flaherty
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Teresa R Zembower
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Pathology, Clinical Microbiology Laboratory, Northwestern University Feinberg School of Medicine, USA
| | - Mohammed Alghoul
- Division of Plastic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karen M Krueger
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Singh SK, Rajoria K. Medical leech therapy in Ayurveda and biomedicine - A review. J Ayurveda Integr Med 2020; 11:554-564. [PMID: 30709686 PMCID: PMC7772495 DOI: 10.1016/j.jaim.2018.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 09/28/2018] [Accepted: 09/30/2018] [Indexed: 11/20/2022] Open
Abstract
Medicinal leech therapy or Hirudino therapy have roots back in ancient civilization. It was a prevalent form of therapy in various ailments. The novel Ayurveda text Sushruta Samhita devoted a complete chapter on hirudino therapy. In the early 20th century this therapy had a major setback due to origin and evolution of antibiotics. There was a discontinuity in the flow of knowledge about this therapy. Then, resumed and revived after few recent decades, due to its contribution in reconstructive surgeries. During this period, the research work on various aspects have been conducted. The present paper summarizes the various aspects of medicinal leech therapy both from Ayurveda text and the present knowledge and to enable the fraternity to use the both source for benefits of humankind.
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Affiliation(s)
- Sarvesh Kumar Singh
- Department of Panchakarma, National Institute of Ayurveda, Jaipur, Rajasthan, India.
| | - Kshipra Rajoria
- Department of Panchakarma, National Institute of Ayurveda, Jaipur, Rajasthan, India
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Lemke S, Vilcinskas A. European Medicinal Leeches-New Roles in Modern Medicine. Biomedicines 2020; 8:biomedicines8050099. [PMID: 32349294 PMCID: PMC7277884 DOI: 10.3390/biomedicines8050099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/18/2020] [Accepted: 04/24/2020] [Indexed: 11/16/2022] Open
Abstract
Before the advent of modern medicine, natural resources were widely used by indigenous populations for the prevention and treatment of diseases. The associated knowledge, collectively described as folk medicine or traditional medicine, was largely based on trial-and-error testing of plant extracts (herbal remedies) and the use of invertebrates, particularly medicinal maggots of the blowfly Lucilia sericata and blood-sucking leeches. The widespread use of traditional medicine in the West declined as scientific advances allowed reproducible testing under controlled conditions and gave rise to the modern fields of biomedical research and pharmacology. However, many drugs are still derived from natural resources, and interest in traditional medicine has been renewed by the ability of researchers to investigate the medical potential of diverse species by high-throughput screening. Likewise, researchers are starting to look again at the benefits of maggot and leech therapy, based on the hypothesis that the use of such animals in traditional medicine is likely to reflect the presence of specific bioactive molecules that can be developed as drug leads. In this review, we consider the modern medical benefits of European medicinal leeches based on the systematic screening of their salivary proteins.
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Affiliation(s)
- Sarah Lemke
- Institute for Insect Biotechnology, Justus-Liebig-University Giessen, Heinrich-Buff-Ring 26-32, D-35392 Giessen, Germany;
| | - Andreas Vilcinskas
- Institute for Insect Biotechnology, Justus-Liebig-University Giessen, Heinrich-Buff-Ring 26-32, D-35392 Giessen, Germany;
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Department of Bioresources, Ohlebergsweg 12, D-35392 Giessen, Germany
- Correspondence:
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Liu Z, Tong X, Su Y, Wang D, Du X, Zhao F, Wang D, Zhao F. In-depth profiles of bioactive large molecules in saliva secretions of leeches determined by combining salivary gland proteome and transcriptome data. J Proteomics 2019; 200:153-160. [DOI: 10.1016/j.jprot.2019.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 01/01/2023]
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Leeching as Salvage Venous Drainage in Ear Reconstruction: Clinical Case and Review of Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 6:e1820. [PMID: 30881774 PMCID: PMC6414113 DOI: 10.1097/gox.0000000000001820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/16/2018] [Indexed: 11/26/2022]
Abstract
Background Ear avulsion is a rare complication of different traumas, such as car accidents, human or animal bites and stab wounds, and can result in dramatic cosmetic consequences for the patient. Ear replantation, revascularization, and reattachment are the options offering best aesthetic results. But venous outflow insufficiency is responsible for a high rate of failures. Leeching is one the most efficient methods to relieve venous congestion. It has been used as an alternative venous outflow in case of severe impairment of the physiologic one. Methods We present a case of successful rescue of a congested reattached ear by leeching after subtotal avulsion, along with a review of the literature on cases of avulsed auricle reconstruction salvaged by hirudotherapy. Data were collected and analyzed to identify a best regimen to deal with venous congestion. Results More than 130 cases of avulsed auricle savage are described in the literature, in a fourth of which leech therapy was used in the management of venous congestion. Discussion In case of both venous outflow deficit or absence, leeches are a potentially successful option to correct the congestion while new veins reestablish normal physiology. The need for anticoagulant/antiaggregant therapy, antibiotics, and often blood transfusion are the main pitfalls of leeching. Conclusion Leeches can be considered a salvage method for ear replantation and reattachment in those cases that lack venous outflow in the presence of valid arterial inflow.
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Aktaş H, Hamidi AA, Ertuğrul G, Erol H. A case of cutaneous pseudolymphoma induced by medicinal leech application and review of the literature. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2018. [DOI: 10.25000/acem.434115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Grau D, Masson R, Villiet M, Lamy B. Leech management before application on patient: a nationwide survey of practices in French university hospitals. Antimicrob Resist Infect Control 2018; 7:19. [PMID: 29441201 PMCID: PMC5800073 DOI: 10.1186/s13756-018-0311-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/30/2018] [Indexed: 03/26/2023] Open
Abstract
Background Leech therapy in plastic/reconstructive microsurgery significantly improves a successful outcome of flap salvage but the drawback is a risk of severe infection that results in a drop of the salvage rates from 70-80% to below 30%. We report the results of a national survey conducted in all the French university hospitals to assess the current extent of use of leech for medical practices in the hospital and to investigate maintenance, delivery practices and prevention of the risk of infection. Methods Data concerning conditions of storage, leech external decontamination, microbiological controls, mode of delivery and antibiotic prophylaxis were collected from all the French university hospitals in practicing leech therapy, on the basis of a standardized questionnaire. Results Twenty-eight of the 32 centers contacted filled the questionnaire, among which 23 practiced leech therapy, mostly with a centralized storage in the pharmacy; 39.1% of the centers declared to perform leech external decontamination and only 2 centers recurrent microbiological controls of the water storage. Leech delivery was mostly nominally performed (56.5%), but traceability of the leech batch number was achieved in only 39.1% of the cases. Only 5 centers declared that a protocol of antibiotic prophylaxis was systematically administered during leech therapy: either quinolone (2), sulfamethoxazole/trimethoprim (2) or amoxicillin/clavulanic acid (1). Conclusions Measures to prevent infectious complications before application to patient have to be better applied and guidelines of good practices are necessary.
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Affiliation(s)
- Delphine Grau
- 1Department of Clinical Pharmacy, CHU de Montpellier, 371, Avenue du Doyen Gaston Giraud, 34090 Montpellier, France.,2UMR 5569 HSM, Team "Pathogènes Hydriques Santé et Environnements", Unit of Bacteriology, Faculté de Pharmacie, Montpellier, France
| | - Raphaël Masson
- 3Department of internal medicine and geriatrics, HUG de Genève, Genèva, Switzerland
| | - Maxime Villiet
- 1Department of Clinical Pharmacy, CHU de Montpellier, 371, Avenue du Doyen Gaston Giraud, 34090 Montpellier, France
| | - Brigitte Lamy
- 4Department of Clinical microbiology, CHU de Nice, Nice, France.,5Inserm U1065, Centre Méditerranéen de Médecine Moléculaire, Team « Microbial toxins in host pathogen interactions », Nice, France.,6Université de Nice-Sophia Antipolis, Faculté de Médecine, Nice, France
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Macias D, Kwon DI, Walker PC, Peterson NR. Microvascular replantation of a composite facial avulsion in a 24-month-old child after dog bite. Microsurgery 2017; 38:218-221. [PMID: 29230869 DOI: 10.1002/micr.30275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/16/2017] [Accepted: 11/10/2017] [Indexed: 11/11/2022]
Abstract
Dog bite injuries are common sources of morbidity with an estimated incidence of 4.5 million bites per year with over 350,000 requiring treatment in the emergency room. Children under the age of 14 are most likely to be affected with a peak age of 5-9 years old. We report a case of a 24-month-old female who sustained a large composite facial avulsion injury from a pit bull dog bite. The avulsed tissue involved a substantial portion of the patient's mid-face, including the entire soft tissue of the nose, upper lip, part of the left cheek, and left oral commissure. Artery-only microvascular replantation was performed because no recipient vein could be identified from the facial defect. Medicinal leech therapy was used for eight days postoperatively to prevent venous congestion. The patient experienced significant blood loss due to leech therapy and required nearly 29 L of blood product replacement. At the last follow up of 8 months postoperatively, the patient was recovering well with significant improvement in function and cosmesis of the mid-face. This case describes a successful artery-only replantation of an avulsive bite injury to the face of a young child. Despite the technical difficulty of cases such as this one, microvascular replantation should be attempted because when successful it provides a superior cosmetic and functional result to other reconstructive techniques.
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Affiliation(s)
- David Macias
- Loma Linda University School of Medicine, Loma Linda, California
| | - Daniel I Kwon
- Loma Linda University Department of Otolaryngology, Head and Neck Surgery, Loma Linda, California
| | - Paul C Walker
- Loma Linda University Department of Otolaryngology, Head and Neck Surgery, Loma Linda, California
| | - Nathaniel R Peterson
- Loma Linda University Department of Otolaryngology, Head and Neck Surgery, Loma Linda, California
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Ruppé E, Cherkaoui A, Wagner N, La Scala GC, Beaulieu JY, Girard M, Frey J, Lazarevic V, Schrenzel J. In vivo selection of a multidrug-resistant Aeromonas salmonicida during medicinal leech therapy. New Microbes New Infect 2017; 21:23-27. [PMID: 29204282 PMCID: PMC5709350 DOI: 10.1016/j.nmni.2017.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/15/2017] [Accepted: 10/04/2017] [Indexed: 12/18/2022] Open
Abstract
We report the selection in a 15-year-old boy of a multidrug-resistant, extended-spectrum β-lactamase (ESBL)-producing Aeromonas salmonicida after medicinal leech therapy that required an antibiotic prophylaxis based on piperacillin/tazobactam and cotrimoxazole. Whole genome sequencing of the strain indeed revealed 13 antibiotic resistance genes, including the ESBL CTX-M-3 and the unusual β-lactamase SCO-1.
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Affiliation(s)
- E Ruppé
- Genomic Research Laboratory, Division of Infectious Diseases, Switzerland
| | - A Cherkaoui
- Bacteriology Laboratory, Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Switzerland
| | - N Wagner
- Pediatric Infectious Diseases, Department of Pediatrics, Switzerland
| | - G C La Scala
- Division of Pediatric Surgery, Department of Pediatrics, Switzerland
| | - J-Y Beaulieu
- Hand Surgery Unit, Division of Orthopedic Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - M Girard
- Genomic Research Laboratory, Division of Infectious Diseases, Switzerland
| | - J Frey
- Institute of Veterinary Bacteriology, University of Bern, Bern, Switzerland
| | - V Lazarevic
- Genomic Research Laboratory, Division of Infectious Diseases, Switzerland
| | - J Schrenzel
- Genomic Research Laboratory, Division of Infectious Diseases, Switzerland.,Bacteriology Laboratory, Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Switzerland
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Medicinal leech therapy-an overall perspective. Integr Med Res 2017; 6:337-343. [PMID: 29296560 PMCID: PMC5741396 DOI: 10.1016/j.imr.2017.08.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/24/2017] [Accepted: 08/07/2017] [Indexed: 11/21/2022] Open
Abstract
Complementary medicine methods have a long history, but modern medicine has just recently focused on their possible modes of action. Medicinal leech therapy (MLT) or hirudotherapy, an old technique, has been studied by many researchers for possible effects on various diseases such as inflammatory diseases, osteoarthritis, and after different surgeries. Hirudo medicinalis has widest therapeutic usage among the leeches, but worldwide, many different species were tested and studied. Leeches secrete more than 20 identified bioactive substances such as antistasin, eglins, guamerin, hirudin, saratin, bdellins, complement, and carboxypeptidase inhibitors. They have analgesic, anti-inflammatory, platelet inhibitory, anticoagulant, and thrombin regulatory functions, as well as extracellular matrix degradative and antimicrobial effects, but with further studies, the spectrum of effects may widen. The technique is cheap, effective, easy to apply, and its modes of action have been elucidated for certain diseases. In conclusion, for treatment of some diseases, MLT is not an alternative, but is a complementary and/or integrative choice. MLT is a part of multidisciplinary treatments, and secretes various bioactive substances. These substances vary among species and different species should be evaluated for both treatment capability and their particular secreted molecules. There is huge potential for novel substances and these could be future therapeutics.
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