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

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.

Beyond the epistaxis: voluntary nasal leech (Dinobdella ferox) infestation revealed the leech behaviours and the host symptoms through the parasitic period

Dinobdella ferox is the most reported and studied leech species parasitizing mammalian mucus membranes. However, our knowledge of D. ferox during parasitizing and its effects on hosts has remained limited. To investigate the behaviour of D. ferox in the parasitic period and the subsequent host symptoms, the author was infested voluntarily with three juvenile leeches under regularly-conducted examinations of complete blood count (CBC) and nasal endoscopy (NE). After the first head protrusion of the parasitizing leech at the host nostril, the occurrence of bleeding-related symptoms decreased and ceased completely weeks before the end of the parasitic period. Negligible impacts of the parasitizing leech on the host were shown by CBCs, and a parasitizing leech was able to hide from NE despite being so large it at times protrudes out of the host nostril. Finally, parasitizing D. ferox were coaxed to emerge at the nostril by water only after their first head protrusion, indicating that non-invasive removal of parasitizing D. ferox before head protrusion might be difficult. Through the voluntary infestation, the full documentation of behaviours of D. ferox in the parasitic period and host symptoms shown in this study will promote better diagnoses and treatments of nasal leech infestation.

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.