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

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.

Bronchoscopic removal of a leech from the trachea by cryotherapy

This report presents a 74-year-old man with haemoptysis, cough and pharyngeal discomfort. Bronchoscopy revealed a brown worm-like moving foreign body attaching to the upper trachea approximately 2 cm below the glottis. This worm was identified as a leech, measured about 4 cm and was mobile. It was removed safely in one piece via cryotherapy by flexible bronchoscope. Intrabronchial cryotherapy by bronchoscope might be the best way of extraction of leeches.

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.

Leech in the Rectum Causing Lower GI Bleeding in a Four Years Old Child: A Case Report

Background

Leeches belong to a group of annelids of the class Hirudinea which are blood feeding ecto-parasites of humans, wild animals and domesticated animals. A leech can suck out as much blood as ten times its own weight. Leech can occur at different sites in humans commonly in the eyes, nasopharynx, larynx, urethra, and vagina and rarely in the rectum.

Case Details

This is a four years old male child who presented with painless, bright red rectal bleeding for two weeks. Heamatocrit was 9.2%. Leech was removed from the rectum by letting the child sit on a bucket of water. The patient was transfused, followed for 24 hours and discharged with iron sulphate syrup.

Conclusion

Leech infestation should be considered in the differential diagnosis of a child presenting with hematochezia.

Myxobdella socotrensis sp. nov., a new parasitic leech from Socotra Island, with comments on the phylogeny of Praobdellidae (Hirudinida: Arhynchobdellida)

The Socotra Archipelago (Yemen) is remarkable for unique ecosystems and high endemism, for which it is often referred to as the "Galápagos of the Indian Ocean". Here we describe a new parasitic leech Myxobdella socotrensis sp. nov. from Socotra, the largest island of the archipelago. The new species was found in a freshwater spring attached to the endemic crab Socotrapotamon socotrensis (Hilgendorf, 1883) (Crustacea: Potamidae). Based on its morphology, ecology and a phylogenetic analysis of DNA sequence data (12S, 18S, 28S and COI gene markers), the new leech species is classified into the highly diversified family Praobdellidae (Hirudinida: Arhynchobdellida), distributed in tropical regions of Africa, Asia and Central and South America. The praobdellid leeches are known to infest mammalian mucous membranes, however, some taxa are associated with other hosts, namely crabs, amphibians and birds. By its morphology, the new species fits quite well in the current concept of the genus Myxobdella Oka, 1917. However, the monophyly of Myxobdella was not supported here by molecular data, pointing at the need of a more comprehensive systematic revision of the genus and family. As far as known, Myxobdella socotrensis sp. nov. is endemic to the Socotra Island, but more data are needed to understand its evolutionary origin, biology and distribution.

Mucosal hirudiniasis presenting as palatal mass: A case report and review of the literature

This paper presents the case of a 5-year-old child who presented with an 15-day history of a swelling over the palatal region and blood stained saliva. Intraoral examination showed dark red circular mass rising from the hard palate. Diagnosis of mucosal hirudiniasis have been made. The parasite has been extracted under local anesthesia using a blunt forceps, it has been identified as an adult Limnatis nilotica. Leech endoparasitism must be suspected in case of bleed from throat, dysphagia or any other related symptom, especially in pediatric patients who have been exposed to freshwater. Prevention remains the best medicine.

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This paper presents the case of a 5-year-old child who presented with an 15-day history of a swelling over the palatal region and blood stained saliva.

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Intraoral examination showed dark red circular mass rising from the hard palate. Diagnosis of mucosal hirudiniasis have been made.

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Leech endoparasitism must be suspected in case of bleed from throat, dysphagia or any other related symptom, especially in pediatric patients who have been exposed to freshwater

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.

Alive in the Airways: Live Endobronchial Foreign Bodies

Aspiration of a foreign body into the lower airways is a common occurrence and can cause significant morbidity and mortality in humans. Most foreign bodies of the tracheobronchial tree are inanimate. However, the medical literature includes reports of live foreign bodies in the airways. Fish, leeches, and roundworms are the most common live foreign bodies of the lower airways. Fishermen are more prone to experience a live fish aspiration, whereas substandard conditions may expose individuals to leech and roundworm infestations. The dangers of and the approaches to the management of these foreign bodies differ from those associated with aspirated inanimate objects. The focus of this review of the medical literature was on live foreign body aspiration and its management.

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.