The emergency management of a medicinal leech bite

doi:10.1016/S0196-0644(89)80422-6

Annals of Emergency Medicine

Volume 18, Issue 3, March 1989, Pages 316-319

https://doi.org/10.1016/S0196-0644(89)80422-6 Get rights and content

Leeches have been used as a medicinal remedy for years untold. Recently, there appears to have been a resurgence in the use of the medicinal leech, Hirudo medicinalis. Presented is the case of a patient who called the emergency department for advice concerning the management of a bleeding leech bite. We discuss briefly the pharmacologically active salivary contents of the leech and an approach to the emergency therapy of a medicinal leech bite.

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Cited by (22)

A Comprehensive Review of Hirudiniasis: From Historic Uses of Leeches to Modern Treatments of Their Bites
2017, Wilderness and Environmental Medicine
Citation Excerpt :
Voice alteration or hoarseness, cough, stridor, and dyspnea are present when the leech attachment is associated with the larynx. Gross painless hematuria and dysuria, fever, pallor, and vomiting can also be found with internal leech attachment.3,13,19–22,25–32 Due to severe local alterations in coagulation associated with leech attachment, initial treatment should focus on removing the leech(es), controlling blood loss, and preventing exposure to blood-borne pathogens.2
Exposure to leeches in the wilderness setting is common. Leeches may attach themselves to exposed skin or pass through one of the body’s orifices and attach internally. The condition of leech attachment is known as hirudiniasis, which can result in serious morbidity and, rarely, mortality. A comprehensive review of the literature was performed to detail the prevention of leech attachment, as well as both anecdotal and studied methods of removal. Complications from leech attachments include ongoing bleeding, wound infection, and poor wound healing. Although medicinal leeches are the most well-studied variety, this review examines all aspects of leech attachment, prevention, and management.
Novel use of a hemostatic dressing in the management of a bleeding leech bite: A case report and review of the literature
2012, Wilderness and Environmental Medicine
Citation Excerpt :
Additionally, there is a paucity of published reports that addresses the problem of such hemorrhage when it occurs. The application of sterile gauze soaked with thrombin solution has been suggested, although no trials have been conducted.1,22 Electrocoagulation has been used successfully, but is only practical in the hospital setting.18
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.
Leech bites: massive bleeding, coagulation profile disorders, and severe anemia
2008, American Journal of Emergency Medicine
Leeches have been in use for centuries, especially in plastic and reconstructive surgery wound and flap healing, in venous insufficiencies, and in the treatment of many disorders such as hemorrhoids and varicosity. With this study, we aimed to discuss coagulation disorder due to uncontrolled leech bites, consequent excessive skin hemorrhage, and anemia requiring blood transfusion.
A 65-year-old male patient was referred to the emergency department because of excessive intractable bleeding that had occurred after leech bites. On physical examination, a total of 130 bites were detected on various regions of the body. In the laboratory findings of the patient, hemoglobin and hematocrit levels were extremely low, and prothrombin time, international normalized ratio, and partial thromboplastin time were markedly increased. The patient received a total of 8 units of fresh frozen plasma and 6 units of erythrocyte suspension. Bleeding stopped by decreasing after the transfusion of fresh frozen plasma.
Although the complications due to leech injuries are rare, they may be an important cause of morbidity and mortality when an injury or prolonged bleeding in an internal region occurs. Prolonged skin hemorrhages rarely cause anemia, and deaths are caused by intractable hemorrhages. However, a coagulation disorder and consequent intractable hemorrhage have not been reported previously in the literature. In conclusion, it should be known that uncontrolled, blind, and excessive leech use causes severe hemorrhage and excessive blood loss, causing significant morbidity and mortality. Therefore, the awareness of either physicians or people using or recommending alternative medicine should be raised on this subject.
Leech in urinary bladder causing hematuria
2008, Journal of Pediatric Urology
Citation Excerpt :
The leech looses body water in a hypertonic peripheral environment, and application of common salt to its body surface to dislodge it is usual practice. Removal from surface areas can be assisted by application of salt, alcohol, vinegar or a flame to the leech [6]. Internally attached leeches may detach on exposure to gurgled saline or may be removed by forceps.
To estimate efficacy of normal saline in the management of hematuria caused by accidental entry of a leech per urethra into the urinary bladder.
An intervention study was carried out in the Department of Pediatric Surgery of Sylhet MAG Osmani Medical College between January 1998 and December 2003. A total of 43 boys (mean age 8 years, SD ± 2.6) were enrolled. In all cases, a leech had entered the urinary bladder through the urethra causing hematuria. All patients were equipped with a self-retaining Foley catheter. They were managed by infusing 50 ml of normal saline into the urinary bladder through the catheter that was then clamped for 3 h.
After removing the catheter, in all cases the whole leech was spontaneously expelled intact, dead or alive, within 2–24 h during the subsequent act of micturition. Hematuria gradually diminished to a clear flow within the next 6 h in 27 cases, 12 h in 14 cases and 24 h in two cases. All patients were followed up for 2 weeks, and none developed recurrent hematuria.
Catheterization and irrigation of the urinary bladder with normal saline is a relatively simple, safe and inexpensive method of removing the leech and controlling hematuria.
Plant and Animal Toxins
2023, Hayes’ Principles and Methods of Toxicology: Volume I, Seventh Edition
Icaridin-Loading Nitrocellulose As a New Repellent Against Aquatic Leech with Waterproof and Long-Acting Properties
2022, Vector-Borne and Zoonotic Diseases

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Case reportThe emergency management of a medicinal leech bite

Br J Plast Surg

Br J Plast Surg

Injury

J Bio Chem

J Biol Chem

Comp Biochem Physiol

Br J Plast Surg

Trans R Soc Trop Med Hyg

Br J Dis Chest

The March of Medicine

The medicinal leech: A page from the annelids of internal medicine

Ann Intern Med

Leeches, anyone?

The medicinal leech

J R Soc Health

Bloodsucking leeches

Hirudo

Die Bakterien, flore der medizinischen Blutegel

Archiv fur Mikrobiologie

On the action of secretion obtained from the medicinal leech on the coagulation of the blood

Pharmacology for hirudin: One hundred years after the first report of the anticoagulant agent in medicinal leeches

Biomed Biochem Acta

Cloning and expression of a cDNA coding for the anticoagulant hirudin from the bloodsucking leech, Hirudo medicinalis

Case report
The emergency management of a medicinal leech bite