1 After removing the leech, pressure should be applied to the wound. It should not be forcibly removed because its jaws may remain in the wound, causing infection. 1Īs regards treatment, if the leech is still in place, it should be removed with the help of table salt, a saline solution, or vinegar. 7 As a medicinal leech bite heals, ecchymosis and scarring are not uncommon sequelae. 1, 3 Leech application can also cause infection with Mycobacterium marinum, a parasitic bacteria usually hosted by salt water fish, or with Aeromonas hydrophilia, which leeches carry in their gut. 5Ĭontamination with pathogenic microorganisms may result in erysipelas and submucosal abscesses. The prolonged duration of bleeding can be attributed to collagen–platelet interaction, along with possible modifications of the vascular walls by proteases or other enzymes secreted by the leech during feeding. 6 Munro et al reported that hirudin has only a transient antithrombin effect, lasting only about 15 minutes in humans. The saliva of the leech contains hirudin, which inhibits thrombin in the clotting process, and histamine-like substances which may cause continuous bleeding by preventing closure of capillaries. The mean duration of bleeding from leech bite wounds in one report was 10 hours (range 6.5–23). 3 In our patient, the bleeding continued for three hours and persisted intermittently for the next 18 hours, although he did not have any haematological problems. 1, 3, 4 Prolonged haemorrhage may result in anaemia, and deaths from excessive exsanguination have been reported. The amount and duration of bleeding vary according to the area bitten, with bleeding from the vagina, rectum, urinary bladder, and pharynx having been reported. The commonest complication of leech application is oozing, as was the case in our patient. Leech bites are painless and results in a triradiate wound which remains open for a long time and heals slowly 1, 3 (fig 1). The leech can ingest blood almost ten times its own weight (5–15 ml). The mouth lies in the anterior sucker and has three jaws with teeth well designed for biting. medicinalis has an approximately 10 cm long, cylindrical body with two suckers: one present anteriorly on the head, and the other on the posterior end. 2 Our patient used leeches for alleviating pain and placed them at painful periarticular sites of the knee. 1– 3 A recent clinical study has reported that leech therapy may be an effective treatment for rapid reduction of pain associated with knee osteoarthritis. The medicinal leech has been used for medical purposes since at least 200 bc and is still used in Asia and Africa. When he had changed the dressings later that day, he had noticed clots on the wounds with bruising in the surrounding tissues, but there was no redness, warmth, or pain in the areas surrounding the wounds. The wounds were unremarkable three days later, but the patient stated that the wounds had started oozing again one hour after discharge from the ED. He was then discharged as no further bleeding had occurred. The wounds were rinsed with antiseptic solutions and bandaged with sterile gauze, following which he was observed in the ED for three hours. Laboratory findings were as follows: haemoglobin 18.1 g/dl, haematocrit 56%, mean corpuscular volume 98.1 femto l, white blood cells 6400/mm 3, platelets 171 000/mm 3, prothrombin time 13.48 seconds, activated partial thromboplastin time 35.3 seconds, and international normalised ratio 1.19. His physical examination was otherwise normal. No ecchymosis, swelling, or erythema was present. In addition, there were two lacerations on the lateral head of the gastrocnemius muscle on the left leg that had stopped bleeding. Blood was oozing from two lacerations on his right leg, one 3 cm below and the other 4 cm medial to the tibial tuberosity. Vital signs were as follows: blood pressure 110/80 mm Hg, heart rate 92 beats per minute, respiration rate 16 per minute, temperature 36 ☌. ![]() On physical examination, he appeared generally healthy, was alert and oriented, and in no acute distress. As the bleeding did not stop in spite of compression and wrapping with tight bandages, he came to the ED at 8 45 am. The exact time of the onset of bleeding was unknown. When he woke up three hours later, he saw bloody bandages. After the leeches spontaneously detached, he dressed his wounds and went to bed. He had applied leeches to both legs at midnight to treat chronic leg pains of over a year’s duration. A 19 year old man presented to our ED complaining of bleeding from both legs.
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