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.

Case Report: Mucosal Leishmaniasis Presenting with Nasal Septum Perforation after Almost Thirty Years.

Mucosal leishmaniasis (ML) is associated with progressive tissue destruction and granuloma formation, often after a considerable period of latency from an initial cutaneous infection. We report a case of recurrent epistaxis of 3 years duration and nasopharyngeal obstruction in a woman with treated cutaneous leishmaniasis nearly 30 years before and with no further exposure to Leishmania. Computed tomography revealed nasal septal perforation and histopathology demonstrated chronic inflammation. Microscopy was negative for amastigotes, but molecular testing of nasal mucosa biopsy detected Leishmania (Viannia) braziliensis. The patient underwent 28 days of treatment with IV sodium stibogluconate and her symptoms improved significantly. Sixteen months after treatment, she continues to have episodic epistaxis and detectable parasite load in her nasal lesion. Although ML is known to take years to decades to develop, there are few reported cases in the literature of such a long latency period. This report highlights the importance of considering ML in the differential diagnosis of chronic epistaxis in countries where leishmaniasis is endemic or in immigrants from these countries, even when presentation occurs decades after leaving an endemic region.

Reach the Leech: An Unusual Cause of Hematuria.

Leeches are found in fresh water as well as moist marshy tropical areas. Orifical Hirudiniasis is the presence of leech in natural human orifices. Leech have been reported in nose, oropharynx, vagina, rectum and bladder but leech per urethra is very rare. We report a case of leech in urethra causing hematuria and bleeding disorder in the form of epistaxis and impaired clotting profile after use of stream water for ablution. The case was diagnosed after a prolonged diagnostic dilemma. Asingle alive leech was recovered from the urethra after ten days with the help of forceps. The hematuria and epistaxis gradually improved over next 48 hours and the patient became asymptomatic. Natives of leech infested areas should be advised to avoid swimming in fresh water and desist from drinking and using stream water without inspection for leeches.

[An Uncommon Cause of Epistaxis: Nasopharyngeal Hirudiniasis]. / Epistaksisin Nadir Bir Nedeni: Nazofarengeal Huridiniasis.

The leech that is taken by ingestion of contaminated water can settle on any location at upper respiratory tract from nose to larynx. It sucks blood by adhering to the mucosa and causes mucosal bleeding by secreting hirudin. If the leech goes forward to the larynx, this can be life threatening due to severe airway obstruction. We are presenting 23 year-old male patient who admitted to our hospital with anterior and posterior nose bleeding and dysphagia due to the leech located in the posterior wall of the nasopharynx. The treatment and differential diagnosis of epistaxis is discussed in this article.

Melena revealing a nasopharyngeal leech: a paediatric case.

Leech infestation occurs after swimming or ingestion of freshwater, especially in rural areas. Symptoms are different depending on the binding site of the leech. At the nasopharynx, it is mainly responsible for epistaxis. We report a case of an unknown pharyngeal location of a leech in a three year-old girl responsible for melena and leading to a severe anaemia.

[Leeches of the upper aerodigestive tract]. / Sangsues des voies aérodigestives supérieures.

INTRODUCTION: The leech is an aquatic worm living in fresh water, especially in tropical areas. It may be found exceptionally in the upper aerodigestive tract (UADT) after consumption of spring water or water from natural wells, after swimming in still waters (lakes and dams). The author's objective was to study epidemiological, clinical, therapeutic, and evolutive aspects of this infestation. PATIENT AND METHODS: This prospective 2-year study was carried out from January 1, 2007 to December 31, 2008. We included all patients consulting at the emergency unit presenting with leeches in the UADT. RESULTS: Twenty patients living in rural settings were included: 16 children, mostly boys (sex ratio 3:1). All cases were recorded during the summer season, with 14 cases due to consumption of fresh water and six due to swimming in still waters. The delay between infestation and onset of symptoms ranged from 2 to 15 days. Leeches were found in the oropharynx (six cases), the nasopharynx (five cases), the hypopharynx (six cases), and the glottis (three cases). An anemia syndrome was noted in four patients. All parasites were removed. All patients were given local antiseptics and analgesics. Patients with anemia were given iron supplementation. The outcome was favorable for all patients. DISCUSSION: UADT leeches are not uncommon in Morocco. The infestation is usually observed in the summer. Symptoms vary according to UADT localization. The diagnosis should be made rapidly to prevent complications. Whatever the localization, removing the parasite is difficult. In laryngeal localizations induction general anesthesia is recommended, without intubation. Evolution after treatment is rapidly favorable, with complete disappearance of symptoms.

Nasal Hirudiniasis--an unusual cause of epistaxis.

BACKGROUND: Common causes for unilateral nasal bleeding in adults are benign or malignant tumours, deviated nasal septum, nasal trauma and foreign bodies. Nasal leech infestation has not been identified as a cause of nasal bleeding in most of the textbooks of Ear Nose and Throat. Over 3 years, at Combined Military Hospital Muzaffarabad, and Combined Military Hospital Abbottabad, we have dealt with 38 such cases presenting with epistaxis where the cause was found to be leech infestation. METHODS: A descriptive study was carried out at Combined Military Hospital Muzaffarabad and Combined Military Hospital Abbottabad over a period of 3 years. All patients whose epistaxis was due to leech infestation were included in the study regardless of age and sex. RESULTS: A total of 38 such cases presented with nasal Hirudiniasis as a cause of unilateral epistaxis. 29 were male and 09 female. All of the patients related their problem to the intake of fresh water of stream origin. The mean duration of symptoms was 12 weeks SD 3.0. CONCLUSION: It is concluded that nasal Hirudiniasis (nasal leech infestation) is a cause of unilateral epistaxis in areas like Muzaffarabad, Azad Kashmir and Abbottabad, where leeches are a common inhabitants of fresh water streams.

Severe anemia due to the pharyngeal leech Limnatis nilotica in a child.

Leech infestation can cause many different clinical symptoms such as epistaxis, haemoptysis, haematemesis, and vaginal bleeding. Therefore leech infestation should be considered as a cause of unexplained severe anemia in rural areas where aquatic leeches are common. In this paper we report a case of pharyngeal leech infestation (Limnatis nilotica) presenting with haemoptysis, and epistaxis which resulted in difficulty in making a diagnosis.

Immune thrombocytopenic purpura associated with Brucella and Toxoplasma infections.

Bacterial and protozoal infections can cause thrombocytopenia and may mimic idiopathic thrombocytopenic purpura (ITP). Brucella species and Toxoplasma are among the infectious agents with protean clinical manifestations which may induce immune thrombocytopenia. In rare cases, thrombocytopenia can be severe and may result bleeding into the skin and from mucosal sites. Prompt recognition of this complication and aggressive therapy are essential, since the mortality associated with bleeding into the central nervous system is high. We report two patients with complaints of severe epistaxis and thrombocytopenia associated with brucellosis and toxoplasmosis. Thrombocytopenic purpura in these cases responded well to the high-dose corticosteroid treatment with platelet recovery within 2-3 days. For cases with infection-induced immune thrombocytopenic purpura, short-term high-dose corticosteroids may be applied as an urgent therapy without worsening of the clinical condition.

A nasopharyngeal mass: leech in the nasopharynx.

This paper presents a case with a 4-month history of nasal obstruction and intermittent epistaxis. The cause was found to be a leech in the nasopharynx by means of endoscopic examination. Leech endoparasitism, although rare, may cause serious, even lethal, complications. A high index of suspicion of leech infestation must be entertained when faced with nasal obstruction and intermittent epistaxis in children, and should be investigated surgically as with all other foreign bodies.

[Unavoidable epistaxis in the nasal infestation of leeches]. / Epistaxis debida a infestición nasal por sanguijuela.

An adult man is presented with a case of epistaxis due to leech (Limnatis linotica) intranasal parasitation. The geographical area where infection was performed is in the province of Teruel, northwest Spain. The only presented symptom was an incoercible nasal haemorrhage with low flow which didn't cease by anterior tamponade. 7 days after the process began he was heeded at the Emergency Service, Alcañiz Hospital, where the exam of left nasal fossa showed the presence of a olive-green long mass, very mobile. The treatment consisted on the leech extraction with a dissection forceps. Haemorrhage stopped immediately after the mild intervention and, reexamination the nasal fossa 15 days after, it was no wound or infectious complication observed. The patient was infested when drinking water from a fountain placed in rural area.

Nasal hirudiniasis in Kumaon Hills, India.

Fourteen cases of nasal hirudiniasis, seen during a period of less than a year in Kumaon Hills of Northern India are reported. Unilateral epistaxis was the main symptom. Diagnosis was made by history and clinical examination. The leeches were removed by using locally a weak solution of chloroform and turpentine oil.