A Rare Cause of Hypovolemic Shock in Prepubertal Girl: Vaginal Leech Infestation

Abstract

Vaginal bleeding in girls is an alarming symptom for both parents and pediatricians. Serious underlying causes should be always evoked. Case Report. We describe here a 9-year-old girl who was admitted at our emergency department for vaginal bleeding and severe anemia. No history of trauma and no evidence of prior abuse were reported by the parents. Full Blood Count showed profound anemia (hemoglobin at 4 g/dl). The child was managed as a hypovolemic shock and resuscitated with intravenous fluids and urgent blood transfusion. Gynecologic examination found a live leech at the vulva and the extraction was facilitated by applying a saline solution. The child was clinically stable and discharged home the next day with ambulatory treatment. Conclusion. This case emphasizes that a through external genital exam with possible exam under anesthesia should be undertaken in all girls with unexplained vaginal bleeding and that in those living in rural areas without potable water, leech infection should be considered.

Hirudiniasis in Cattle in Mpwapwa District, Dodoma Region of Tanzania

“…Anaemia in most cases affects women and children who are more likely to acquire the parasites due to their sociocultural behaviour in rural settings. Moreover, Kruger et al [27] reported leeches to be the potential cause of severe anaemia in a 15-year child in Mbulu district in Tanzania, and this has been echoed by other studies elsewhere [3,24,28]. The public health importance of the parasites calls for more studies to investigate the extent of the problem in rural areas of Tanzania.…”