Nasal leech infestation causing persistent epistaxis

Abstract

Foreign bodies in the nasal cavity are commonly encountered as a cause of epistaxis; however, nasal leech infestation as a cause of unilateral persistent epistaxis is very rare. Examination of nasal cavity revealed fleshy material in the left nostril, which was identified as leech. The leech was removed with the help of an artery forceps following irrigation of the left nostril with normal saline and adopting wait-and-watch policy. In developing countries, leech infestation as a cause of epistaxis should be suspected in patients with lower socioeconomic status or in those living in rural areas who give history of drinking polluted water from, or bathing in, stagnant ponds and puddles.

Epistaxis Due to Leech Infestation in Nose: A Report of Six Cases and Review of Literature

“…Intranasal or nasopharyngeal foreign bodies are a common cause of epistaxis [1,2]. Living parasite (leech) as foreign body is a very rare entity in Western countries [2].…”

“…Children and old aged peoples are commonly affected by leech infestation, while data does not show the male-female percentage [3,9]. Patients with lower socio-economic status or those living in the rural areas having a history of drinking water from or bathing in, stagnant ponds, puddles, springs, natural wells, lakes or dams [1,6] are commonly affected. Similar history was obtained from the present series also.…”

“…Similar history was obtained from the present series also. Clinical examination reveals a fleshy greenish-brown mobile mass in affected nostril or protruding from different nasopharyngeal and oropharyngeal areas; which is identified as blood engorged leech [1,11]. Sometimes a part of its body may go inside the maxillary antrum and a part remains at the middle meatus.…”

Oral infestation with leech Limnatis nilotica in two mixed‐breed dogs

“…The number of leeches that infest humans or animals is also important, although as shown here one or two leeches may cause sufficient blood loss to result in anaemia. Leeches can ingest large amounts of blood into their stomach, even up to over ten times their body weight (Moser et al 2009, Sarathi 2011. Various anticoagulant agents are known to be injected by the leech; theromyzon tessulatum, cytin (chymotrypsin inhibitors), tessulin (a trypsin and chymotrypsin inhibitor), therin (a trypsin inhibitor), theromin (a thrombin inhibitor) and therostatin (a factor Xa inhibitor) have been identified ( Salzet 2001).…”

Recurrent epistaxis: a diagnostic dilemma

“…Direct removal of the leech from the nasal cavity can be troublesome because of its powerful attachments to the nasal mucosa and the presence of slippery slime over its body (5) . During removal if the leech is damaged this leads to regurgitation of its bacteria filled stomach content into the wound leading to secondary infection (6) . Therefore removal requires special care and the utmost gentleness to prevent any damage to the leech.…”