The medicinal leech and its use in plastic surgery: a possible cause for infection

Whitlock, Madeline; O’Hare, Patricia; Sanders, R. L.; Morrow, N.C.

doi:10.1016/0007-1226(83)90100-5

Cited by 105 publications

(52 citation statements)

References 7 publications

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“…A few studies reported the occasional presence of other bacteria that were considered by some authors to be contaminants from the ingested blood (46) and suggested by others to be potential infectious agents during the medical application of leeches (33). The frequent detection of pure cultures of Aeromonas suggested a capability of H. medicinalis to control the composition of the microbial flora in its digestive tract, which is important for the understanding of the symbiosis (15,43) and for the clinical application of leeches in modern medicine (8,11,27,41,45). We addressed this issue experimentally by comparing three clinical strains (E. coli, P. aeruginosa, and S. aureus) to a symbiotic strain (HM21R) that proliferated well and persisted at a concentration of ca.…”

Section: Discussionmentioning

confidence: 99%

“…The revival of the medical application of H. medicinalis (17,32) and the associated risk of wound infections at the attachment site by the symbiotic digestive-tract flora (8,11,27,45) have increased the need to assess the ability of pathogenic bacteria to colonize the leech's digestive tract (15,16,33). Medicinal leeches are used to relieve venous congestion after reconstructive or plastic surgery (17,32).…”

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confidence: 99%

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Ingested Blood Contributes to the Specificity of the Symbiosis ofAeromonas veroniiBiovar Sobria andHirudo medicinalis, the Medicinal Leech

Indergand

Graf

2000

Appl Environ Microbiol

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Hirudo medicinalis, the medicinal leech, usually carries in its digestive tract a pure culture of Aeromonas veronii bv. sobria. Such specificity is unusual for digestive tracts that are normally colonized by a complex microbial consortium. Important questions for the symbiotic interaction and for the medical application after microvascular surgery are whether other bacteria can proliferate or at least persist in the digestive tract of H. medicinalis and what factors contribute to the reported specificity. Using a colonization assay, we were able to compare experimentally the ability of clinical isolates and of a symbiotic strain to colonize H. medicinalis. The symbiotic A. veronii bv. sobria strain proliferated well and persisted for at least 7 days inside the digestive tract. In contrast, the proliferation of Pseudomonas aeruginosa and Staphylococcus aureus was inhibited inside the animal compared to growth in the in vitro control, indicating that the ingested blood was modified within the digestive tract. However, both strains were able to persist in the digestive tract for at least 7 days. For an Escherichia coli strain, the viable counts decreased approximately 1,000-fold within 42 h. The decrease of viable E. coli could be prevented by interfering with the activation of the membrane-attack complex of the complement system that is present in blood. This suggests that the membrane-attack complex remained active inside H. medicinalis and prevented the proliferation of sensitive bacteria. Thus, antimicrobial properties of the ingested vertebrate blood contribute to the specificity of the A. veronii-H. medicinalis symbiosis, in addition to modifications of the blood inside the digestive tract of H. medicinalis.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Ingested Blood Contributes to the Specificity of the Symbiosis ofAeromonas veroniiBiovar Sobria andHirudo medicinalis, the Medicinal Leech

Indergand

Graf

2000

Appl Environ Microbiol

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“…7,8 In 1955, Markwardt was the first to isolate hirudine from the pharyngeal glands of leeches. 4 In 1983, Whitlock et al 9 reported A hydrophylia in the mucous secretions and gut of the medicinal leech. Shortly after, Dickson et al 3 reported the first case of an Aeromonas wound infection related to use of the medicinal leech.…”

Section: About the Authorsmentioning

confidence: 99%

“…A wide body of evidence suggests that the early application of a leech improves survival of venouscongested tissue. 6,9,11 Leeching therapy comes with the risks associated with introducing live biologic material into a fresh surgical site, namely infection with Aeromonas. Other minor disadvantages are patients' inability to cope with the biologic therapy from a psychological standpoint and reports of minor pain at the site.…”

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confidence: 99%

Aeromonas Septicemia After Medicinal Leech Use Following Replantation of Severed Digits

Levine

Frangos

Hanna

et al. 2009

American Journal of Critical Care

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Medicinal leeches are used to control venous congestion. Aeromonas in the leech gut are essential for digestion of blood. This case report describes a patient who had Aeromonas bacteremia develop after leeching. He had an injury to his hand that required replantation of his thumb. Following the surgery, leech therapy was started with ampicillin-sulbactam prophylaxis. Sepsis developed. Blood cultures were positive for Aeromonas that were resistant to ampicillinsulbactam. The antibiotic was changed to ciprofloxacin on the basis of the sensitivity profile of the organisms. Cultures from the leech bathwater confirmed it as the source of the Aeromonas. Clinicians who use leech therapy must be aware that leeches can harbor Aeromonas species resistant to accepted prophylactic antibiotics and that sepsis may occur.

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“…The potential for aeromonad infections due to postoperative leech use was quickly recognized (29), and concern for appropriate prophylaxis with third-generation cephalosporins soon followed this recognition (11). Meanwhile, following the use of medicinal leeches, the digestive tract symbiont has been implicated in cellulitis and loss of replanted tissue (7,15), as well as septicemia and meningitis (6,19).…”

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confidence: 99%

Novel Role for Aeromonas jandaei as a Digestive Tract Symbiont of the North American Medicinal Leech

Siddall

Worthen

Johnson

et al. 2007

Appl Environ Microbiol

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The medicinal leech and its use in plastic surgery: a possible cause for infection

Cited by 105 publications

References 7 publications

Ingested Blood Contributes to the Specificity of the Symbiosis ofAeromonas veroniiBiovar Sobria andHirudo medicinalis, the Medicinal Leech

Ingested Blood Contributes to the Specificity of the Symbiosis ofAeromonas veroniiBiovar Sobria andHirudo medicinalis, the Medicinal Leech

Aeromonas Septicemia After Medicinal Leech Use Following Replantation of Severed Digits

Novel Role for Aeromonas jandaei as a Digestive Tract Symbiont of the North American Medicinal Leech

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