What is Leech Bite?
Leeches are a type of parasite that can change their gender. They are part of a group called Annelida and a class known as Hirudinea. There are over 600 different types of leeches, but only a few of them suck blood and can make humans sick.
Leeches have been used in medicine since around 1500 BC. Even today, they are used, mainly in reconstructive surgery where they help in healing processes. For example, an adult leech can drink 1 milliliter of blood per minute, and their bite can cause bleeding that can last from 10 hours to even 7 days in some cases.
Leeches that live on the land can bite through thick skin, while those that live in the water attach themselves to slimy surfaces, causing prolonged bleeding. In reconstructive surgery, leeches are used on purpose when an area undergoing surgical treatment, for instance, a skin flap or reattached finger, has too much blood accumulation. The leeches help in draining the excessive blood, which increases the chances of the treated area healing successfully.
What Causes Leech Bite?
Leech bites can happen if you swim or bathe in water where there are lots of leeches. Interestingly, leeches are also sometimes purposely used in certain types of reconstructive surgery.
Risk Factors and Frequency for Leech Bite
Leech bites, especially in the vagina of children, are mostly reported in the rural areas of north-eastern India and in regions with a tropical or sub-tropical climate, usually after exposure to freshwater. Due to improvements in sanitation, there has been a decrease in nasal leech infestations in developed countries. A review of cases involving six patients who had nasal leeches showed that they had all been in rural streams between 2 weeks and 2 months prior to their symptoms appearing.
Signs and Symptoms of Leech Bite
If you have been in contact with fresh water recently, and then start to experience unusual bleeding, you may have been bitten by a leech. These bites can be either outside or inside your body. Possible symptoms of internal leech bites include nosebleeds, vomiting blood, coughing up blood, vaginal bleeding, ear bleeding, and rectal bleeding. For external leech bites, you could experience symptoms like painless bleeding, bruising, itching, burning, irritation, and redness. If you have repeated instances of nosebleeds, it could mean you have a leech in your nose.
Doctors will need to perform specific exams based on where they believe the leech may be located. For example, if a leech is suspected within the nose, a tool called an endoscope must be used. Rhinoscopes, which are commonly used to examine the nose, will not be enough in this case. Similarly, if there is suspicion of a leech in the vagina, a speculum exam is necessary. This might need to be performed under anesthesia depending on the patient’s age. Finally, if you are having rectal bleeding and a leech bite is suspected, a proctoscope will be used for a rectal exam.
Testing for Leech Bite
If you get bitten by a leech, it usually doesn’t change the way your blood clots. There have been a few exceptions, where times taken for tests called Prothrombin (PT) and Partial Thromboplastin Time (PTT)–which are used to measure how quickly blood clots–were affected. If there’s worry that a lot of bleeding is happening, a Complete Blood Count (CBC) may be carried out. This is a common blood test that gives a count of each type of cell in your blood, including red blood cells, white blood cells, and platelets.
Leech bites can sometimes cause serious bleeding leading to a condition called acute blood loss anemia. This is when your body loses too much blood quickly, and your remaining red blood cells can’t supply your body with enough oxygen.
Normally, doctors can spot if a leech has attached itself to you during a physical exam, and so imaging tests, like X-rays or scans, aren’t usually needed. However, if there’s still doubt whether there’s a leech present, imaging of the concerned area might be required. There have been cases where leeches were spotted in unusual places, like inside the abdominal cavity and over the left nasal cavity, using ultrasound and computed tomography (CT) scan respectively.
Treatment Options for Leech Bite
Initial treatment for a leech bite involves removing the leech or leeches, controlling the bleeding, and protecting against blood-borne diseases.
A variety of methods can be used to remove leeches, such as using salt, saline, vinegar, turpentine, alcohol, heat, and other chemical methods like cocaine, lidocaine, and topical anesthetic sprays. Out of all, making the leech come in contact with saltwater has been proven successful as it makes them relax and let go. It’s important to be very careful during the removal process to avoid potential risks like causing the leech to release blood or foreign bodies into the bite, which can increase the risk of infection and bleeding. Also, it’s crucial to ensure that the leech’s jaws are completely removed from the wound to stop ongoing bleeding.
The removal of a leech can sometimes require specific techniques based on where it’s located. For instance, in a two-year-old toddler, a leech had entered her abdomen and pierced her uterus, requiring surgical exploration for its removal. Another situation involved a 24-year-old man who had a leech bite near his eardrum. Lidocaine and saline solutions didn’t help to slow down the leech’s movement, so a glycerin-based medicine was used which successfully slowed the leech and stopped the bleeding after four hours. Following this, the leech was safely removed using specialized forceps. A vaginal leech in a child was successfully removed by flushing saline through a small feeding catheter.
Once the leech is removed, the wound has to be cleaned, and the bleeding controlled. Wound-cleaning solutions like betadine or topical antibiotics can be used to clean the area, and a pressure dressing or hemostatic agent (which helps blood clot) can help stop the bleeding. Other options include cauterization (burning the wound to stop bleeding), applying medications like tranexamic acid or silver nitrate, using sutures (stitches), or using a tampon. There have been cases where blood transfusions have been needed to replace lost blood. Tranexamic acid can also help stop bleeding.
Leeches have bacteria of the Aeromonas type in their gut. There have been cases of infection following leech bites, so it’s recommended to take antibiotics after a leech bite to prevent an infection.
What else can Leech Bite be?
Here are some medical conditions that may need to be considered or ruled out:
- Erysipelas (a type of skin infection)
- HIV infection and AIDS
- Impetigo (another skin infection)
- Mantle cell lymphoma (a type of cancer)
- Millipede envenomation (resulting from a millipede’s venom)
- Pediatric anaphylaxis (a severe and sudden allergic reaction in children)
- Rattlesnake envenomation (bites from a rattlesnake)
- Poisoning by plant resin
- Scabies (a skin infestation by mites)
- Scorpion envenomation (bites from a scorpion)
Possible Complications When Diagnosed with Leech Bite
Leeches can carry viruses and bacteria. For instance, HIV and Hepatitis B have been detected in leeches that were removed from fishermen in Africa. Viruses can stay in leeches for up to five months. Researches have found out that malaria can multiply in the red blood cells that a leech consumes. Infectious diseases have also been spotted in medicinal leeches, with a disease rate of about 2.4% to 20% linked with medicinal leech therapy. Most of these infections were caused by a bacteria called Aeromonas hydrophila, which can usually be treated with a type of antibiotics called fluoroquinolones. However, there have been reports of some strains being resistant to these antibiotics. It might be a good idea to consider giving antibiotics to a patient after a leech bite, after considering the potential risks and benefits.
Potential Risks with leeches:
- Carriers of viruses and bacteria including HIV and Hepatitis B
- Viruses can remain active within leeches for up to five months
- Malaria can replicate in the red blood cells consumed by leeches
- Medicinal leeches can carry infectious diseases with 2.4% to 20% infection rate during therapy
- Most infections by leeches are caused by bacteria called Aeromonas hydrophila
- Some bacterial strains are resistant to fluoroquinolones, a common antibiotic used for treatment
Preventing Leech Bite
To prevent leech bites, there are a few steps you can take. Avoid visiting places that are known to have a lot of leeches and make sure to wear clothing that covers your legs. If you decide to swim in a place that might have leeches, wear swimwear that fits you tightly. You can also use bug sprays, specifically those that contain N, N-diethyl-meta-toluamide or N, N-diethyl phenylacetamide, chemicals known to deter leeches.
