Unique case of Leech inside nasal cavity


Dr. E. Sivakumar M.S. D.L.O. D.N.B.

Introduction: This is a unique case report of a live leech present in the nasal cavity of a patient for nearly 3 weeks.

30 year old male patient working in an estate reported to my op with h/o foreign body in right nasal cavity while taking bath in  a pond.  He also had h/o of bleeding from the right nasal cavity since then.  He also had pain in the right nasal cavity and right eye for the past 7 days.

Examination of nasal cavity was unremarkable except for excessive mucoid discharge from the right nasal cavity.  So under topical anaesthesia diagnostic nasal endoscopy was done using a 0 degree nasal endoscope.  A live leech was seen moving inside the nasal cavity.  The same was removed.

Leeches are annelids belonging to the subgroup Hirudinea.  The leeches may be classified as:

1. Fresh water leeches
2. Terrestrial leeches
3. Marine leeches

This classification is based on the habitat of the leeches.  All leech species are carnivorus feeding on a variety of invertebrates like worms, snails etc.  A few are haemorrhagic parasitic in nature feeding on blood of animals.  Like earthworms leeches are hermaphrodites. 

Leeches attach themselves to humans.  They are capable of sucking blood.  The saliva secreted by leech helps it to feed.  The saliva of leech contains a local anaesthetic that limits the sensation of the host.  The host donot attempt to dislodge the leech because there is no sensation.  The saliva also contains a potent vaso dilator that dilates the blood vessels enabling the leech to feed on the increased blood supply.  Another important constituent of its saliva is hirudin which is a potent anticoagulant which prevents blood from clotting.

Advised procedure for removal:

Contrary to popular belief leeches must be removed promptly.  Leech bites cause intense itching which is normal.  Leeches should not be removed by burning or applying harsh agents like salt because it could cause the leech to damage the wound by biting further.  Damaging a leech may cause it to regurgitate its bacteria filled stomach contents into the wound adding to the already existing problems.  Leeches have a tendency to release their bite on exposure to menthol.  This can be effectively utilised in their removal. 

Hirudiniasis:  is the term used to indicate leech invasion into a body orifice or cavity.  The species Dinobdella ferox (ferocious leech / nasal leech) are known to invade the nasal cavity and airways.  This is a life threatening condition which could compromise the patient's airway.  These patients will benefit from gargling a solution of 50 % alcohol.  The detached leech must be spitted out. 

The following points should be borne in mind:

1. There is absolutely no risk of substantial blood loss following leech bites.

2. The wound will continue to bleed for sometime after the leech has stopped feeding due to the effect of hirudin present in the leech saliva.   Bleeding will stop on its own.

3.  Leeches are not normally known to transmit blood parasites to humans.

4.  Leeches are more likely to be encountered in still waters of ponds than in flowing rivers.  They are more often found in the edges of clean / clear water than in swamps.

View the video clipping showing a live leech in  a patient's nasal cavity


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