Infections following the application of leeches: two case reports and review of the literature
Case reports published in J Med Case Rep (2012)
Abstract
INTRODUCTION: Since the 1980s, leeches have been ingeniously used in the management of venous flap congestion. The presence of anticoagulative substances in their saliva improves the blood drainage. Their digestive tract contains several bacterial species, the main ones being Aeromonas hydrophila and Aeromonas veronii biovar sobria, which contribute to the digestion of ingested blood. These bacteria can be the cause of infections. CASE PRESENTATION: We report two cases of septicemia related to Aeromonas veronii biovar sobria that presented after leeches had been applied to congested transverse rectus abdominis myocutaneous flaps for delayed mammary reconstructions.Patient number 1 was a 55-year-old Caucasian woman who underwent a delayed breast reconstruction procedure. On the sixth postoperative day she showed a clinical presentation of septicemia. Aeromonas veronii biovar sobria was identified in the patient's skin and blood bacteriological samples. Her fever ceased after 4 days of antibiotic treatment.Patient number 2 was a 56-year-old Caucasian woman who underwent a delayed breast reconstruction procedure. On the seventh postoperative day we noticed that she showed a clinical presentation of septicemia. Aeromonas veronii biovar sobria was identified in the patient's blood cultures and local bacteriological samples. An antibiogram showed resistance to amoxicillin/clavulanic acid. Her fever ceased on the eleventh postoperative day after 4 days of antibiotic treatment. CONCLUSION: The rate of infection after application of leeches is not negligible. The concentration of Aeromonas inside the digestive tracts of leeches largely decreases when the patient is under antibiotic therapy. These germs are sensitive to third-generation cephalosporins and fluoroquinolones and resistant to amoxicillin/clavulanic acid. We recommend preventive treatment based on classical measures of asepsis and on oral antibioprophylaxy with a fluoroquinolone during the whole period of treatment by leeches.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Two cases of Aeromonas veronii biovar sobria septicemia after leech application to congested TRAM flaps in delayed breast reconstruction. Recommends oral fluoroquinolone prophylaxis during the entire leech-therapy period.
Warum dies für die Hirudotherapie relevant ist
This article presents two cases of Aeromonas veronii biovar sobria septicemia following leech application to congested transverse rectus abdominis myocutaneous flaps during delayed breast reconstruction in women aged 55 and 56. Both patients developed fever on postoperative days six and seven respectively; one isolate showed resistance to amoxicillin/clavulanic acid, and both recovered with antibiotic therapy. The authors recommend preventive asepsis measures and oral fluoroquinolone antibioprophylaxis throughout the period of leech treatment. For ASH's domain, this directly addresses an important infectious complication of therapeutic hirudotherapy. Caveat: These are case reports without a denominator population, precluding assessment of infection incidence; the authors note the infection rate is 'not negligible' but do not quantify it.
Zitation
Infections following the application of leeches: two case reports and review of the literature.
Maetz B et al. · Journal of medical case reports, 2012
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