Lethal Aeromonas Sepsis in the Course of Medicinal Leech Therapy
Case report published in Antibiotics (Basel) (2022)
Abstract
A patient with oral squamous cell carcinoma (OSCC) underwent complex surgical tumor therapy, including the reconstruction of soft tissues using a radial forearm flap. Due to venous congestion that could only partly be resolved by revision surgery, leech therapy was started on the second postoperative day. The patient developed pneumonia and sepsis and died as a result of septic shock, despite having received targeted broad-spectrum antibiotic therapy since day 5. Aeromonas spp. were cultured from both the patient's specimens and unused leeches. Biochemical identification and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) yielded inconsistent identification results. Finally, microbiological identification of Aeromonas spp. was performed via 16S rDNA sequencing and use of the basic local alignment search tool (BLAST), and strains from both the patient and the leeches were identified as Aeromonas veronii. Aeromonas spp. strains derived from the patient and leeches and independent laboratory strains were submitted to randomly amplified polymorphic DNA (RAPD) subtyping. RAPD of A. veronii strains from both sources revealed an identical pattern, strongly suggesting the transmission of A. veronii from the leeches to the patient. Physicians should be aware of the potential for severe lethal infections as a fatal side-effect of leech therapy in critically ill patients, which should be addressed using antibiotic prophylaxis.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
OSCC patient with radial forearm flap developed Aeromonas pneumonia, sepsis and septic shock after leech therapy despite broad-spectrum antibiotics; RAPD confirmed transmission from leeches.
Warum dies für die Hirudotherapie relevant ist
This case report documents a fatal outcome in a patient with oral squamous cell carcinoma reconstructed with a radial forearm flap who developed Aeromonas veronii sepsis after medicinal leech therapy was initiated for venous congestion. Despite targeted broad-spectrum antibiotics from day five, the patient died of septic shock; 16S rDNA sequencing and RAPD subtyping confirmed identical A. veronii strains from both the patient and unused leeches, strongly indicating leech-to-patient transmission. This is directly relevant to ASH's domain as it highlights a lethal infectious complication of hirudotherapy and underscores the critical importance of antibiotic prophylaxis. The caveat is that this is a single case report involving a critically ill oncology patient, limiting generalizability, and biochemical/MALDI-TOF identification was inconsistent.
Zitation
Lethal Aeromonas Sepsis in the Course of Medicinal Leech Therapy.
Sproll C et al. · Antibiotics, 2022
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