American Society of Hirudotherapy

Aeromonas hydrophila infections following use of medicinal leeches in replantation and flap surgery

Research article published in Annals of plastic surgery (1992)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Case reportSafety & Infection ControlLineaweaver WC et al. · Annals of plastic surgery, 1992

Abstract

Aeromonas hydrophila infections are a recognized complication of postoperative leech application, and can occur with measurable frequency in populations of patients treated with leeches. We review 11 previously reported leech-related Aeromonas infections and analyze seven unreported cases. These infections range from minor wound complications to extensive tissue loss and sepsis. Often, these infections followed leech application to tissue with questionable arterial perfusion. Onset of clinical infection in these patients ranged from within 24 hours of leech application to 10 days or more after leech application. Late infections may represent bacterial invasion from colonized necrotic tissue. Based on these observations, we recommend that leech applications be restricted to tissue with arterial perfusion to minimize contamination of necrotic tissue. We also recommend that patients treated with leeches receive antibiotics effective against Aeromonas hydrophila before leech application. Patients treated with leeches and discharged with eschars or open wounds might benefit from oral antibiotic therapy until wound closure. These precautions may minimize or eliminate this complication of leech use.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeCase ReportsJournal ArticleReview
Indexed MeSH termsAdolescentAdultAeromonas hydrophilaAnimalsAnti-Bacterial AgentsFemaleGram-Negative Bacterial InfectionsHumansLeechesMalePremedicationReplantation

Summary

Peer-reviewed infection-control and safety surveillance relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.

Why This Matters for Hirudotherapy

This case series and literature review examined 18 cases of Aeromonas hydrophila infection following postoperative leech application, analyzing seven previously unreported cases alongside 11 prior reports. Infections ranged from minor wound complications to extensive tissue loss and sepsis, frequently occurring when leeches were applied to tissue with questionable arterial perfusion, with onset from within 24 hours to 10 days or more after application. For ASH and hirudotherapy, this study highlights a recognized infectious complication of medicinal leech use and offers practical recommendations—including restricting application to well-perfused tissue and administering Aeromonas-effective antibiotics prophylactically—that directly inform clinical safety protocols. As a descriptive case review without a control group, it cannot precisely quantify infection incidence or formally test the efficacy of the proposed preventive measures.

Citation

Aeromonas hydrophila infections following use of medicinal leeches in replantation and flap surgery.

Lineaweaver WC et al. · Annals of plastic surgery, 1992

DOIPubMed

Added to ASH library: May 28, 2026 · Site last updated: June 18, 2026

This website provides educational information and does not constitute medical advice, diagnosis, or treatment recommendations. Medicinal leech therapy carries clinically meaningful risks and should be performed only by qualified clinicians under institutionally approved protocols. FDA 510(k) clearance for medicinal leeches is limited to specific indications; investigational and off-label discussions are labeled accordingly. For patient-specific guidance, consult a qualified healthcare provider.