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 paper reviews 11 previously reported and 7 new cases of Aeromonas hydrophila infection following medicinal-leech application in replantation and flap surgery, describing complications ranging from minor wound problems to extensive tissue loss and sepsis, with onset from within 24 hours to 10 or more days, and noting that infections often followed leech use on tissue with questionable arterial perfusion. It is highly relevant to hirudotherapy because Aeromonas is the gut symbiont that makes infection the principal recognized risk of leech therapy, and the authors' recommendations-restrict leeches to tissue with arterial perfusion and give antibiotic prophylaxis effective against Aeromonas before application-remain central to modern leech-therapy safety protocols. The caveat is that this is an aggregated case review, not a controlled trial, so while it robustly establishes the hazard and motivates prophylaxis, it does not by itself quantify infection rates under current practice or prove the efficacy of any specific antibiotic regimen.

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.