American Society of Hirudotherapy

Aeromonas septicemia after medicinal leech use following replantation of severed digits

Case report published in American Journal of Critical Care (2009)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Case reportSafety & Infection ControlLevine SM, Frangos SG, Hanna B, Colen K, Levine JP · American journal of critical care, 2009

Abstract

Medicinal leeches are used to control venous congestion. Aeromonas in the leech gut are essential for digestion of blood. This case report describes a patient who had Aeromonas bacteremia develop after leeching. He had an injury to his hand that required replantation of his thumb. Following the surgery, leech therapy was started with ampicillin-sulbactam prophylaxis. Sepsis developed. Blood cultures were positive for Aeromonas that were resistant to ampicillin-sulbactam. The antibiotic was changed to ciprofloxacin on the basis of the sensitivity profile of the organisms. Cultures from the leech bathwater confirmed it as the source of the Aeromonas. Clinicians who use leech therapy must be aware that leeches can harbor Aeromonas species resistant to accepted prophylactic antibiotics and that sepsis may occur.

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

Publication typeCase ReportsJournal Article
Indexed MeSH termsAeromonasAnimalsAntibiotic ProphylaxisGram-Negative Bacterial InfectionsHirudo medicinalisHumansMaleMiddle AgedReplantationSepsisSurgical Wound InfectionThumb

Summary

Patient developed Aeromonas septicemia after leech therapy for thumb replantation despite ampicillin-sulbactam prophylaxis; cultures from leech bathwater confirmed it as the infection source, antibiotic changed to ciprofloxacin based on sensitivity.

Why This Matters for Hirudotherapy

This case report describes a patient who developed Aeromonas bacteremia and sepsis after medicinal leech therapy following thumb replantation; despite ampicillin-sulbactam prophylaxis, blood cultures grew Aeromonas resistant to that agent, the regimen was switched to ciprofloxacin per sensitivities, and leech bathwater cultures confirmed the bath as the source. It directly documents the core infectious hazard of hirudotherapy: Aeromonas in the leech gut is essential for blood digestion, so the organism that makes leeches therapeutically useful is also the one that can cause resistant infection. As a single case report it establishes a hazard and a plausible source, not its frequency, and the authors' practical lesson is that clinicians must anticipate Aeromonas resistant to the usual prophylactic antibiotics.

Citation

Aeromonas septicemia after medicinal leech use following replantation of severed digits.

Levine SM, Frangos SG, Hanna B, Colen K, Levine JP · American journal of critical care, 2009

Added to ASH library: May 26, 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.