Lethal Sepsis in the Course of Medicinal Leech Therapy
Case report published in Antibiotics (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.
Resumen
Patient with oral squamous cell carcinoma receiving leech therapy after radial forearm flap died of Aeromonas septic shock; RAPD subtyping confirmed identical strains from patient and leeches, definitively proving leech-to-patient transmission.
Por qué esto importa para la hirudoterapia
Este caso clínico describe un paciente con carcinoma escamocelular oral que desarrolló choque séptico fatal tras terapia con sanguijuelas para la congestión venosa de un colgajo radial del antebrazo. Se cultivó Aeromonas veronii tanto del paciente como de sanguijuelas no utilizadas, y la subtipificación por RAPD reveló patrones idénticos, lo que sugiere fuertemente una transmisión de la sanguijuela al paciente. El paciente había recibido antibióticos de amplio espectro desde el día cinco, pero sucumbió a neumonía y sepsis. Este caso es directamente relevante para la seguridad de la hirudoterapia, al demostrar que la transmisión de Aeromonas a partir de sanguijuelas medicinales puede causar infección letal en pacientes críticos y subraya la importancia de la profilaxis antibiótica. Sin embargo, esto representa un único caso fatal en un paciente oncológico médicamente complejo, y el MALDI-TOF MS arrojó una identificación de especie inconsistente, lo que requirió secuenciación del ARNr 16S para la identificación definitiva.
Citación
Lethal Sepsis in the Course of Medicinal Leech Therapy.
Sproll C, Lommen J, Balasiu A et al. · Antibiotics, 2022
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Añadido a la biblioteca ASH: May 26, 2026 · Última actualización del sitio: 18 de junio de 2026