Hirudiniasis is a disease of humans and animals associated with the suction and penetration of leeches into the body. The manifestations are different, depending on the localization of the parasite. Nasal, intestinal and other bleeding, hemoptysis, hoarseness of voice, weakness, headaches, dizziness, hearing loss are more often detected. Diagnosis of pathology is carried out in the process of physical examination, in case of damage to internal organs – with the help of instrumental imaging methods. The treatment consists in removing the leeches. Symptomatic therapy, drug correction of anemia is carried out.
B88.3 External hirudiniasis
Hirudiniasis is an invasive disease. Nosology is common in the territories of countries with a tropical climate (South America, Africa, Southeast Asia), but the habitats of leeches are in Europe, the USA. Young men, children, and the elderly are more likely to get sick. The seasonality of external hirudiniasis is associated with periods of heavy rains and subsequent mass breeding of parasites. Due to the rare treatment and detection, only a few cases of internal damage are described.
Pathogens of pathology are various types of leeches. Leeches of the genus Haemopis, Limnatis, Hirudo (medical), and the species Tyrannobdella rex (royal) are almost ubiquitous. Parasites live in wet grass, peat bogs, stagnant freshwater reservoirs. They are hermaphrodites and active predators, feed on the blood of animals, birds, humans, sucking with the help of proboscis or chitinous jaws. They attack mainly at night.
The main risk factors for hirudiniasis are related to professional activity, tourism, and living in endemic regions. So, the most often infected are:
- travelers passing routes through the jungle, swampy terrain;
- residents of regions with high humidity, a large number of non-flowing lakes;
- employees of water utilities;
- professional fishermen and hunters.
At the time of suction, the leech bites through the human skin, simultaneously secreting a glandular secret, which is a strong anticoagulant (girudin), proteins, histamine-like substances. This leads to capillary expansion, local bleeding. A medical leech can suck up to 15 ml of blood in half an hour, taking into account the subsequent bleeding after the removal of the parasite, the body loses up to 60 ml. Sometimes the bleeding of the bite site lasts up to a day.
During feeding, the leech increases significantly in size, blocking the lumen of the hollow organ. The resulting wound leads to mechanical damage to tissues, has a stellate shape, a diameter of up to 2 mm, a depth of up to 1.5 mm. Subcutaneous hemorrhage occurs. Later, the bite area turns yellow, a triangular scar remains in place of the wound, noticeable for several months and years.
The disease is classified depending on the type of invasion, sometimes there is a combined lesion – leeches are found both outside and inside the body cavities. There are the following types of hirudiniasis:
- Outdoor. Occurs when pathogens stick to the skin. The most common is the attachment of leeches to the area of the armpits, the interstitial space, the perineum. The lower extremities (calves) and the neck area often suffer.
- Internal. It is manifested by symptoms of damage to the respiratory tract, gastrointestinal tract, genitourinary organs. More often than others, cavities communicating with the external environment suffer: nasopharyngeal mucosa, esophagus, urethra, vagina.
The incubation period depends on the duration of suction, localization and type of pathogen. The most common symptoms of hirudiniasis are manifestations of chronic anemia caused by blood loss: weakness, decreased performance, drowsiness. Often patients note pallor of the skin, tinnitus, increased pulse, breathing, pronounced dizziness.
External suction of leeches is quickly detected by the victim himself. Initially, there is a moderate acute pain in the bite area, which soon subsides. The parasite, saturated with blood, increases tenfold. After removing the leech, the wound may bleed for a short time.
With nasal hirudiniasis, the first symptoms are nasal bleeding, a feeling of a foreign body, itching, sometimes violations of the sense of smell and a feeling of stuffiness. The defeat of the oropharynx and larynx is manifested by changes in voice, hoarseness, barking paroxysmal cough, as well as dryness, a feeling of “lump in the throat”, perspiration.
Finding a leech inside the trachea, lower respiratory tract causes increasing symptoms of lack of air, shortness of breath. In severe cases, patients take a forced pose to facilitate inhalation and exhalation, note episodes of hemoptysis and throat bleeding.
With the localization of leeches in the esophagus, there are pains behind the sternum, difficulty swallowing food, nausea, vomiting with blood. Girudinosis of the gastrointestinal tract is almost immediately manifested by vomiting of the “coffee grounds” type, tar-like stools or the presence of blood veins in the stool. The defeat of the genitourinary system (urethra, vagina, bladder) manifests with the appearance of bloody discharge from the genital tract, painful sensations in the perineum and above the pubis, red urine.
The most dangerous complications of hirudiniasis are acute respiratory failure and asphyxia. With prolonged stay in the body or multiple lesions, severe anemia occurs. People with coagulation disorders and patients taking anticoagulants may develop life-threatening symptoms of massive blood loss. Leeches can cause intestinal obstruction, perforation and peritonitis.
The addition of secondary flora, sepsis is possible. The role of leeches as a source or method of transmission of infections to humans is not clearly defined, cases of infection are not described. Experiments have shown a 30-day survival in leeches of the causative agent of typhoid fever, and up to 90 days of the causative agent of paratyphoid B. In case of non-compliance with safety regulations in hirudotherapy rooms and repeated use, a medical leech can cause infection of patients with hemocontact diseases.
Diagnosis of hirudiniasis is carried out by doctors of various specialties – it depends on the localization of the pathogen. Most often, patients get an appointment with an otorhinolaryngologist, gynecologist and surgeon. It is important to collect anamnesis for staying in wet, swampy areas, facts of using water from non-flowing sources, wells. Additionally, laboratory-instrumental and clinical studies are carried out:
- Physical examination. With an external location, the pathogen is noticeable and can be removed. In a patient with internal hirudiniasis, an objective examination reveals symptoms of asthenia, pallor, dryness of the skin, often tachycardia, dysphonia, shortness of breath. When palpating the abdomen, rumbling, bloating is noted, diffuse or local soreness, splenomegaly are determined. Visual assessment of vomiting, feces and urine is mandatory.
- Endoscopic examinations. Instrumental examination of the nasal cavity (rhinoscopy), oropharynx, respiratory organs (laryngoscopy, tracheobronchoscopy), as well as various parts of the digestive tract (esophagogastroscopy, colonoscopy) is carried out according to indications for suspected organ girudinosis. If a leech is detected during the study, it is removed, cauterization of the suction site is performed.
- Laboratory tests. In the blood test – normochromic or hypochromic anemia, minor leukocytosis, rarely eosinophilia, acceleration of ESR. An increase in the activity of CRP, transaminases, blood clotting disorders, and a decrease in ferritin may be detected. General clinical urine analysis detects leukocyturia, erythrocyturia, hematuria.
- Instrumental methods. To exclude neoplasms, radiography of the lungs, MRI of the larynx, pharynx, digestive tract, irrigoscopy is performed. Ultrasound of the abdominal cavity and pelvis is recommended. In some cases, diagnostic laparoscopy is performed.
During the examination, polyps of the respiratory and digestive tracts, the presence of malignant tumors, metastases are excluded. Episodes of bleeding can also give ulcerative lesions of the gastric and intestinal mucosa, hemorrhoids, anal fissures. In women, it is necessary to refute the presence of uterine polyps, abnormal uterine bleeding.
The removal of the leech with external suction is often carried out by the patient himself or by a doctor on an outpatient basis. An important condition is complete disposal of the parasite without leaving the oral apparatus in the wound. By affecting the visible part of the parasite with strong salt, alcohol solutions, iodine, the leech is forced to stop sucking, removed with tweezers. A pressure bandage is applied to the wound.
Treatment of visceral hirudiniasis, as a rule, involves the removal of a leech during endoscopic examination. In stationary conditions, manipulation is carried out only in the presence of a history burdened by coagulation disorders. During endoscopy, the leech is treated with a swab moistened with an alcohol-iodine solution, forcing it to stop sucking, and removed. The wound is sutured or coagulated.
Patients with signs of complications should be hospitalized. Patients with respiratory insufficiency, severe blood loss are placed in intensive care wards. After removal of the pathogen, it is recommended to enrich the diet with protein and iron-containing food.
An important stage is the restoration of blood loss, correction of iron deficiency anemia and its consequences. Restoration of the volume of circulating blood is indicated only in the case of massive bleeding, carried out with glucose-salt solutions, freshly frozen plasma, less often with erythrocyte mass.
Locally applied hemostatic dressings, chemical, laser coagulation of the wound. Antibacterial agents for hirudiniasis are prescribed according to indications. There is no pharmacological antidote to the components of the glandular secretion of leeches.
Prognosis and prevention
The prognosis for the timely detection and treatment of hirudiniasis is favorable, no fatal cases have been recorded. There is no specific prevention. Non–specific measures – refusal to drink raw water from wells, lakes, swimming on unequipped beaches, in stagnant reservoirs. Bathing suits should be closed, it is necessary to wear a hat and glasses, you can not swallow water.
On hikes, especially in the morning, it is recommended to wear trousers tucked into shoes, socks, high rubber boots, do not unbutton the shirt collar. You can use salt dressings, chemicals to repel leeches (indanol, dimethylfolate), or apply perfume or liquid soap with a pungent odor to clothes, body and shoes. It is forbidden to walk barefoot and in open shoes on wet grass.