Treatment of Hirudiniasis
Immediate mechanical removal of the leech is the definitive treatment for hirudiniasis, with topical application of weak chloroform or turpentine solution to facilitate detachment, followed by extraction using forceps or endoscopic techniques depending on the anatomical location.
Immediate Management
Detachment Techniques
- Apply topical agents to facilitate leech detachment before attempting removal, including weak chloroform solution, turpentine oil, or 70% alcohol 1
- General anesthesia may facilitate spontaneous detachment in cases of airway involvement, as the anesthetic effect appears to weaken the leech's mucosal attachment 2
- Hypertonic solutions and cryoprobes have also been described as alternative detachment methods 2
Extraction Methods by Location
Nasal/Oral Cavity:
- Remove using non-toothed sterile plastic forceps or gloved hands after topical detachment agent application 3, 1
- For nasal hirudiniasis presenting with unilateral epistaxis, apply weak chloroform and turpentine oil solution locally before extraction 1
Laryngeal/Tracheal:
- Rigid bronchoscopy under general anesthesia is the procedure of choice for tracheobronchial leeches 2
- Multiple failed extraction attempts may cause the leech to migrate deeper into the airway, necessitating more invasive intervention 4, 2
- Prompt surgical removal is critical in cases presenting with airway obstruction or hemoptysis 4
Superficial Wounds (Therapeutic Leech Application):
- Allow the leech to feed and detach naturally when used therapeutically 3
- Remove only after spontaneous detachment 3
- Kill the used leech with 70% alcohol prior to disposal in biohazard waste 3
Post-Removal Care
Wound Management
- No specific antibiotic prophylaxis is routinely indicated for simple leech removal sites 3
- Monitor the attachment site for signs of secondary infection
- Fresh oxygenated blood flow typically promotes rapid healing at the attachment site 3
Monitoring
- Observe for recurrent bleeding, as leech saliva contains anticoagulant substances (hirudin) that may prolong bleeding 5
- Monitor for anemia in cases of prolonged infestation with recurrent hemoptysis 4
- Ensure complete removal, as retained leeches can cause persistent symptoms 4, 2
Critical Pitfalls to Avoid
- Never attempt forceful extraction without first applying a detachment agent, as the leech's slippery nature and strong mucosal attachment make removal difficult and may cause it to migrate to more dangerous locations 2
- Do not misdiagnose airway hirudiniasis as asthma or other respiratory conditions in patients with freshwater exposure history 4
- Avoid delayed intervention in cases of airway involvement, as suffocation risk is real 4
- Do not overlook the possibility of internal hirudiniasis in patients presenting with unilateral epistaxis, hemoptysis, or dysphagia after drinking from streams, pools, or springs 4, 2, 1