Fluoroquinolones (FQs) and ciprofloxacin (Cp) are important antimicrobials that pollute the environment in trace amounts. Although Cp has been recommended as prophylaxis for patients undergoing leech ...therapy to prevent infections by the leech gut symbiont
, a puzzling rise in Cp-resistant (Cp
)
infections has been reported. We report on the effects of subtherapeutic FQ concentrations on bacteria in an environmental reservoir, the medicinal leech, and describe the presence of multiple antibiotic resistance mutations and a gain-of-function resistance gene. We link the rise of Cp
isolates to exposure of the leech microbiota to very low levels of Cp (0.01 to 0.04 µg/ml), <1/100 of the clinical resistance breakpoint for
Using competition experiments and comparative genomics of 37 strains, we determined the mechanisms of resistance in clinical and leech-derived
isolates, traced their origin, and determined that the presence of merely 0.01 µg/ml Cp provides a strong competitive advantage for Cp
strains. Deep-sequencing the Cp
-conferring region of
enabled tracing of the mutation-harboring
population in archived gut samples, and an increase in the frequency of the Cp
-conferring mutation in 2011 coincides with the initial reports of Cp
infections in patients receiving leech therapy.
The role of subtherapeutic antimicrobial contamination in selecting for resistant strains has received increasing attention and is an important clinical matter. This study describes the relationship of resistant bacteria from the medicinal leech,
, with patient infections following leech therapy. While our results highlight the need for alternative antibiotic therapies, the rise of Cp
bacteria demonstrates the importance of restricting the exposure of animals to antibiotics approved for veterinary use. The shift to a more resistant community and the dispersion of Cp
-conferring mechanisms via mobile elements occurred in a natural setting due to the presence of very low levels of fluoroquinolones, revealing the challenges of controlling the spread of antibiotic-resistant bacteria and highlighting the importance of a holistic approach in the management of antibiotic use.
Hippocrates preached the importance of balancing the four humours (blood, phlegm and black and yellow bile) through bloodletting. Because they secrete a host of enzymes to anaesthetize their victims ...at the spot of a bite and to keep the blood flowing, leeches were useful when drawing blood from sensitive parts of the body such as the mouth, larynx and anus. Britain's largest supplier, Biopharm Leeches in Hendy, Wales (which has the tag line "The biting edge of science"), ships around 50,000 per year, and in 2004, a French firm, Ricarimpex in Eysines, won clearance from the US Food and Drug Administration to market its leeches as medical devices in the United States.
Osteoarthritis is a degenerative disease that affects synovial joints. Micro-injuries of articular structures initiate inflammatory processes, leading to persistent pain. Due to various risk factors, ...osteoarthritis is often diagnosed in multimorbid patients. This makes pain management one of the key challenges, with a consistent need for new therapeutic strategies. Hence, complementary and integrative methods such as hirudotherapy have become increasingly important, even though their mechanisms of action are not entirely understood.
We retrospectively analyzed the longitudinal effect of a single leech application on osteoarthritic joints in a heterogenic cohort of 24 cases with various chronic pain syndromes. We assessed articular pain intensity ratings and movability of the treated joint after one-time leeching for up to 12 months. We further investigated the effect of hirudotherapy on the systemic pain status and multimodal treatment strategies of the patients.
There was a significant reduction in pain intensity ratings at the joint of leech application for up to 12 months after treatment. The improvements in pain intensities were independent of the form of osteoarthritis treated. In addition, we saw a considerable enhancement in local movability of the treated joint. Hirudotherapy did not seem to influence the systemic pain status as well as the previously established individualized multimodal treatment model of the patients.
Leeching as an adjuvant therapy has a great potential especially in terms of safety and long-term outcome.
Medicinal leeches (Hirudo medicinalis, Hirudo verbana) have been used in the field of medicine to treat various diseases for thousands of years. Popularity of their use changed over time and in ...Europe, it peaked at the beginning of the 19th century. In modern medicine, application of leeches on flaps with venous congestion was first used and described by Deganc and Zdravic in 1960. A certain renaissance of leech use is currently taking place, especially in the field of reconstructive surgery. In general, use of leeches is indicated during critical post-operative period, in which the microcirculation and veins are incapable of sufficient drainage of venous blood, which can lead to stagnation of circulation in tissues at all levels, clinically manifested as a change in color and turgor of the flap. If this venostasis is not recognized in time and treated adequately, tissue necrosis can develop. Medicinal leeches can be used in venous drainage disorders after a replantation of fingers, auricles, lips and parts of the nose. In head and neck reconstructive surgery, there are many studies that confirm the success rate of hirudotherapy in hematoma evacuation or in dealing with complications after scalp replantation and transfers of free and pedicled flaps. Leech application therapy can also be indicated as a part of non-surgical methods that improve conditions of the venous system.
We retrospectively reviewed 201 digit replantations or revascularizations that were performed between August 2007 and June 2015. Leeching therapy was used in 48 digits and was more commonly required ...in replanted digits. In revascularized digits, leeching was used significantly more frequently in avulsion injuries and injuries associated with fractures. Digits that were leeched for more than 4.5 days had significantly higher rates of survival of digits after replantation or revascularization. Leeching was associated with higher incidence of transfusion, higher mean number of transfusions, and longer length of stay. We conclude from this study that leeching is used more frequently after digital replantation than revascularizaion, and in revascularized digits, leeching is used more often in avulsion injury and in patients with fractures. In patients requiring leeching therapy, leaching for more than 4.5 days leads to higher rate of digital survival.
Level of evidence: IV
Background
Medicinal leech therapy, otherwise known as
hirudotherapy
or
leeching
, has been utilized for numerous pathologies over centuries. The technique resurfaced in modern medicine for its ...beneficial effects in microsurgical complications, particularly venous congestion. Recently, several cases have documented the utilization of medicinal leech therapy for the management of urologic disease states and surgical complications. It is important to understand the past, present, and future possibilities for hirudotherapy in urology. However, a systematic review of medical leech therapy in this context has yet to be conducted. Accordingly, and with an emphasis on salient clinical details, this study aims to systematically review the cases of hirudotherapy applied to urological conditions.
Main body of the abstract
A systematic review of cases in MEDLINE/PubMed was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 49 search results, 11 articles detailing 13 unique cases of medicinal leech therapy used in the urological context were included. Hirudotherapy was conducted in 10 of 13 cases (76.9%) for the management of congested blood occurring in five cases post-penile replantation, two cases of postoperative scrotal hematoma, two cases of venous congestion of the glans post-neonatal bladder exstrophy repair, and one case of refractory priapism. Leeching in the remaining three cases was for the management of penoscrotal edema in patients with hormone refractory prostate carcinoma treated with radical radiation therapy. All 13 cases (100%) reported clinical improvement from hirudotherapy. Venous congestion/hematoma cases noted decreased displaced blood volume. The patient experiencing priapism reported decreased pain despite the persistence of cavernosal swelling. The three cases of penoscrotal edema reported significant decreases in swelling due to serous fluid drainage from leech puncture sites. No complications or side effects were reported in the nine adult patients. The four postoperative neonatal patients all required blood product throughout treatment.
Short conclusion
The systematic review of the cases demonstrates that medicinal leech therapy is a favorable treatment option for individuals with varied urological pathologies and that hirudotherapy may improve post-surgical outcomes in the urological setting. Hirudotherapy should be considered as a viable treatment modality in specific venostatic urological conditions.
As the number of patients seeking surgical and nonsurgical rhinoplasty continues to increase, the risk of nasal skin compromise after surgery also has risen. Vascular insult to the nasal skin ...envelope can lead to permanent disfigurement that is nearly impossible to correct. Tissue loss often requires major reconstruction that yields suboptimal cosmetic results. This article discusses prevention, early recognition, and effective treatment that aim to mitigate skin necrosis and the resulting soft tissue destruction.
This article offers vascularity as a multi‐dimensional imaginary for the interspecies entanglements constituting Ayurvedic leech therapy. Whether, when, where, and how a leech decides to bite, suck, ...and release comprise pivotal junctures in leech therapy as practiced in southern Kerala, India. In the course of leech–human intra‐actions, leeches translate matter, providing sensory mediation, relief, and amusement. Enmeshed in social and ecological relations inflected by gender, religion, class, and caste, this analysis of Ayurvedic leech therapy reframes questions of agencies starting with and from the viewpoint of the vascular capacities of leeches in their interactions with humans. This image of vascularity provides an analytic for the emergent agencies of humans and leeches constituted by sensory intra‐actions at branching points in this multispecies clinical practice.
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