Chest Infections: Chest Infections |

A Rare Case of Pneumonia Caused by Leeches FREE TO VIEW

Van Derick Mangulabnan, MD; RajKumar Dasgupta, MD
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University of Southern California, Keck School of Medicine, Los Angeles, CA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A70. doi:10.1016/j.chest.2016.02.075
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SESSION TITLE: Chest Infections

SESSION TYPE: Case Report Slide

PRESENTED ON: Sunday, April 17, 2016 at 09:45 AM - 11:15 AM

INTRODUCTION: Leech therapy has been used since the early 19th century for plastic and reconstructive surgery, to manage venous congestion and improve the microrevascularization of flaps, grafts, or replants. Complications include excessive bleeding and soft tissue infection with Aeromonas hydrophila. We report a case of Aeromonas causing pneumonia.

CASE PRESENTATION: A 68 year old man with recurrent laryngeal squamous cell carcinoma underwent pharyngectomy, anterolateral thigh free flap, and tracheostomy. He was maintained on dopamine for flap perfusion, Empiric antibiotics were given for bacterial prophylaxis and he was subsequently weaned to tracheostomy mask. Leech therapy was started to improve flap perfusion. 5 days later, he developed worsening dyspnea and increased thick secretions, requiring ventilator support. Vital signs trend since leech therapy was started showed increasing leukocytosis, fevers, and tachycardia. Exam reveals right lower lung field crackles, with no signs of swelling or exudates on the flap site. Chest radiography showed development of right lower lobe pneumonia. Bronchoscopy with lavage grew Aeromonas hydrophila and Proteus mirabilis. Treatment with 7 days of Cefepime resulted to clinical resolution and weaning from the ventilator.

DISCUSSION: Leech therapy is considered an ancient modality, but has been proven to improve the success rates of flap, graft, and replantation procedures to up to 83%. However, Aeromonas hydrophila, which has a symbiotic relationship with leeches, is a bacteria that resides in the mucus trails of all medicinal leeches. They have been known to cause soft tissue infections and bacteremia. In rare case reports, pneumonia has been caused by Aeromonas. No guidelines exist with the use of leeches for flap perfusion, however, some literature on the use of fluoroquinolones or third generation cephalosphorins exist.

CONCLUSIONS: Leech therapy is still an option to improve success rates on flap procedures. Awareness of possible concomitant infection warrants some form of antibiotic prophylaxis, however, guidelines guiding prophylaxis or therapy are still not present at this time.

Reference #1: Sartor, et al. Nosocomial Infections with Aeromonas hydrophila from Leeches. Clinical Infectious Diseases 2002; 35:e1-5

Reference #2: Maetz, et al. Infections following the application of leeches: two case reports and review of the literature. Journal of Medical Case Reports 2012, 6:364

DISCLOSURE: The following authors have nothing to disclose: Van Derick Mangulabnan, RajKumar Dasgupta

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