Gibrie Asnake, Daniel Molla, Lidetu Tadious, Habtamu Desiyalew
Department of Medicine, Humedica E.V, Bahir Dar, Ethiopia.
Department of Public Health Emergency, Humedica E.V, Bahir Dar, Ethiopia.
J Med Case Rep. 2025 Mar 26;19(1):138. doi: 10.1186/s13256-025-05046-z.
Leech infestations are rare but potentially serious medical conditions, often leading to hemorrhage and anemia. Leeches, which belong to the phylum Annelida and class Hirudinea, typically infest humans through contact with contaminated water or ingestion of unfiltered water. They attach to the mucosa of the aerodigestive tract, causing bleeding, and in severe cases, complications such as airway obstruction or severe anemia. Leech infestations are more prevalent in rural areas with limited access to safe water, where environmental conditions facilitate exposure.
We presented the case of a 65-year-old male farmer of Amhara ethnicity from a rural area in North Wollo, Ethiopia, who experienced spitting blood-tinged saliva for 2 weeks. He also reported a foreign body sensation in his throat, lightheadedness, and difficulty speaking. The symptoms started after he drank water from a spring commonly used for livestock. Upon examination, the patient appeared pale and had a dark brown cylindrical leech attached to the posterior wall of his oropharynx, along with clotted blood. The patient was first found at his home during home-to-home medical care by a mobile medical team. This case represents a rare instance of esophageal bleeding caused by a single leech infestation, which resulted in severe anemia.
This case highlighted the need to consider uncommon causes, such as leech infestations, in the differential diagnosis of anemia and oropharyngeal bleeding, particularly in rural areas with limited access to clean water. Early recognition and intervention are crucial in preventing severe complications. Preventive measures, such as promoting access to safe water and improved sanitation and educating rural communities on the importance of seeking early medical attention for unusual symptoms, are essential for reducing the incidence of leech infestations.
水蛭感染较为罕见，但可能是严重的医学状况，常导致出血和贫血。水蛭属于环节动物门蛭纲，通常通过接触受污染的水或饮用未过滤的水感染人类。它们附着在呼吸道和消化道黏膜上，导致出血，严重时会引发气道阻塞或严重贫血等并发症。水蛭感染在安全用水供应有限的农村地区更为普遍，那里的环境条件容易导致接触感染。
我们报告了一名来自埃塞俄比亚北沃洛农村地区的65岁阿姆哈拉族男性农民的病例，他出现痰中带血的症状达两周之久。他还报告有咽部异物感、头晕和说话困难。这些症状在他饮用了常用作牲畜饮水的泉水后开始出现。经检查，患者面色苍白，一条深棕色圆柱形水蛭附着在其口咽后壁，伴有凝血块。该患者最初是在流动医疗队逐户医疗服务时在家中被发现的。此病例代表了由单一水蛭感染引起食管出血并导致严重贫血的罕见情况。
该病例凸显了在贫血和口咽出血的鉴别诊断中需要考虑水蛭感染等不常见病因，尤其是在清洁水供应有限的农村地区。早期识别和干预对于预防严重并发症至关重要。促进安全用水供应、改善卫生条件以及对农村社区进行教育，使其了解出现异常症状时尽早就医的重要性等预防措施，对于降低水蛭感染的发生率至关重要。
