Indications for treatment with medicinal leeches :

Leech Therapy or hirudotherapy is known since ancient times. Along with the general blood letting, it has been considered as a necessary remedy in treatment for different diseases. Leeches have been used in medicine for thousands of years. Leeches remove blood ("phlebotomize") from their host, and they release pain-killing (anesthetic) and blood-thining (anticoaggulant) substances with their saliva. Live leeches are currently used to treat blood-congested limbs, which otherwise might die or require amputation, if the pooling blood cannot be removed any other way. They are also sometimes used to provide pain relief, and for many other therapeutic effects.

Indications for treatment with medicinal leeches :

• 1. Cardiovascular diseases, including essential hypertension and ischemia disease, phlebogene diseases of the lower extremities;
• 2. Chronic bronchitis, pneumonia, bronchial asthma;
• 3. Gastrointestinal tract diseases (hepatitis, cholecystitis, pancreatitis, stomach ulcer);
• 4. ENT diseases;
• 5. Urological diseases;
• 6. Male sterility;
• 7. Skin diseases (neurodermatitis, psoriasis, eczema, herpes);
• 8. Gynaecological disorders (commissural processes in the small pelvis, female sterility, chronic adnexitis, parametritis, endometriosis, fibromastopathy);
• 9. Systemic diseases (rheumatic arthritis, systemic lupus erythematosus, scleroderma);
• 10. Osteochondrosis and radiculitis;
• 11. Eyes diseases, including glaucoma;
• 12. Infantile cerebral paralysis (ICP) and other diseases

Components of medicinal leech saliva that exert effects in the host's body are :

Hirudin	Inhibits blood coagulation by binding to thrombin
Calin	Inhibits blood coagulation by blocking the binding of von Willebrand factor to collagen. Inhibits collagen- mediated platelet aggregation
Destabilase	Monomerizing activity. Dissolves fibrin. Thrombolytic effects
Hirustasin	Inhibits kallikrein, trypsin, chymotrypsin, neutropholic cathepsin G
Bdellins	Anti-inflammatory. Inhibits trypsin, plasmin, acrosin
Hyaluronidase	Increases interstitial viscosity. Antibiotic
Tryptase inhibitor	Inhibits proteolytic enzymes of host mast cells
Eglins	Anti-inflammatory. Inhibit the activity of alpha-chymotrypsin, chymase, substilisin, elastase, cathepsin G
Factor Xa inhibitor	Inhibits the activity of coagulation factor xa by forming equimolar complexes
Complement inhibitors	May possibly replace natural complement inhibitors if they are deficient
Carboxypeptidase A inhibitors	Increases the inflow of blood at the bite site
Histaminelike substances	Vasodilator. Increases the inflow of blood at the bite site
Acetylcholine	Vasodilator
Anesthetics subsctance	Anesthetic

Indications for treatment with medicinal leeches :

Leeches (European specie Hirudo Medicinalis) can consume between 5 and 15 ml of blood – 4-6 times their body weight in a single feeding. An American specie Macrobdella Decora can consume 10 times less blood than Hirudo Medicinalis. That's why only the European specie is used in medicine. Generally leech therapists use up to 10 leeches so the patient can lose up to 150 ml of blood during the treatment With 8 leeches the blutverlust for the patient is including to the Nachbluten with approx. 200 to 350 ml blood. "a small leech sucks 2g - the quantity doubles itself 3 g, more largely to 30 g, on average by the postoperative hemorrhage. Generally one counts on an average value of 20 - is limited 30 g total blood loss per leech and to setting 4 - 12 copies in a meeting”

Does a leech bite cause pain?

The bite of a leech is felt by the patients like 2-3 mosquito bites.So the bite of the leech is not painful. The leech saliva is filled with a chemical that contains a painkiller, which stops you from feeling the bite. The saliva also has a chemical, which keeps the blood from clottingIn

which diseases can leeches help?

Thanks to its blood-diluting and container-extending effect the leech is the ideal therapist for blood circulation disturbances.Usually unsatisfactory blood circulation is connected with diseases such as: Thrombose, cramp veins, Haemorrhoiden, cardiac infarct, impact accumulations, calcifying the containers, Tinnitus. Positive effects could be determined with rheumatism, Arthrose, volume disk problems, pulling, bruises, muscular pains or muscle injuries.

How can I accomplish the leech therapy?

• 1. Wash hands.
• 2. Select appropriate personal protective equipment (gloves).
• 3. Cleanse area with normal saline soaked sterile gauze
• 4. Apply leeches with gloved hand on tweezers.
• 5. Allow leech to attach large posterior end first and direct smaller head end to the desired site. (Leeches can be loaded into an empty syringe without a plunger “rear end first” and the open end of syringe is placed over the desired site to ensure proper placement.)
• 6. Apply the other leeches if neseseary.
• 7. Monitor leeches until they fill with blood (10-20 minutes). Usually the leech falls off itself (if not use salt. Leeches do not like salt and will drop off).

Why does a leech sometimes not want to bite?

• With certain site conditions leech bite more badly
• with cold skin
• with smokers
• with perfume-pure
• with older humans

Complications

With the right execution of leech therapy and attention of all contraindications heavy side effects arise very rarely. Local reactions are possible in the proximity of the point of the bite.Also; cycle weakness occurs relatively more frequently.The histamine emitted by the leech can lead to an allergic reaction, which may immediately occur, or within four days .

• Soreness after the bite rarely appears.
• A small scar at the bitten area may remain for weeks.
• A plaster allergy is more often found after a treatment with leeches, therefore it is advisable to use skin preserving, hypoallergenic plasters.).

In which other cases can leeches be used?

Leeches can relieve blood pooling around a muscle or skin flap better than drugs or other treatments. They are used to keep the blood flow in muscle, skin and fat tissue that has been surgically moved from one part of your body to another. These tissues are also called flaps.

Why is leech therapy used instead of other medical treatment?

In some cases, leeches do a better job by removing pooled blood than any other medical therapy.

In some cases, leeches do a better job by removing pooled blood than any other medical therapy.

What are the benefits of leech therapy?

The benefits of leech therapy are not only the amount of blood that the leech removes: It is the anti-blood clotting enzymes in their saliva that allow blood flow from the area where they have been.

Why do some people reject using leeches?

Many people are afraid of these creatures crawling on their body and biting them Can leeches transmit disease? There is no evidence to suggest that they do. The presence of trypanosomes, (malarial parasites), in the gut of jawless leeches has been noted, but jawed leeches do not appear to be hosts. Allergy to leech bite has been reported. Medical opinion should be sought, depending on the severity of the reaction.

Miraculous effect of Leech in the field of medicine time to time.

• Starting from the anterior sucker is the jaw, the pharynx then the esophagus extending to the crop, which leads to the Intestine, where it ends at the posterior sucker. The crop is a type of stomach that works like an expandable storage compartment. The crop allows a leech to store blood up to five times its body size; and because the leech produces an anti-coagulant, the stored blood remains in a liquid state ; because of this ability to hold blood without the blood decaying, due to bacteria living inside the crop, medicinal leeches only need to feed two times a year.
• Deficiency of digestive enzymes (except exopeptidases) but more importantly deficiency of vitamins, B complex for example, in leeches is compensated for by enzymes and vitamins produced by endosymbiotic micro flora. In Hirudo medicinalis these supplementary factors are produced by an obligatory symbiotic relationship with two bacterial species, Aeromonas veronii and a still uncharacterized Rikenella species. The bacteria are passed from parent to offspring in the cocoon as it is formed. Leeches normally carry parasites in their digestive tract which cannot survive in humans and do not pose a threat. However, bacteria, viruses, and parasites from previous blood sources can survive within a leech for months, and may be retransmitted to humans. A study found both HIV and hepatitis B in African leeches from Cameroon . In the failure of adequate venous return from a graft, reduces blood supply – causing tissue necrosis placing a leech on the congested skin flat, fingers or other vascular compromised area removes the congested blood and enables the graft to be salvaged. Leeches are currently used during post-operative care of re-implanted fingers, skin graft and breast reconstructions .
• Leech has been used in tens of thousands of cases of treat swelling after plastic surgery and graft operations until 1985 micro-surgeons often failed when sewing severed ears, fingers and other body parts back on. Leeches are now regularly used in such cases to keep the blood oozing into the sewn or tissue until the venous congestion is relieved and normal venous drainage of the graft can develop properly .
• Tourists are advised to avoid bathing in lakes and creeks in Africa, since the HIV infection is also transmissible by leeches, the blood that they suck from their human hosts (often unnoticed) lands in the intestines of the worm, and it is stored in reservoir unchanged because of the lack of digestive enzymes. In this manner, the blood meal provides ideal grounds for breeding of the disease-causing microorganisms that live there, such as Toxoplasma gondii, Escherichia coli or HIV. The greatest danger of transmitting an infection from the intestine of the leech occurs during any attempt to remove the parasite by force. During this manipulation, the infectious blood is emitted from the intestine of the worm, and thus it can immediately infect a new victim at the site of the bite. If the leach has sucked the blood on an HIV-infected person, it operates as a can of conserved infectious blood for the next victim. It is less risky to wait until the worm has fed itself fully, then it releases itself and falls off. In this manner, the infectious blood-to-blood contact is avoided, and the causative microorganisms perish before they can infect anybody .
• Did you know a leech has 32 brains! Actually, these brains are suprapharyngeal and suprapharyngeal ganglia .
• As a fall in atmospheric pressure results in a small decrease in dissolved oxygen concentrations, rising leeches in a jar of water provided nineteenth century weather forecasters with a simple way of predicting bad weather.
• In dry weather, some species burrow in the soil where they can survive for many months even in a total lack of environmental water. In these conditions the body is contracted dry and rigid, the suckers not distinguishable, and the skin completely dry. Within ten minutes of sprinkling with a few drops of water, these leeches emerge, fully active .
• 15 traditional healers, in the quzvin region were identified and categorized by the method thereon. Leech therapy is one amongst that.
• Leech therapy may be an effective therapy for rapid reduction of pain associated with osteo-arthritis of the knee.
• Leeches are anti-phlogistic, used for the local obstruction of the blood. They are used in acute inflammation, abscess, boils, in bruises, sprains and blows.
• The leech saliva has helped in countless tricky re-attachment as well as being effective against various inflammatory conditions and skin diseases such as eczema, psoriasis.
• A medicinal leech can once bite, victims can bleed for hours, allowing oxygenated blood to enter the wound area until vein re-grows and regain circulation .
• The leech saliva has helped in degradation of fibrinogen, inhibition of factor XIIIa and lyses of fibrin clots.
• As the benefits of judicious treatment with leeches are recognized, the range of conditions that can be treated extends. There are case reports of effective leech treatment for hematomas, purpuri fulminans, paronychia and even vascular congestion in the penis.
• Leeches extracts the blood of their victims in a painless manner. Thus, leeches were broadly used in surgery for Phlebotomy under the mistaken belief that removal of bed blood may cure the diseases .
• Prof. Charles Lent, leading biologist of U.S. said that leeches are useful in removing the blood from area where tissue has been transplanted or reattached. Because when blood accumulates, tissue can die before it heal. Applying leech to the area once or twice a day for a week give capillaries time to grow across sutures and restore blood circulation.

Limitations and solutions in leech therapy:

The leeches are very useful in micro-surgical practice i.e. plastic and graft surgery. But there is significant risk of infections (?)

• The leech's natural anticoagulant, hirudin, keeps blood flowing for the 20 to 40 minutes it takes to feed.
• Particularly in those procedures were the vascularity of the tissues are compromised.
• Hirudo medicinalis has endosymbiotic bacteria almost 20% of infectious complications seen after leech therapy. So appropriate antibiotic prophylaxis should be administered to the patient who need leech therapy. Antibacterial agent can be determined by the resistance patent of the bacterial flora of regional hirudomedicinalis.
• Aeromonas infections are reported after medicinal leech therapy.
• Pseudo lymphomas are rare but not worthy side effect of medicinal leech therapy.

There are two problems with leech therapy .

• The squeamishness factor
• The possibility of bacterial infection

As leeches cannot be sterilized, Historical account warns of the transmission of syphilis, AIDS, hepatitis, after the re-application of leeches used on infected patients. So leeches should be used single time then they should be disposed away.

• More recently, Aeromonas, hydrophilia, the leech’s Natural gut flora has been isolated from wound infections after leech treatment. So, properly prophylactic antibiotic should be provided before the leech application.

The leech therapy may not be used in case of –

• Hemorrhagic diathesis (hemophilia)
• Many leeches are held under suspicion to act as vectors for pathogenic organism i.e. Hirudinaria manilenses of the Philippines is play the role of carrier of the pathogenic organism of rinderpest disease. The lands of leeches JAVA are believed to transmit the flagellate herpentomonas causing gangrenous ulcers.

The perfect 19th century solution for many surgical conditions is leeches says Ruth Sordle, in his special report on leeches in surgery published in the science and medicine section of Houston Chromide quoting the miraculous events that attracted the Huston plastic surgery he is hopeful of getting solutions for many modern medical problems from them.

The long history of the medical utilities of leeches has revealed its much applauded therapeutic effects and even its risks. It is also said that leeches grow bacteria in their gut. In the April 1987 issue of British Medical Journal, researchers at Frenchay Hospital in Bristol, England noted that they had diagnosed six cases of infections caused by Aeromonas hydrophilia. Despite these findings, leeches will remain useful in plastic and reconstructive surgery to treat venous congestion according to latest reports from the west.

In the words of Prof. Charles Lent, leading biologist of United States, leeches are useful in removing the blood from areas where tissue has been transplanted or reattached. Because when blood accumulates, tissue can die before it heals. Applying leeches to the area once or twice a day for a week gives capillaries time to grow across sutures and restore blood circulation.

Though, we are able to supplement better coagulants than Hirudin, in the peak of medical innovations the importance of leeches are not faded. Leech farms of medical times are still under progress, growing millions of medicinal leeches from the developed ones like United States of America. The Carolina Biological Supply Co. in Burlington, N.C. is getting increased demand for the supply of leeches day by day from physicians all over the world indicating newer horizons of its utility in the coming days. Thus words of Sushruta, are becoming a reality even after 2000 years of change of events that the physician having the art of leech application will be a successful one crossing the boundaries of time and space .