Heart failure secondary to severe anemia from oropharyngeal leech infestation: A case report

Leeches can rarely act as blood-sucking endoparasites. The major ways to acquire leeches are swimming in streams, ponds, and drinking contaminated water.

In this case, a 5-year-old female patient presented with nasal bleeding, hematemesis, and melena of two weeks' duration. She has a history of drinking water from streams and ponds. She has easy fatiguability and is unable to play as usual for a one-week duration.

Leech infestation is described as an important source of hemorrhage and subsequent anemia, particularly in children. Leeches can feed on a volume of blood nearly 10 times their body weight. This happens after adhering and piercing the host's mucosa, a process that is painless owing to a local anesthetic released in the leech's saliva. They get access to the human body either by drinking unfiltered water or through the natural orifices of individuals who swim, play, or bathe in contaminated water. Due to this method of spread, nearly all cases have been reported from developing countries where access to and use of safe water is limited, particularly in rural areas.

Leech infestation should be considered as a possible cause of heart failure, unexplained hematemesis, spitting of blood and acute onset severe anemia in rural areas. Early identification and removal leech, along with timely transfusion, are critical and often life saving.