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Morganella Morganii Infection in Hirudo Medicinalis (Iran): A Case Report. Vet Sci 2022; 9:vetsci9100562. [PMID: 36288175 PMCID: PMC9608614 DOI: 10.3390/vetsci9100562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Simple Summary Morganella morganii is a motile, non-spore-forming, rod-shaped facultative an-aerobic gram-negative bacterium found in the intestines of people, the oral cavity of animals, and the environment. Reptiles, guinea pigs, rabbits, jaguars, elephant seals, broiler chickens, piglets, and dolphins have all been documented to have M. morganii infection. Medicinal leeches are used in surgical and non-surgical manners. Treatment of long-term and chronic pain syndrome induced by degenerative diseases in a non-surgical method. For the first time in Iran, our investigation discovered M. morganii-infected Hirudo medicinalis. Infection with M. morganii caused a significant death and morbidity rate (70%) and severe clinical abnormalities. Abstract Medicinal leeches (Hirudo medicinalis) are used in surgical and non-surgical manners. Morganella morganii is an opportunistic and zoonotic pathogenic bacterium causing serious clinical complications. In this study, we isolated, discovered and characterized M. morganii-infected H. medicinalis. We detected and identified M. morganii in all inflamed and swollen Hirudo medicinalis samples. The 16S rRNA sequence of the isolates confirmed all strains of M. morganii. All strains were sensitive to Ceftriaxone, Ceftiofur, Danofloxacin, Ciprofloxacin, Enrofloxacin, Oxytetracycline, and Meropenem and were resistant to Erythromycin, Amoxicillin, Ampicillin, Cefazolin, Colistin, Penicillin G, and Lincomycin. This pathogenic bacterium is a zoonotic pathogen, and monitoring the prevalence rate of this bacteria is strongly necessary for leeches used in human medical treatment and care. Finally, all infected leeches were treated successfully in this case report study.
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McCracken JA, Koehler SM, Sharma R. Rethinking antimicrobial prophylaxis in patients receiving medicinal leech therapy. Am J Health Syst Pharm 2021; 79:e14-e19. [PMID: 34390241 DOI: 10.1093/ajhp/zxab330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE To describe challenges in the management of prophylaxis against infections for patients receiving medicinal leech therapy given changes in antimicrobial resistance patterns in the normal flora of leeches. SUMMARY This article presents a patient case of reconstructive surgery complicated by infection associated with the use of medicinal leeches, as well as a discussion of prophylaxis in medicinal leech therapy, focusing on considerations for choosing a prophylactic agent. CONCLUSION Our case report highlights resistance changes in Aeromonas isolates associated with medicinal leeches and the potential for complications if isolates resistant to chosen prophylactic agents arise. When administering antimicrobial prophylaxis in patients receiving medicinal leech therapy, clinicians should be familiar with the susceptibilities of Aeromonas species but also conscious of evolving antimicrobial resistance given the extent of the consequences of infected surgical grafts.
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Affiliation(s)
- James Andrew McCracken
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Steven M Koehler
- Department of Surgery, University Hospital of Brooklyn, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Roopali Sharma
- Department of Pharmacy, University Hospital of Brooklyn, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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A Comprehensive Review of Medicinal Leeches in Plastic and Reconstructive Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2555. [PMID: 32537302 PMCID: PMC7288891 DOI: 10.1097/gox.0000000000002555] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/09/2019] [Indexed: 12/16/2022]
Abstract
Medicinal leeches are a US Food and Drug Administration-approved treatment for venous congestion in graft tissue to promote healing and can serve as a nonsurgical option for plastic surgery patients with concern for tissue compromise. Although there is a wealth of documentation on medicinal leech therapy, the surgical space currently lacks an updated summary of proper indications, use, and risks as they pertain to plastic surgical patients. The purpose of this article is to provide a platform for understanding the recent literature as it relates to reconstruction to improve understanding of indications and necessary considerations in using hirudotherapy. Topics examined include basics of hirudotherapy, indications in plastic surgery, implementation (leech application, number and duration of therapy, and removal), risks (infection and bleeding), and alternative treatments. The evidence provided will aid in physician understanding and implementation, patient counseling, and the informed consent process.
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Wound Coverage Options for Soft Tissue Defects Following Calcaneal Fracture Management (Operative/Surgical). Clin Podiatr Med Surg 2019; 36:323-337. [PMID: 30784540 DOI: 10.1016/j.cpm.2018.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Soft tissue defects and wound healing complications related to calcaneus fractures may result in significant morbidity. The management of these soft tissue complications requires following reconstructive principles that provide the requisites for preservation of the injured limb and the maximization of function. Soft tissue complications are addressed with methods that commensurate with the degree of injury, ranging from local wound care to free flap reconstruction. With the orthoplastic approach to both bone and soft tissue plastic reconstruction, outcomes for limb salvage are greatly enhanced. This article discusses in detail the reconstructive ladder for soft tissue injuries associated with calcaneus fractures.
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The use of medical leeches for venous congestion. Vet Comp Orthop Traumatol 2017; 27:173-8. [DOI: 10.3415/vcot-13-10-0122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 03/07/2014] [Indexed: 11/17/2022]
Abstract
SummaryThe medicinal leech, Hirudo medicinalis, has been used for hundreds of years in human medicine for a variety of diseases, most recently including venous congestion following reconstructive surgeries (skin flaps and reimplantations), excessive lingual and periorbital swelling, and non-traditional treatments for osteoarthritis, compartment syndrome and sialoadenitis. The treatment of venous congestion in animals using leeches has been mentioned anecdotally, but the only published report pertains to the use of leeches in a cat suffering from polycythemia vera. We report the use of medical grade leeches in a one-year-old male castrated Domestic Shorthaired cat presenting with severe swelling of the paw after sustaining a constrictive injury from a bandage. The limb use had become compromised and the swelling was not responsive to compression bandages so leech therapy was instituted for four days and the swelling dramatically improved. The patient's limb use improved back to normal and the constrictive wound went on to heal without complication. The use of leeches in this case allowed for resolution of severe venous congestion and a full return to function in this patient with no continued skin loss. The mechanism of action of hirudotherapy for venous congestion is to allow for an alternative egress of pooled venous blood leading to a reduction in capillary pressure and increases in arterial reperfusion of capillary beds. The human and veterinary applications, method, and potential complications with hirudotherapy are discussed in this review.
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Rothenberger J, Petersen W, Schaller HE, Held M. Determining the appropriate number and duration of leech therapy in congested tissues using tissue spectrophotometry and laser Doppler flowmetry. Wound Repair Regen 2016; 24:1023-1029. [DOI: 10.1111/wrr.12491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 09/30/2016] [Indexed: 01/07/2023]
Affiliation(s)
- Jens Rothenberger
- Department of Plastic, Reconstructive; Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tuebingen; Germany
| | - Wiebke Petersen
- Department of Plastic, Reconstructive; Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tuebingen; Germany
| | - Hans-Eberhard Schaller
- Department of Plastic, Reconstructive; Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tuebingen; Germany
| | - Manuel Held
- Department of Plastic, Reconstructive; Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tuebingen; Germany
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Verriere B, Sabatier B, Carbonnelle E, Mainardi JL, Prognon P, Whitaker I, Lantieri L, Hivelin M. Medicinal leech therapy and Aeromonas spp. infection. Eur J Clin Microbiol Infect Dis 2016; 35:1001-6. [PMID: 27039338 DOI: 10.1007/s10096-016-2629-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/16/2016] [Indexed: 01/11/2023]
Abstract
While the use of medicinal leech therapy (MLT) in reconstructive and orthopaedic surgery is widely described, post-operative complications related to leeches remain a major concern. Aeromonas spp. strains are involved in the majority of reported cases. As surgical success rate is directly impacted, an adapted antibiotic prophylaxis should be instituted in order to minimize these complications. We assessed pharmaceutical process, microbiological control and related infections in order to provide data and choose the appropriate antibiotherapy for patients requiring MLT. We report a clinical and microbiological study over a 24-month period. Clinical data were collected from patients' database, and microbiological analysis both on leeches' tank water and crushed leeches were performed to characterize isolated strains and their susceptibility to antibiotics. A total of 595 leeches were used to treat 28 patients (12 in plastic surgery and 16 in orthopaedic surgery), and three documented cases of post-operative infections were reported. Aeromonas spp. isolates yielded from 62 % of analyzed batches (75 % of Aeromonas veronii). Eighteen Aeromonas spp. isolates yielded from 23 water samples and three crushed leeches. Isolates were similar in tank and crushed leeches. Strains were susceptible to fluoroquinolones, sulfamethoxazole/trimethoprim, aminosides, and third-generation cephalosporins but resistant to amoxicillin/clavulanic acid and second-generation cephalosporins. According to collected data, routine tank water microbiological analyses are mandatory in order to identify leeches' batches containing resistant strains and to discard them. In this context, the surgeon is able to select an appropriated antibiotic prophylaxis in order to avoid MLT associated serious post-operative complications.
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Affiliation(s)
- B Verriere
- Pharmacy Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France.
| | - B Sabatier
- Pharmacy Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France
| | - E Carbonnelle
- Microbiology Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France
| | - J L Mainardi
- Microbiology Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France
| | - P Prognon
- Pharmacy Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France
| | - I Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Wales, UK
| | - L Lantieri
- Reconstructive Surgery Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France
| | - M Hivelin
- Reconstructive Surgery Department, Georges Pompidou European Hospital, 20 rue Leblanc, 75015, Paris, France
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Pannucci CJ, Nelson JA, Chung CU, Fischer JP, Kanchwala SK, Kovach SJ, Serletti JM, Wu LC. Medicinal leeches for surgically uncorrectable venous congestion after free flap breast reconstruction. Microsurgery 2014; 34:522-6. [DOI: 10.1002/micr.22277] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/29/2014] [Accepted: 05/02/2014] [Indexed: 11/06/2022]
Affiliation(s)
| | - Jonas A. Nelson
- Division of Plastic Surgery; University of Pennsylvania; Philadelphia PA
| | - Cyndi U. Chung
- Division of Plastic Surgery; University of Pennsylvania; Philadelphia PA
| | - John P. Fischer
- Division of Plastic Surgery; University of Pennsylvania; Philadelphia PA
| | | | - Stephen J. Kovach
- Division of Plastic Surgery; University of Pennsylvania; Philadelphia PA
| | - Joseph M. Serletti
- Division of Plastic Surgery; University of Pennsylvania; Philadelphia PA
| | - Liza C. Wu
- Division of Plastic Surgery; University of Pennsylvania; Philadelphia PA
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Agha RA, Gundogan B, Fowler AJ, Bragg TWH, Orgill DP. The efficacy of the Cook-Swartz implantable Doppler in the detection of free-flap compromise: a systematic review protocol. BMJ Open 2014; 4:e004253. [PMID: 24622948 PMCID: PMC3963127 DOI: 10.1136/bmjopen-2013-004253] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The Cook-Swartz implantable Doppler monitors venous or arterial blood flow from free flaps and can detect free-flap compromise. Previous studies have shown that the use of this Doppler can improve detection and salvage rates as it provides an earlier warning than the current method of clinical assessment. Such studies assert that the implantable Doppler is of great value in monitoring free flaps in current microsurgical units. This systematic review aims to compare the efficacy of the Cook-Swartz implantable Doppler in monitoring free-flap compromise against conventional clinical free-flap monitoring techniques. METHODS AND ANALYSIS Various electronic databases will be systematically searched for studies that compare the use of Cook-Swartz implantable Doppler with clinical assessment. The selected studies will then have their titles and abstracts screened by two authors. Articles selected after title and abstract screen will have full text downloaded and the complete article will be assessed for suitability. Once the articles have been selected for inclusion, data extraction will take place. For data analysis, the outcomes of the studies will be tabulated, with descriptive statistics performed as appropriate and the detection rate of the Doppler and clinical assessment will be compared and synthesised where possible. ETHICS AND DISSEMINATION The authors hope to disseminate the findings as widely as possible. This systematic review will be published in a peer-reviewed journal and include a number of recommendations as its conclusion based on the evidence contained within. Given the wide range of specialties now utilising flaps, it will be presented at a wide range of national and international conferences. PROTOCOL REGISTRATION IN PROSPERO CRD42013005818 The literature search and data extraction went on until 28 January 2014. These steps were revised in line with peer review comments.
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Affiliation(s)
- Riaz A Agha
- Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK
| | | | | | - Thomas W H Bragg
- Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK
| | - Dennis P Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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