Hypopharyngeal hirudiniasis presenting as hematemesis

Abstract

Leeches belong to the Annelida division, Clitellata class, Hirudinea subclass. Common species of leeches that infest humans are Dinobdella ferox, Hirudinea granulosa, and Hirundinea viridis [1]. A 72-year-old man, a cattle breeder, presented to the emergency room with hematemesis of 10 days' duration. He reported having drunk water from an open trough. He was conscious, and the physical examination findings were normal. He had a history of smoking 50 packs per year, but no co-morbidities or alcohol use. The hematology values at presentation were as follows: white cell count, 10 500/mm 3 ; hemoglobin, 11.7 g/dL; mean corpuscular volume, 85/μm 3 ; platelet count, 357 000/mm 3 . The next morning, the blood values were similar, without any significant changes. Endoscopic examination revealed several crater-type lesions that were slightly elevated from the mucosa, some of which were slowly bleeding. The lesions were located in the posterior wall of the oropharynx, root of the tongue, some parts of the esophagus, and the cardia region of the stomach. A careful endoscopic examination of the hypopharyngeal area revealed a live mobile organism, which was identified as a leech (• " Fig. 1, • " Fig. 2, • " Fig. 3). It was carefully removed with a surgical clamp. Follow-up blood tests revealed no significant changes in the hemoglobin values. Leeches are known to adhere to various regions of the body. They may cause anemia and various symptoms, such as hemoptysis, epistaxis, nasal congestion, stridor, headache, hematemesis, difficulty swallowing, and vaginal bleeding. When the trachea and bronchi are affected by bleeding, asphyxia and death can occur [2]. Death as a result of profuse bleeding after the removal of leeches has been recorded [3]. If a leech is located in the nasopharynx and can be seen with the naked eye, it may be easier and preferable to have an otolaryngologist remove it with a surgical clamp [4]. The consumption of water from unsafe sources can still be risky in some rural areas. When patients in rural areas present with upper gastrointestinal bleeding of unknown cause, the possibility of leech infestation should not be overlooked. Endoscopy_UCTN_Code_CCL_1AB_2ABCompeting interests: None

Esophageal Hirudiniasis: an Unusual Cause of Upper Gastrointestinal Bleeding

“…The clinical presentation included melena, hematemesis and hematochezia. Interestingly, in nearly all cases of leeches presenting with hematemesis, the worm was located in the nasal cavity, the pharyngeal or the hypopharyngeal walls [ 7 , 10 , 11 , 16 , 18 ]. On the other hand, the esophageal site seems to be rare.…”

A new hybrid model for wind speed forecasting combining long short-term memory neural network, decomposition methods and grey wolf optimizer

“…Among the statistical methods, used for WSF there are both linear and nonlinear models. Common linear statistical models for WSF include the autoregressive (AR) [18], linear regression [19], moving average (MA) [20], Kalman filtering [23,24], ARMA [21], Markov chain [25] and AR integrated MA (ARIMA) [22] models. If the J o u r n a l P r e -p r o o f Journal Pre-proof nonlinear characteristics are prominent, however, the forecasting results by these models may not be satisfactory for the intended application [26].…”

“…In this case, non-linear statistical models for WSF perform better, which include nonlinear auto regressive (NAR) and nonlinear auto regressive exogenous (NARX) models [28][29][30]. In [19], an AR model that is sufficiently flexible for modeling the main features of WS and sufficiently sensitive for wind turbines has been used. Riahy and Abedi [20] proposed a linear MA prediction model for ST-WSF.…”

“…The stage of the chasing, approaching, and tracking of the prey is shown in Fig.1(A); the stages of the pursuing, harassing, and encircling of the prey are shown in Fig.1(B-D); the stages of the stationary wait and attack towards the prey are shown in Fig.1(E). The encircling behavior of a grey wolf throughout hunting is modeled as[69,70] (19)…”

An unusual cause of chest discomfort: case report of oesophageal hirudiniasis

“…Leeches (Annelida: Clitellata: Hirudinida) species that commonly infest humans include Dinobdella ferox, Poecilobdella granulosa and Poecilobdella viridis (Kani et al 2014). Leeches are found worldwide, living mostly in fresh water, and occasionally enter human orifices-a condition known as mucosal, orifice, vesical or internal hirudiniasis, depending on the localization of the leech (Phillips et al 2010, Sawyer 1986).…”