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Leeches are annelids comprising the subclass Hirudinea. There are freshwater, terrestrial, and marine leeches. Like the Oligochaeta, they share the presence of a clitellum. Like earthworms, leeches are hermaphrodites. Some, but not all, leeches are hematophagous.

The European Medical Leech (Hirudo medicinalis) and some congeners, as well as some other species, have been used for clinical bloodletting for thousands of years, although most leeches do not feed on human blood, but instead prey on small invertebrates, which they eat whole.

Haemophagic leeches attach to their hosts and remain there until they become full, at which point they fall off to digest. A leech's body is composed of 34 segments. They all have an anterior (oral) sucker formed from the first six segments of their body, which is used to connect to a host for feeding, and also release an anesthetic to prevent the host from feeling the leech. They use a combination of mucus and suction (caused by concentric muscles in those six segments) to stay attached and secrete an anti-clotting enzyme, hirudin, into the host's blood stream.

Some species of leech will nurture their young, while providing food, transport, and protection, which is unusual behavior amongst annelids.

Systematics and taxonomy

Leeches are presumed to have evolved from certain Oligochaeta, most of which feed on detritus. However, some species in the Lumbriculidae are predatory and have similar adaptations as found in leeches. Consequently, the systematics and taxonomy of leeches is in need of review. While leeches form a clade, the remaining oligochetes are not their sister taxon but a diverse paraphyletic group containing some lineages that are closely related to leeches, and others that are far more distant.

There is some dispute as to whether Hirudinea should be a class itself, or a subclass of the Clitellata. The resolution mainly depends on the eventual fate of the oligochaetes, which as noted above do not form a natural group as traditionally circumscribed. Another possibility would be to include the leeches in the taxon Oligochaeta, which would then be ranked as a class and contain most of the clitellates. The Branchiobdellida are leechlike clitellates which were formerly included in the Hirudinea but are apparently just rather close relatives.


The more primitive Acanthobdellidea are often included with the leeches, but some authors treat them as a separate clitellate group. True leeches of the infraclass Euhirudinea have both anterior and posterior suckers. They are divided into two groups:

  • Rhynchobdellida (pl. Rhynchobdellae): "Jawless" leeches, armed with a muscular straw-like proboscis puncturing organ in a retractable sheath. The Rhynchobdellae consist of two families:
    • Glossiphoniida (pl. Glossiphoniidae): Flattened leeches with a poorly defined anterior sucker
    • Piscicolida (pl. Piscicolidae): have cylindrical bodies and a usually well-marked, bell-shaped, anterior sucker. The Glossiphoniidae live in fresh-water habitats; the Pisciolidae are found in seawater habitats.


  • Arhynchobdellida (pl. Arhynchobdellae): Leeches which lack a proboscis and which may or may not have jaws armed with teeth. Arhynchobellids are divided into two orders:
    • Gnathobdela (pl. Gnathobdelae): In this order of "jawed" leeches, armed with teeth, is found the quintessential leech: the European medical (bloodsucking) leech, Hirudo medicinalis. It has a tripartite-jaw filled with hundreds of tiny sharp teeth. The incision mark left on the skin by the European medical leech is an inverted Y inside a circle. Its North American counterpart is Macrobdela decora, a much less efficient medical leech. Within this order, the family Hirudidae is characterized by aquatic leeches and the family Haemadipsidae by terrestrial leeches. In the latter are Haemadipsa sylvestris, the Indian leech and Haemadipsa zeylanica (Yamabiru), the Japanse Mountain or Land Leech.
    • Pharyngobdella (pl. Pharyngobdellae): These so called worm-leeches consist of freshwater or amphibious leeches that have lost the ability to penetrate a host's tissue and suck blood. They are carnivorous and equipped with a relatively large, toothless, mouth to ingest worms or insect larvae, which are swallowed whole.

      The Pharyngobdella have six to eight pairs of eyes, as compared with five pairs in Gnathobdelliform leeches, and include three related families. The Erpobdellidae are some species from freshwater habitats.


Reproduction

Leeches are hermaphrodites, meaning each one of them has both female and male reproductive organs (ovaries and testes respectively). Leeches reproduce by reciprocal fertilization, and sperm transfer occurs during copulation.The leech exercising the role of the male will grow a sperm sack near the end of its tail, and the leech playing the female will bite it off, thus reproducing. Similarly to the earthworms, leeches also use a clitellum to hold their eggs and secrete the cocoon.

During reproduction leeches utilize hyperdermic injection of their sperm. They use a spermatophore, which is a structure containing the sperm. Once next to another leech, the two will line up with their anterior side opposite the other's posterior. The leech then shoots the spermatophore into the clitellur region of the opposing leech where its sperm will make its way to the female reproductive parts.

Nutrition

On haematophagous leeches, the digestive system starts with the jaw which is located ventrally on the anterior side of the body. It is attached to the pharynx, then the esophagus extending to the crop, which leads to the Intestinum, 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.

The anatomy of predacious leeches are similar, though some may also have a protrusible proboscis which is retracted in their mouth. Such leeches are often ambush predators, which lie in wait, and strike their prey using their proboscis in a spear-like fashion.

It was long thought that bacteria in the gut carried on digestion for the leech instead of endogenous enzymes which are very low or absent in the intestine. Relatively recently it has been discovered that all leeches and leech species studied do produce endogenous intestinal exopeptidases which can unlink free terminal-end amino acids, one amino acid monomer at a time, from a gradually unwinding and degrading protein polymer. However, unzipping of the protein can start from either the amino (tail) or carboxyl (head) terminal-end of the protein molecule. It just so happens that the leech exopeptidase (arylamidases), possibly aided by proteases from endosymbiotic bacteria in the intestine, starts from the tail or amino protein, free-end, slowly but progressively removing many hundreds of individual terminal amino acids for resynthesis into proteins that constitute the leech. Since leeches lack endopeptidases, the mechanism of protein digestion can not follow the same sequence as it would in all other animals where exopeptidases act sequentially on peptides produced by the action of endopeptidases. Exopeptidases are especially prominent in the common North American worm-leech Erpobdella punctata. This evolutionary choice of exopeptic digestion in Hirudinea distinguishes these carnivorous clitellates from Oligochaeta.

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 microflora. 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. Non-bloodsucking leeches such as Erpobdella punctata are host to three bacterial symbionts, Pseudomonas sp., Aeromonas sp., and Klebsiella sp. (a slime producer). The bacteria are passed from parent to offspring in the cocoon as it is formed.

Leech bites

Effects



Though certain species of leeches feed on blood, not all species can bite; 90% of them solely feed off decomposing bodies and open wounds of amphibians, reptiles, waterfowl, fish, and mammals (including, but not limited to, humans). A leech attaches itself when it bites, and it will stay attached until it has had its fill of blood. Due to an anticoagulant (hirudin) that leeches secrete, bites may bleed more than a normal wound after the leech is removed. The effect of the anticoagulant will wear off several hours after the leech is removed and the wound is cleaned.

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 Cameroonmarker.

Removal

One recommended method of removal is using a fingernail to break the seal of the oral sucker at the anterior end (the smaller, thinner end) of the leech, repeating with the posterior end, then flicking the leech away. As the fingernail is pushed along the person's skin against the leech, the suction of sucker's seal is broken, at which point the leech should detach its jaws.

A common but medically inadvisable technique to remove a leech is to apply a flame, a lit cigarette, salt, soap, or a caustic chemical such as alcohol, vinegar, lemon juice, insect repellent, heat rub, or certain carbonated drinks. These cause the leech to regurgitate its stomach contents into the wound and quickly detach. However, the vomit may carry disease, and thus increase the risk of infection.

Simply pulling a leech off by grasping it can also cause regurgitation, and adds risks of further tearing the wound, and leaving parts of the leech's jaw in the wound, which can also increase the risk of infection.

An externally attached leech will detach and fall off on its own when it is satiated on blood, usually in about 20 minutes (but will stay there for as long as it can). Internal attachments, such as nasal passage or vaginal attachments, are more likely to require medical intervention..

Treatment

After removal or detachment, the wound should be cleaned with soap and water, and bandaged. Bleeding may continue for some time, due to the leech's anti-clotting enzyme. Applying pressure can reduce bleeding, although blood loss from a single bite is not dangerous. The wound normally itches as it heals, but should not be scratched as this may complicate healing and introduce other infections. An antihistamine can reduce itching, and applying a cold pack can reduce pain or swelling.

Some people suffer severe allergic or anaphylactic reactions from leech bites, and require urgent medical care. Symptoms include red blotches or an itchy rash over the body, swelling away from the bitten area (especially around the lips or eyes), feeling faint or dizzy, and difficulty breathing.

Prevention

There is no guaranteed method of preventing leech bites in leech-infested areas. The most reliable method is to cover exposed skin. The effect of insect repellents is disputed, but it is generally accepted that strong (maximum strength or tropical) insect repellents do help prevent bites.

Leech socks can be helpful in preventing bites when the full body will not be at risk of contact with leeches. Leech socks are pulled over the wearer’s trousers to prevent leeches reaching the exposed skin of the legs and attaching there or climbing towards the torso. The socks are generally a light color that also makes it easier to spot leeches climbing up from the feet and looking for skin to attach to.

There are many home remedies to help prevent leech bites. Many people have a great deal of faith in these methods, but none of them has been proven effective. Some home remedies include: a dried residue of bath soap, tobacco leaves between the toes, pastes of salt or baking soda, citrus juice, and eucalyptus oil. Diluted calcium hydroxide may also be used as a repellent, but may be damaging or irritating to the skin.

Hirudotherapy

The term refers to the use of leeches in medicine.

The use of leeches in medicine dates as far back as 2,500 years ago when they were used for bloodletting in ancient Egypt. All ancient civilizations practiced bloodletting including Indian and Greek civilizations. In ancient Greek history, bloodletting was practiced according to the humoral theory, which proposed that when the four humors, blood, phlegm, black and yellow bile in the human body were in balance, good health was guaranteed. An imbalance in the proportions of these humors was believed to be the cause of ill health. Records of this theory were found in the Greek philosopher Hippocrates' collection in the fifth century B.C. Bloodletting using leeches was one method used by physicians to balance the humors and to rid the body of the plethora.

The use of leeches in modern medicine made its comeback in the 1980s after years of decline, with the advent of microsurgery such as plastic and reconstructive surgeries. In operations such as these, one of the biggest problems that arises is venous congestion due to inefficient venous drainage. This condition is known as venous insufficiency. If this congestion is not cleared up quickly, the blood will clot and arteries that bring the tissues their necessary nourishment will become plugged and the tissues will die. It is here where the leeches come in handy. After being applied to the required site, they suck the excess blood, reducing the swelling in the tissues and promoting healing by allowing fresh, oxygenated blood to reach the area until normal circulation can be restored. The leeches also secrete an anticoagulant (known as hirudin) that prevents the clotting of the blood.

Leeches are utilised to provide venous drainage where a piece ('Flap') has been reattached and has only an arterial input.The Hirudin in their saliva also promotes anticoagulation allowing better perfusion of said 'Flap'.

Forensics

Blood held by leeches has been used to solve criminal cases by use of forensic DNA matching of the blood with that of suspected perpetrators or victims at or near the scene of the crime.

See also



References

  1. Sawyer, Roy T. 1986. Leech Biology and Behaviour. Vol 1-2. Clarendon Press, Oxford
  2. Nehili, M., C. Ilk, H. Mehlhorn, K. Ruhnau, W. Dick, M. Njayou. Experiments on the possible role of leeches as vectors of animal and human pathogens: a light and electron microscopy study. (Abstract Only). Parasitology Research. 1994;80(4):277-90, PubMed ID 8073013. Retrieved on 2007-07-28.
  3. The Knowledge: Removing a leech Times Online. 2006-10-15. Retrieved on 2007-07-28.
  4. Scenario Archive, Travel Survival: How to Remove a Leech Worst Case Scenarios. Retrieved on 2007-07-28.
  5. Victorian Poisons Information Centre: Leeches Victorian Poisons Information Centre. Retrieved on 2007-07-28.
  6. Ibrahim, Adibah, Hakim Bilal Gharib, and Mohd. Nizar Bidin. An Unusual Cause Of Vaginal Bleeding: A Case Report The Internet Journal of Gynecology and Obstetrics. 2003. Vol. 2, No. 2, ISSN: 1528-8439. Retrieved on 2007-07-28.
  7. Blood-sucker gets up woman's nose Reuters via ABC News. 2005-04-11. Retrieved on 2007-07-28.
  8. Calling Doctors Leech and Maggot to the O.R. http://www.islamonline.net/servlet/Satellite?c=Article_C&pagename=Zone-English-HealthScience%2FHSELayout&cid=1158321476138


Further reading

  • Sawyer, Roy T. 1986. Leech Biology and Behaviour. Vol 1-2. Clarendon Press, Oxford


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