Leech

Leeches are segmented worms that belong to the phylum annelida and comprise
the subclassHirudinea. Like other oligochetes such as earthworms, leeches share
a clitellum and arehermaphrodites. Nevertheless, they differ from other oligocheates in
significant ways. For example, leeches do not have bristles and the external
segmentation of their bodies does not correspond with the internal segmentation of their
organs. Their bodies are much more solid as the spaces in their coelem are dense with
connective tissues. They also have two suckers, with each sucker located at the end of
each animal.
The majority of leeches live in freshwater environments, while some species can be
found in terrestrial and marine environments as well. Most leeches
are hematophagous as they are predominantly blood suckers that feed on blood from
vertebrate and invertebrate animals
Leeches such as the Hirudo medicinalis, have been historically used in medicine to
remove blood from patients. The practice of leeching can be traced to Ancient ndia and
Greece and has continued well into the 18th and 19th centuries in both Europe and
North America. n modern times, the practice of leeching is much rarer and has been
replaced by other contemporary uses of leeches such as the reattachment of body parts
as well as reconstructive and plastic surgeries.

eeding
Most leeches do not feed on human blood, but instead prey on small invertebrates,
which they eat whole. To feed on its host, leeches use their anterior suckers to connect
to a host for feeding, and also release an anesthetic to prevent the host from feeling the
leech. Once attached, leeches use a combination of mucus and suction to stay attached
and secrete an anti-clotting enzyme, hirudin, into the host's blood stream. Though
certain species of leeches feed on blood, not all species can bite; 90% of them feed
solely 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 becomes full, at which point it falls off to digest.
Due to theanticoagulant 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, but there have been only
a few reports of leeches' transmitting pathogens to humans. A study found
both HV and hepatitis B in African leeches from Cameroon.
Medicinal use of leeches
The European medical leech Hirudo medicinalis and some congeners, as well as some
other species, have been used for clinical bloodlettingfor thousands of years. The use of
leeches in medicine dates as far back as 2,500 years ago, when they were used for
bloodletting in ancient ndia. Leech therapy is explained in ancient Ayurvedic texts.
Many ancient civilizations practiced bloodletting, including ndian and Greek
civilizations. n 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. n
operations such as these, one problem that arises is venous congestion due to
inefficient venous drainage. Sometimes because of the technical difficulties in forming
an anastomosis of a vein, no attempt is made to re-attach a venous supply to a flap at
all. This condition is known as venous insufficiency. f this congestion is not cleared up
quickly, the blood will clot, arteries that bring the tissues their necessary nourishment
will become plugged and the tissues will die. To prevent this leeches are applied to a
congested flap and a certain amount of excess blood is consumed before the leech falls
away. The wound will also continue to bleed for a while due to the
anticoagulant hirudin in the leeches' saliva. The combined effect is to reduce the
swelling in the tissues and promoting healing by allowing fresh, oxygenated blood to
reach the area.
The active anticoagulant principle of leech saliva, is a small protein, hirudin. Discovery
and isolation of this protein led to a method of producing it by recombinant technology.
Recombinant hirudin is available to physicians as an intravenous anticoagulant
preparation for injection, particularly useful for patients who are allergic to or cannot
tolerate heparin.

Hookworm
The hookworm is a parasitic nematode that lives in the small intestine of its host, which
may be amammal such as a dog, cat, or human. Two species of hookworms commonly
infect humans,ncylostoma duodenale and Necator americanus.
duodenale predominates in the Middle East,North Africa, ndia and (formerly) in
southern Europe, while N americanus predominates in the Americas, Sub-Saharan
Africa, Southeast Asia, China, and ndonesia. Hookworms are thought to infect more
than 600 million people worldwide. The braziliense and tubaeforme species infect
cats, while caninum infects dogs. Uncinaria stenocephala infects both dogs and cats.
Hookworms are much smaller than the larger roundworm scaris lumbricoides, and the
complications of tissue migration and mechanical obstruction so frequently observed
with roundworm infestation are less frequent in hookworm infestation. The most
significant risk of hookworm infection is anemia, secondary to loss of iron (and protein)
in the gut. The worms suck blood voraciously and damage the mucosa. However, the
blood loss in the stools is not visibly apparent.
Ancylostomiasis, also known by several other names, is the disease caused when
duodenalehookworms, present in large numbers, produce an iron deficiency anemia by
sucking blood from the host's intestinal walls.
Hookworm is a leading cause of maternal and child morbidity in the developing
countries of the tropics and subtropics. n susceptible children hookworms cause
intellectual, cognitive and growth retardation, intrauterine growth
retardation, prematurity, and low birth weight among newborns born to infected
mothers. n developed countries, hookworm infection is rarely fatal, but anemia can be
significant in a heavily infected individual.
Signs and symptoms
There are no specific symptoms or signs of hookworm infection. As mentioned above,
they arise from a combination of intestinal inflammation and progressive iron/protein-
deficiency anaemia. Larval invasion of the skin might give rise to intense, local itching,
usually on the foot or lower leg, which can be followed by lesions that look like insect
bites, can blister ("ground itch"), and last for a week or more. Animal hookworm larvae
on penetrating humans may produce a creeping eruption called cutaneous larva
migrans. The larvae migrate in tortuous tunnels in between stratum
germinativum and stratum corneum of the skin, causing serpigenous vesicular lesions.
With advancing movement of the larvae, the rear portions of the lesions become dry
and crusty. The lesions are typically intensely pruritic. Coughing, chest pain, wheezing,
and fever will sometimes be experienced by people who have been exposed to very
large numbers of larvae. Epigastric pains, indigestion, nausea, vomiting, constipation,
and diarrhea can occur early or in later stages as well, although gastrointestinal
symptoms tend to improve with time. Signs of advanced severe infection are those
of anemia and protein deficiency, including emaciation, cardiac failure and abdominal
distension with ascites

Life cycIe
See the image for the biological life cycle of the hookworms where it thrives in warm
earth where temperatures are over 18C. They exist primarily in sandy or loamy soil and
cannot live in clay or muck. Rainfall averages must be more than 1000 mm (40 inches)
a year. Only if these conditions exist can the eggs hatch. nfective larvae of Necator
americanus can survive at higher temperatures, whereas those of ncylostoma
duodenale are better adapted to cooler climates. Generally, they live for only a few
weeks at most under natural conditions, and die almost immediately on exposure to
direct sunlight or desiccation.
nfection of the host is by the larvae, not the eggs. While duodenale can be ingested,
the usual method of infection is through the skin; this is commonly caused by walking
barefoot through areas contaminated with fecal matter. The larvae are able to penetrate
the skin of the foot, and once inside the body, they migrate through the vascular
system to the lungs, and from there up the trachea, and are swallowed. They then pass
down the esophagus and enter the digestive system, finishing their journey in
the intestine, where the larvae mature into adult worms.
Once in the host gut, Necator tends to cause a prolonged infection, generally 15 years
(many die within a year or two of infecting), though some adult worms have been
recorded to live for 15 years or more. On the other hand, ncylostoma adults are short
lived, surviving on average for only about 6 months. However, infection can be
prolonged because dormant larvae can be "recruited" sequentially from tissue "stores"
(see Pathology, above) over many years, to replace expired adult worms. This can give
rise to seasonal fluctuations in infection prevalence and intensity (apart from normal
seasonal variations in transmission).
They mate inside the host, females laying up to 30,000 eggs per day and some 18 to 54
million eggs during their lifetime, which pass out in feces. Because it takes 57 weeks
for adult worms to mature, mate and produce eggs, in the early stages of very heavy
infection, acute symptoms might occur without any eggs being detected in the patient's
feces. This can make diagnosis very difficult.
$ummary of BioIogicaI Life CycIe
N americanus and duodenale eggs can be found in warm, moist soil where they will
eventually hatch into first stage larvae, or L1. L1, the feeding non-infective rhabditoform
stage, will feed on soil microbes and eventually molt into second stage larvae, L2. L2,
which is also in the rhabditoform stage, will feed for approximately 7 days and then molt
into the third stage larvae, or L3. L3 is the filariform stage of the parasite, that is, the
non-feeding infective form of the larvae. The L3 larvae are extremely motile and will
seek higher ground to increase their chances of penetrating the skin of a human host.
The L3 larvae can survive up to 2 weeks without finding a host. While N
americanuslarvae only infect through penetration of skin, duodenale can infect both
through penetration as well as orally. After the L3 larvae have successfully entered the
host, the larvae then travel through the subcutaneous venules and lymphatic vessels of
the human host. Eventually, the L3 larvae enter the lungs through the pulmonary
capillaries and break out into the alveoli. They will then travel up the trachea to be
coughed and swallowed by the host. After being swallowed, the L3 larvae are then
found in the small intestine where they molt into the L4, or adult worm stage. The entire
process from skin penetration to adult development takes about 59 weeks. The female
adult worms will release eggs (N mericanus about 9,000-10,000 eggs/day and
duodenale 25,000-30,000 eggs/day) which are passed in the feces of the human host.
These eggs will hatch in the environment within several days and the cycle with start
anew.
ncubation Period
The incubation period can vary between a few weeks to many months and is largely
dependent on the number of Hookworm parasites an individual is infected with.




Eggs are passed in the stool , and under favorable conditions (moisture, warmth, shade), larvae
hatch in 1 to 2 days. The released rhabditiform larvae grow in the feces and/or the soil , and
after 5 to 10 days (and two molts) they become filariform (third-stage) larvae that are infective .
These infective larvae can survive 3 to 4 weeks in favorable environmental conditions. On
contact with the human host, the larvae penetrate the skin and are carried through the veins to
the heart and then to the lungs. They penetrate into the pulmonary alveoli, ascend the bronchial
tree to the pharynx, and are swallowed . The larvae reach the small intestine, where they reside
and mature into adults. Adult worms live in the lumen of the small intestine, where they attach to
the intestinal wall with resultant blood loss by the host . Most adult worms are eliminated in 1 to
2 years, but longevity records can reach several years.
Some A. duodenale larvae, following penetration of the host skin, can become dormant (in the
intestine or muscle). n addition, infection by A. duodenale may probably also occur by the oral
and transmammary route. N. americanus, however, requires a transpulmonary migration phase.