Infektionen im Zusammenhang mit der Anwendung von Hirudo medicinalis – Zwei Fallberichte und Literaturübersicht

Zusammenfassung

Zwei etablierte Anwendungsgebiete von medizinischen Blutegeln sind die Förderung des venösen Abstroms bei Transplantaten/Lappenplastiken und die Schmerztherapie bei Arthrose. Auch wenn medizinische Blutegel unter kontrollierten Bedingungen gezüchtet und gehalten werden, sind sie genuin mit einer Spezies-eigenen Bakterienflora besiedelt. Da die Anwendung der Egel mit einer Kontinuitätsunterbrechung der Haut verbunden ist, ist a priori ein Infektionsrisiko gegeben. Es werden 2 Fälle mit unterschiedlicher Indikation der Egeltherapie geschildert, in denen eine Wundinfektion in enger zeitlicher und örtlicher Korrelation mit der Egeltherapie oder mit Nachweis eines Egel assoziierten Keimes auftrat, die jeweils erfolgreich behandelt werden konnten. Aufgrund der nicht eindeutig geklärten Komplikationsrate durch die Anwendung von Blutegeln ist eine strenge Indikationsstellung notwendig. Mögliche präventive Maßnahmen stehen derzeit auf dem Prüfstand.

Abstract

Medicinal leeches are well-established for promoting venous drainage in transplants/flaps and analgesia in osteoarthritis. Although medicinal leeches are bred and kept under controlled conditions, they are colonised by a genuine species-specific bacterial flora. Therapeutic application of leeches implies skin penetration carrying an a priori risk of infection. We report 2 cases with different indications for medicinal leech therapy. In both cases wound infection occurred in close temporal and spatial correlation or with evidence of a leech-associated germ that could be treated successfully. An unclarified complication rate warrants strict indications for the application of medicinal leeches. Preventive measures are currently tested.

Schlüsselwörter

Infektion - Hirudo - medizinischer Blutegel - Komplikationen - Aeromonas

Key words

infection - Hirudo - medical leech therapy - complications - Aeromonas

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