Tuesday, January 25, 2005

Medicinal Maggots, Leeches and Whipworms

I was just thinking of the time during medical school I had the pleasure of taking care of a man from a nursing home who was brought in after someone noticed the bandages around his foot wriggling. He was diabetic, immobile, and had a large ulcer on his heel. They removed the bandages and found some fat and happy maggots. The great thing though, was that the wound looked great. So I did some looking into the latest news about medical critters, and here is what I found:

Leeches (Hirudo medicinalis)-not that new really, but they have just recently gained FDA approval for use as medical devices. They are mostly used in skin grafts and reattachment surgery. Additionally the anticoagulant produced by the leech to aid their bloodsucking is used in a recombinant form,lepirudin, for heparin induced thrombocytopenia. Sources: Biopharm Leeches, MSNBC, FDA

Maggots-Their use was approved last year by the FDA for treatment of wounds and ulcers as I had noted above. For more info: MSNBC,CNN,

Whipworms- The pig whipworm (Trichuris suis) is being used in medical trials for the treatment of Inflamatory bowel disease such as ulcerative colitis and Chron's disease. The theory behind their proposed effectiveness is that the human immune system has evolved to handle these infections, without them the bowels become overactive. Throughout the world the prevalence of IBD appears to be inversely proprotional to the prevalence of these intestinal parasites. Source:Medical Observer

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posted by Clay @ 1/25/2005 06:39:00 PM   6 comments

6 Comments:

At 9:43 PM, Blogger Shane said...

Nice blog on leeches. As a resident, I had a lot of experience with leeches. A lot. At Sinai we did free flap surgery. This is surgery where tissue from one part of the body was moved into a head and neck defect site (i.e. replacing the mandible with bone from the fibula or the iliac crest). When these flaps would develop venous congestion (meaning the blood was getting in ok, just not out), we would use a number of leeches. We obtained them from 1-800-USLEECH, and would get 20 per pack. They could get them to us in a few hours. These little guys saved a lot of flaps. My first month, we had a guy who had a radial forearm free flap that was going bad. It was an area in his anterior neck. I personally placed about 60 leeches on this guys neck, and he had over 80 total. We would often put 3-4 on at a time. The best technique involved making a small prick with a 25-gauge needle,then carefully attaching the leech. I would grab the tail with a hemostat and the head with a pair of blunt pick-ups. Boy, the nurses sure hated us.

The only problem is that once you started the leeching process, you had to be aggressive. I had to check this guy's flap every hour and leech as necessary. You also had to stay by the patient while the leeches were filling. I fell asleep once at three in the morning while standing and suddenly woke and was horrified to find that one had detached and was about to crawl into the guy's trach. Fortunately I caught it before my ENT residency came to a suddenly abrupt end.

So there it is. Leeching 101. Oh yeah, to kill the little guys, put them in alcohol. It purges all the blood and kills the leech. Cool to watch. Clearly not fun for the leech. You then flush the leech. You also need to put them on a IV abx, usually a 3rd generation cephalosporin to cover a naturally occuring bacteria that is usually present even in the medicinal leeches. You also need an airtight tank to store them in. Leeches are wiley little buggers and prone to escape. I could tell you a harrowing call room story, but I'll let your imagination figure out what happened.

Leeching is also used in the ENT world for amputated ears. When the ear is reattached, again, it is usually not arterial flow that is the problem. Usually, when you've had your ear amputated, you'll usually do anything to get it to live.

 
At 10:52 AM, Blogger Clay said...

very nice!

 
At 10:54 AM, Blogger Clay said...

Anybody have anything on the pig whipworm?

 
At 10:58 AM, Blogger Flash said...

I did research in undergrad at ASU on maggot therapy. I think they use larvae from the green bottle fly. These larvae only feed on necrotic tissue and leave the healthy granulating tissue alone. It really is amazing how they will clean up a smelly eschar-filled wound. Some of the leaders in maggot therapy believe that the digestive secretions from the larvae may even have antibacterial properties, although I don't think they have been able to isolate a particular chemical/antibiotic. Of course, this was 4-5 years ago when I researched this topic, so I'm sure there have been some advances. I know that the Europeans have been using maggots for chronic wounds for some time. I don't know why the US hasn't embraced maggots any more than they have. I think they're kinda cute.

 
At 5:00 PM, Blogger Clay said...

I found a study that used 4 patients with CD and 3 with UC, they were given a single dose of 2500 live Trichuris suis eggs orally, and then followed every 2 weeks for 12 weeks. Six of seven patients achieved remission. The effect was temporary however, except for patients who continued maintenance therapy every 3 weeks. They showed continued benefit and no adverse effects for greater than 28 weeks. Source:
Trichuris suis seems to be safe and possibly effective in the treatment of inflammatory bowel disease. American Journal of Gastroenterology, 98(9):2034-41, 2003 Sept.

 
At 5:48 PM, Blogger joe said...

Make sure you prescribe whipworms and not tapeworms de suis, or you may give your pt. a case of neurocysticercosis.
http://content.nejm.org/content/vol350/issue3/imag.

By the way does it bother you that the physician in charge to this project is from IOWA(the PIG capital of the world)? Sounds like he might be into pig by-products.

 

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