Managing Live Leech and Roundworm Endobronchial Infestation (Video)

Live foreign body aspiration is a life-threatening emergency that presents unique challenges to clinicians. In a recent article in Chest, Atul Mehta, MBBS, Vice Chairman of the Department of Pulmonary Medicine and Medical Director of Lung Transplantation at Cleveland Clinic, and his colleague Syed Rizwan Ali, MBBS, at Bombay Hospital in India, describe several cases of fish, leech and roundworm infestation and aspiration. The below images focus on leech and roundworm aspiration and infestation.

*All images and videos are republished with permission from Wolters Kluwer and/or Elsevier.

Leeches

(Photo and video adapted with permission from Kouismi et al)

Seventeen cases of leech infestations in the subglottic airway appear in the medical literature. Leeches store blood in sacs called crops in their alimentary canals. These engorge with blood upon feeding. A small leech in the laryngeal inlet may not initially cause symptoms, but acute airway obstruction may occur once the leech is well fed, as in the above image and below video of a live leech in the vocal cords. Leeches can also cause aeromonas infections, which can lead to pneumonia, septicemia, gastroenteritis and meningitis.

Tracheobronchial hirudiniasis often presents with nonspecific respiratory symptoms and can be confirmed with flexible bronchoscopy. Removing a leech in the airway is far more complicated than removing one on the skin. Lidocaine can be used to facilitate the leech’s detachment, but it is important to first grasp the leech so that it does not fall into the distal airways. Recent cases have shown successful extraction from a cryoprobe and cryoadhesion.

Ascaris lumbricoides (roundworm)

Finally, fourteen cases of roundworm in the tracheobronchial tree appear in the medical literature. Roundworm is a well-known parasite that infects an estimated 400 million people annually. Cases usually involve a person who presents with trauma or for elective surgery and develops acute respiratory distress after general anesthesia. Roundworms have been shown to respond to trauma or anesthesia with retrograde migration into the airway, as shown in the laryngeal mask airway obstruction below.

(Adapted with permission from Roy and Kundra.)

Tracheobronchial ascariasis should be managed with mechanical removal with a rigid bronchoscope and medical management of the worm. The World Health Organization recommends that patients at high risk of soil-transmitted helminthiasis receive prophylactic treatment with benzimidazoles prior to general anesthesia.