Severe Acute Anaemia Secondary to Laryngopharyngeal Leech Infestation in a Three-Year-Old Child: A Case Report and Critical Review of the Literature from Rural Northern Tanzania
Year: 2026
Type: preprint
Abstract: Background Leech infestation of the upper aerodigestive tract is an uncommon but potentially life-threatening cause of mucosal bleeding and acute anaemia in children. Because symptoms may resemble gastrointestinal bleeding, epistaxis or a bleeding disorder, the diagnosis can be delayed, particularly in rural healthcare settings. Case presentation: A three-year-old boy presented to Haydom Lutheran Hospital in rural northern Tanzania with a three-day history of vomiting blood and recurrent blood-stained saliva. His symptoms were preceded by epistaxis and accompanied by fatigue and reduced appetite. His father reported that the child had drunk water from a pond while playing. On examination, the child was markedly pale and tachycardic, with a heart rate of 150 beats/min and a temperature of 36.7°C. Blood-stained mucosa and a live leech were visible in the posterior pharynx. Laboratory investigation revealed severe anaemia, with a haemoglobin concentration of 4.1 g/dL. The platelet count was normal, and the reported coagulation assessment did not identify a clear alternative explanation for the bleeding. Direct laryngoscopy under general anaesthesia identified a leech attached in the left tonsillar/parapharyngeal region. It was removed under direct visualisation. Bleeding ceased following removal. The child received two units of blood, adjusted for age and weight, together with haematinic therapy. His haemoglobin increased to 9.9 g/dL by the third day after transfusion, and he was discharged in good clinical condition. Discussion This case illustrates the importance of considering upper aerodigestive leech infestation in children presenting with unexplained oral bleeding, apparent haematemesis and severe anaemia, particularly when there is exposure to untreated surface water. Direct visualisation and controlled extraction are central to management, while airway assessment, haemodynamic stabilisation and appropriate transfusion are essential components of care. Conclusion Laryngopharyngeal leech infestation should be considered in the differential diagnosis of acute severe anaemia and recurrent blood-stained saliva in children from rural settings. Early examination of the upper airway and timely removal may prevent continued blood loss and serious complications.
Source: Research Square
Authors: Matei Mselle, Omben Twazihirwa, Kelvin Zephania, Godwin Rogath, Samson Warioba, Justin Kyaruzi, Gabriel Machibya, Barnaba Willium, Elisha Fredrick, Pastory Kimario, Sedekia Shadrack, Frank John, Sando Sando, Frank Olomi, Abdulkarim Mselem, Machunde Lugandya, Salmini Mkojera, Jackson Kipeta, Abdallaa Majake, Nickson Maro, Sospeter Sospeter, Diana Athanas, Bahati Lubongeja, Gideon Shadrack, Privatus Thadeo, Dwight Mbawala, Manase Michael, Mayunga Mswanzari, Abeid Anacleth, Emanuel Shoto, Justa Majula, Johanes Joseph
Institution: Haydom Lutheran Hospital
Language: English
Subfield: Animal Science and Zoology
Domain: Life Sciences
Open Access status: green
OpenAlex ID: W7225916635