The youngest reported oropharyngeal leech infestation: severe anemia without airway obstruction in a 6-month-old Ethiopian infant: a case report

Infestation of the oropharynx by a leech is uncommon, especially in young children, and can cause major bleeding because leech saliva contains the anticoagulant hirudin. This case, which presents oropharyngeal leech infestation causing severe anemia without obstruction of the airway in a 6-month-old infant, is the youngest ever documented. Parents from rural Ambo brought in an Oromo male infant of 6 months of age, complaining of oral bleeding, decreased oral intake, hematemesis, dark stool, and agitation that had occurred throughout the previous two days. Although there was no respiratory distress, a physical examination revealed blood-stained oral mucosa and a dark brown substance in the oropharynx; a complete blood test showed severe anemia (Hb 7.3 g/dL). The bleeding immediately stopped after removal of a 2.5 cm long leech by Magill forceps from the oropharyngeal wall under direct visualization with a rigid laryngoscope. Blood transfusions, antibiotics, and an iron suspension were given, and the patient's complete recovery was confirmed by an outpatient follow-up after discharge. In environments with limited resources, this case highlights the importance of preventing such rare but dangerous infestations by improving water sanitation, adhering to safe feeding practices, and quickly suspecting parasitic causes in infants exhibiting unexplained bleeding.