Clinical characteristics and seasonal patterns of nasal leech infestation: A retrospective case series

doi:10.12998/wjcc.126715

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World Journal of Clinical Cases

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2307-8960

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Clin Cases. Oct 26, 2026; 14(28): 126715
Published online Oct 26, 2026. doi: 10.12998/wjcc.126715

Clinical characteristics and seasonal patterns of nasal leech infestation: A retrospective case series

Lian Huang, Wuna Shama, Lei Li, Juan Ran, Erda Aku, Jian Zou, Yu Zhao, Lei Lei

Lian Huang, Wuna Shama, Lei Li, Juan Ran, Erda Aku, Department of Ophthalmology and Otorhinolaryngology, People’s Hospital of Mabian Autonomous County, Leshan 614600, Sichuan Province, China

Jian Zou, Yu Zhao, Lei Lei, Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, West China Medical School, Chengdu 610041, Sichuan Province, China

Author contributions: Huang L was responsible for manuscript organization, drafting, and writing; Ran J, Shama W, Aku E, and Li L contributed to data collection and organization and performed foreign body extraction procedures; Zou J and Zhao Y contributed to data collection and organization and provided conceptual and methodological input for the study; Lei L was responsible for study design, manuscript revision, project coordination, and overall supervision; and all authors reviewed and approved the final manuscript.

AI contribution statement: AI tools were used only minimally during the preparation of the initial draft, solely for language editing and polishing. The final submitted version was further revised and edited by a native English-speaking scholar. The authors carefully reviewed, revised, and verified all AI-assisted outputs. AI tools were not used to generate original scientific data, perform independent statistical analyses, interpret clinical findings, or draw scientific conclusions. The authors take full responsibility and accountability for the integrity, accuracy, originality, and scientific validity of the manuscript and all submitted materials. AI tools were not listed as authors or co-authors.

Supported by Sichuan Provincial Department of Science and Technology, No. 2024YFFK0360.

Institutional review board statement: This study was approved by the Ethics Committee of People’s Hospital of Mabian Yi Autonomous County (approval No. EC-2026-06).

Informed consent statement: Because this was a retrospective study using medical record data, the requirement for informed consent was waived by the Ethics Committee of People’s Hospital of Mabian Yi Autonomous County.

Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The datasets generated and analyzed during the current study are not publicly available due to patient privacy and ethical restrictions but are available from the corresponding author upon reasonable request and with appropriate institutional approval.

Corresponding author: Lei Lei, Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital, West China Medical School, No. 37 Guoxuexiang, Wuhou District, Chengdu 610041, Sichuan Province, China. leilei@wchscu.cn

Received: August 11, 2026
Revised: September 19, 2026
Accepted: October 22, 2026
Published online: October 26, 2026
Processing time: 73 Days and 13.4 Hours

Abstract

BACKGROUND

Nasal leech infestation is an uncommon but clinically important cause of unilateral epistaxis, particularly in rural and endemic regions. Because symptoms may be nonspecific and leech saliva contains anticoagulant and anesthetic substances, diagnosis may be delayed.

AIM

To retrospectively analyze the clinical characteristics, environmental exposure history, seasonal distribution, management strategies, and immediate outcomes of patients with nasal leech infestation, with the aim of improving clinical awareness, early diagnosis, and timely treatment of this uncommon cause of unilateral epistaxis in rural and endemic regions.

METHODS

We conducted a retrospective single-center case series of patients diagnosed with nasal leech infestation at the otorhinolaryngology outpatient clinic of our hospital between April 1, 2021 and April 1, 2026. Demographic characteristics, environmental exposure history, clinical presentation, seasonal distribution of presentations, management, and immediate outcomes were retrospectively analyzed.

RESULTS

A total of 38 patients were included. Of these, 25 patients were aged ≤ 14 years. All patients lived in mountainous or peri-mountainous rural areas and had a history of exposure to untreated natural water sources or humid outdoor environments. Presentations clustered in summer and early autumn, especially in August and September. The most common symptom was unilateral epistaxis, followed by direct visualization of a leech and nasal foreign body sensation. All leeches were removed during the initial outpatient visit under anterior rhinoscopy or nasal endoscopic guidance using forceps, following topical anesthesia. No patient required general anesthesia, blood transfusion, or hospital admission.

CONCLUSION

Nasal leech infestation should be considered in patients with persistent unilateral epistaxis, especially in endemic rural areas and in patients with recent freshwater exposure. Careful endoscopic examination facilitates diagnosis and immediate removal. Further prospective studies are needed to evaluate long-term outcomes and optimal removal techniques.

Keywords: Nasal leech infestation; Epistaxis; Live foreign body; Seasonal distribution; Nasal endoscopy

Core Tip: Nasal leech infestation is a rare but important cause of persistent unilateral epistaxis, particularly in children living in rural mountainous regions with freshwater exposure, as found in this retrospective case series. In addition, cases tended to cluster during summer and early autumn. Nasal endoscopy enabled accurate diagnosis and complete removal in all cases without general anesthesia, transfusion, or hospitalization. Therefore, maintaining clinical suspicion of nasal leech infestation and performing prompt endoscopic evaluation may prevent significant bleeding and other complications.