Relationship of Leeches and Blood Parasites

Yıl 2025, Cilt: 9 Sayı: 2, 94 - 98, 31.08.2025

Gülşen Yılmaz Jilta , Cem Vuruşaner , Naim Saglam

Öz

Leeches are a group of organisms belonging to the class Hirudinea within the phylum Annelida, with over 650 species that can live in marine, freshwater, and terrestrial environments. Some predatory species among them feed by consuming other Annelida species, various invertebrates, snails, and insect larvae. Most leeches, however, are ectoparasites that primarily feed on the blood of vertebrates and mammals, including fish, frogs, turtles, snakes, snails, and crustaceans. A small number of leech species are known as "medicinal leeches" and have been used for therapeutic purposes from the past to the present. It is known that leeches can transmit a large number of viral and bacterial agents during their blood-sucking feeding, and it has also been reported that they are vectors of many Trypanasoma species seen in fish and blood parasites such as various Haemogregarina and Haemococcidios. The presence of ricketsial agents such as Bartonella spp. and Ehrlichia spp. has also been shown in various molecular studies. Until now, the studies about leeches as vectors of blood parasites are not at a adequate level. Therefore, in this review, it is aimed to present the information and the results of some laboratory studies performed so far in order to shed light on the studies to be carried out on the subject.

Anahtar Kelimeler

Hirudinea , leech , medical leech , ectoparasite , blood parasites

Relationship of leeches and blood parasites

Öz

Leeches are a group of organisms belonging to the class Hirudinea within the phylum Annelida, with over 650 species that can live in marine, freshwater, and terrestrial environments. Some predatory species among them feed by consuming other Annelida species, various invertebrates, snails, and insect larvae. Most leeches, however, are ectoparasites that primarily feed on the blood of vertebrates and mammals, including fish, frogs, turtles, snakes, snails, and crustaceans. A small number of leech species are known as "medicinal leeches" and have been used for therapeutic purposes from the past to the present. It is known that leeches can transmit a large number of viral and bacterial agents during their blood-sucking feeding, and it has also been reported that they are vectors of many Trypanasoma species seen in fish and blood parasites such as various Haemogregarina and Haemococcidios. The presence of ricketsial agents such as Bartonella spp. and Ehrlichia spp. has also been shown in various molecular studies. Until now, the studies about leeches as vectors of blood parasites are not at a adequate level. Therefore, in this review, it is aimed to present the information and the results of some laboratory studies performed so far in order to shed light on the studies to be carried out on the subject.

Anahtar Kelimeler

Hirudinea , leech , medical leech , ectoparasite , blood parasites

Kaynakça

• Abdisa, T. (2018). Therapeutic importance of leech and impact of leech in domestic animals. MOJ Drug Design, Development & Therapy, 2(6), 235‒242.
• Aloto, D., & Eticha, E. (2018). Leeches: A Review on their pathogenic and beneficial effects. Journal of Veterinary Science and Technology, 9, 1-6.
• Ayhan, H., & Mollahaliloğlu, S. (2018). Medicinal leech therapy. Ankara Med J, 20(1), 141-148. Bahmani, M., Abdi, F., & Adineh, A. (2014). The anti leech effect of ethanolic extract of Achillea millefolium L. compared to levamisole and niclosamide on Limnatis Nilotica. Studia Universitatis” Vasile Goldis” Arad. SeriaStiinteleVietii, 24(3), 293.
• Baldacchino, F., Muenworn, V., Desquesnes, M., Desoli, F., Charoenviriyaphap, T. & Duvallet, G. (2013). Transmission of pathogens by Stomoxys flies (Diptera, Muscidae): a review. Parasite, 20-26, 13.
• Barta, J. R. & Desser, S. S. (1989). Development of Babesiosoma stableri (Dactylosomatidae; Adeleida; Apicomplexa) in its leech vector (Batracobdella picta) and the relationship of the dactylosomatids to the piroplasms of higher vertebrates. Journal of Eukaryotic Microbiology, 36, 241-253.
• Borda, E., & Siddall, M. E. (2004) Review of the evolution of life history strategies and phylogeny of Hirudinida (Annelida: Oligochaeta). Lauterbornia, 52, 5-25.
• Das, B.K. (2014). An Overview on Hirudotherapy/Leech therapy. Indian Research Journal of Pharmacy and Science, 1(1), 34.
• Dumler, J. S., Madigan, J. E., Pusterla, N., & Bakken, J. S. (2007). Ehrlichioses in humans: epidemiology, clinical presentation, diagnosis, and treatment. Clinical Infectious Diseases, 45(Supplement-1), S45-S51.
• Duruhan, S., Biçer, B., Tuncay, M. S., Uyar, M. & Güzel, S. (2014).Travma ve plastik cerrahi operasyonları sonrası sülük uygulamaları. İntegratif Tıp Dergisi, 2(2), 32‐7.
• Ellis, J., Barratt, J., Kaufer, A., Pearn, L., Armstrong, B., Johnson, M., Park, Y., Downey, L., Cao, M., Neill, L., Lee, R., Ellis, B., Tyler, K., Lun, Z. R. & Stark, D. (2021). A new subspecies of Trypanosoma cyclops found in the Australian terrestrial leech Chtonobdella bilineata. Parasitology, 148(10), 1125-1136.
• Fermino, B. R., Paiva, F., Soares, P., Tavares, L. E. R., Viola, L. B., Ferreira, R. C., Botero- Arias, R., de-Paula, C. D., Campaner, M., Takata, C. S. A., Teixeira, M. M. G. & Camargo, E. P. (2015). Field and experimental evidence of a new caiman trypanosome species closely phylogenetically related to fish trypanosomes and transmitted by leeches. International Journal for Parasitology: Parasites and Wildlife, 4 (3), 368–378.
• Gileva, O. S., & Mumcuoglu, K. Y. (2013). Hirudotherapy. In: Grassberger, M., Sherman, R. A., Gileva, O. S., Kim, C. M. H., Mumcuoglu, K. Y. editors. Biotherapy-history, principles and practice: a practical guide to the diagnosis and treatment of disease using living organisms. London, England: Springer Science & Business Media, 31–76.
• Govedich, F. R., Bain, B., Moser, W. E., Gelder, S., Davies, R. & Brinkhurst, R. (2010). Annelida (Clitellata): Oligochaeta, Branchiobdellida, Hirudinida, and Acanthobdellida. Ecology and Classification of North American Freshwater Intervertebrates (Third Edition), 385-486.
• Gödekmerdan, A., Arusan, S., Bayar, B., & Sağlam, N. (2011). Tıbbi sülükler ve hirudoterapi. Turkiye Parazitoloji Dergisi, 35, 234-239.
• Graf, J., Kikuchi, Y. & Rio, R. V. (2006). Leeches and their microbiota: naturally simple symbiosis models. Trends in Microbiology, 14(8), 365–371.
• Greenblatt, R. J., Work, T. M., Balazs, G. H., Sutton, C. A., Casey, R. N. & Casey, J. W. (2004). The Ozobranchus leech is a candidate mechanical vector for the fibropapilloma-associated turtle herpesvirus found latently infecting skin tumors on Hawaiian green turtles (Chelonia mydas). Virology, 321(1), 101–110.
• Hamilton, P.B., Gibson, W.C. & Stevens, J.R. (2007). Patterns of co-evolution between trypanosomes and their hosts deduced from ribosomal RNA and protein-coding gene phylogenies. Molecular Phylogenetics and Evolution, 44 (1), 15–25.
• Hamilton, P.B., Stevens, J.R., Gidley, J., Holz, P. & Gibson, W.C. (2005). A new lineage of trypanosomes from Australian vertebrates and terrestrial bloodsucking leeches (Haemadipsidae). International Journal of Parasitology, 35(4), 431–443.
• Haycox, C. L., Odland, P. B., Coltrera, M. D. & Raugi, G. J. (1995). Indications and complications of medicinal leech therapy. Journal of the American Academy of Dermatology, 33(6), 1053–1055.
• Hayes, P. M., Lawton, S. P., Smit, N. J., Gibson, W. C. & Davies, A. J. (2014). Morphological and molecular characterization of a marine fish trypanosome from South Africa, including its development in a leech vector. Parasites and Vectors, 7, 50.
• Hemmingsen, W., Jansen, P. & Mackenzie, K. (2005). Crabs, leeches andtrypanosomes: An unholy trinity? Marine Pollution Bulletin, 50, 336-9.
• Herlin, C., Bertheuil, N., Bekara, F., Boissiere, F., Sinna, R., & Chaput, B. (2017). Leech therapy in flap salvage: Systematic review and practical recommendations. Annales de Chirurgie Plastique et Esthetique, 62(2), e1–e13.
• Hildebrandt, J., & Lemke, S. (2011) Small bite, large impact-saliva and salivary molecules in the medicinal leech, Hirudomedicinalis. Naturwissenschaften, 98(12), 995‒1008.
• Kang, J. G., Won, S., Kim, H. W., Kim, B. J., Park, B. K., Park, T. S., Seo, H. Y. & Chae, J. S. (2016). Molecular detection of Bartonella spp. in terrestrial leeches (Haemadipsa rjukjuana) feeding on human and animal blood in Gageo-do, Republic of Korea. Parasites and Vectors, 9(1), 326.
• Karlsbakk, E., Haugen, E. & Nylund, A. (2005). Morphology and aspects of growth of a trypanosome transmitted by the marine leech Johanssonia arctica (Piscicolidae) from Northern Norway. Folia parasitologica, 52(3), 209–215.
• Kikuchi, Y. & Fukatsu, T. (2005). Rickettsia infection in natural leech populations. Microbial Ecology, 49(2), 265–271.
• Kutschera, U. (2012). The Hirudomedicinalis species complex. Naturwissenschaften, 99(5), 433‒434. Küçük, Ö.M., & Yaman, O. (2019). Tıbbi Sülük Terapisi (Hirudoterapi). Journal of Biotechnology and Strategic Health Research, 3(Special ıssue), 29-46.
• Lainson, R. (1981). On Cyrilia gomesi (Neiva & Pinto, 1926) gen. nov. (Haemogregarinidae) and Trypanosoma bourouli Neiva & Pinto, in the fish Synbranchus marmoratus: simultaneous transmission by the leech Haementeria lutzi. In: E.U. Canning (Ed.), Parasitological Topics. A presentation volume to P.C.C. Garnham, FRS on the occasion of his 80th birthday 1981. Allen Press for the Society of Protozoologists (Special Publications No. 1), (pp. 150–158). Lawrence, Kansas.
• Le Marrec-Croq, F., Drago, F., Vizioli, J., Sautière, P. E., & Lefebvre, C. (2013). The leech nervous system: a valuable model to study the microglia involvement in regenerative processes. Clinical and Developmental Immunology, 2013, 274019.
• Litwinowicz, A., & Blaskowska, J. (2013). Hirudo verbana is a source of fungal isolates potentially pathogenic to humans. African Journal of Microbiology Research, 7(47), 5358-5363.
• Maslov, D. A., Opperdoes, F. R., Kostygov, A. Y., Hashimi, H., Lukeš, J. & Yurchenko, V. (2019). Recent advances in trypanosomatid research: genome organization, expression, metabolism, taxonomy and evolution. Parasitology, 146 (1), 1–27.
• Michalsen, A., Roth, M. & Dobos, G. (2007). Medicinal Leech Therapy. 1st ed. Stuttgart‐New York: Georg Thieme Verlag
• Mory, R. N., Mindell, D., & Bloom, D. A. (2000). The leech and the physician: Biology, etymology, and medical practice with Hirudinea medicinalis. World Journal of Surgery, 24, 878-83.
• Munshi, Y., Ara, I., Rafique, H., & Ahmad, Z. (2008). Leeching in the history-a review. Pakistan Journal of Biological Sciences: PJBS, 11(13), 1650–1653.
• Nehili, M., Ilk, C., Mehlhorn, H., Ruhnau, K., Dick, W. & Njayou, M. (1994). Experiments on the possible role of leeches as vectors of animal and human pathogens: a light and electron microscopy study. Parasitology research, 80(4), 277–290.
• Nelson, M.C., & Graf, J. (2012). Bacterial symbioses of the medicinal leech Hirudo verbana. Gut Microbes, Jul-Aug;3(4), 322-31.
• O'Donoghue, P. (2017). Haemoprotozoa: Making biological sense of molecular phylogenies. Int J Parasitol Parasites Wildl., Aug 26 6(3), 241-256.
• Okka B. (2013) Hirudotherapy from Past to Present. Eur J Basic Med Sci, 3(3), 61-65.
• Petrauskiene, L. (2003). Water and sediment toxicity assessment by use of behavioural responses of medicinal leeches. Environ Int, 28, 729-36.
• Pietrzak, A., Kanitakis, J., Tomasiewicz, K., Wawrzycki, B., Kozłowska-Łój, J., Dybiec, E. & Chodorowska, G. (2012). Cutaneous complications of improper leech application. Annals of agricultural and environmental medicine : AAEM, 19(4), 790–792.
• Porshinsky, B. S., Saha, S., Grossman, M. D., Beery Ii, P. R., & Stawicki, S. P. (2011). Clinical uses of the medicinal leech: a practical review. Journal of postgraduate medicine, 57(1), 65–71.
• Qandei, S. S. (1962). An experimental study of the life cycle of Trypanosoma danilewskyi in the leech, Hemiclepsis matginuta. J. Protozoo., 9, 254–258.
• Ruppé, E., Cherkaovi, A., Wagner, N., La Scala, G.C., Beaulieu, J.Y., Girard, M., Frey, J., Lazarevic, & V., Schrenzel, J. (2018). In vivo selection of a multidrug resistant Aeromonas salmonicida during medicinal leech therapy. New Microbes New Infect, 21, 23-27.
• Saglam, N., Saunders, R., Lang, S. A., & Shain D. H. (2016). A new species of Hirudo (Annelida: Hirudinidae): historical biogeography of Eurasian medicinal leeches. BMC Zoology, 1, 5.
• Saglam, N., Saunders, R., Shain, D. H., & Saidel, W. M. (2020). Detailed ultrastructure of the Hirudo (Annelida: Hirudinea) salivary gland. Micron (Oxford, England : 1993), 136, 102887.
• Sağlam, N. (2000). Sülük Biyolojisi ve Yetiştirme Teknikleri, Ticari Balık Türlerinin Biyolojisi ve Yetiştirme Teknikleri Hizmet içi Eğitim Semineri, 1‐5 Mayıs. Ankara, Türkiye: Tarım ve Köyişleri Bakanlığı, Tarımsal Üretim ve Geliştirme Gn. Md. Su Ürünleri Daire Başkanlığı, 51‐6.
• Sağlam, N. (2004). Tatlı Su ve Deniz Sülükleri Tanı Anahtarı. Elazığ, Türkiye: Fırat Üniversitesi Basım Evi. Sağlam, N. (2018). The effects of environmental factors on leeches. AAE, 1(1), 1-3.
• Sağlam, N. (2019). Tıbbi Sülük Türleri Hirudo sulukii ve Hirudo verbana’nın İç ve Dış Morfolojik Özellikleri. Türkiye Parazitol Derg., 43(4), 204-9.
• Sağlam, N. & Sarıeyyüpoğlu, M. (1998). Tatlısu Sülüğü (Nephelopsis obscura)'nün Biyolojisi, Morfolojisi, Bazı Kimyasal Maddelerle Kontrolü ve Alabalığa (Oncorhynchusmykiss) Olan Etkisi. F.Ü. Fen ve Müh. Bilimleri Dergisi, 10(2), 105-123.
• Salimi, B. & Abdi, K. (2016). Detection of Infectious Pancreatic Necrosis Virus from the Leeches Hemiclepsis marginata and Hirudo medicinalis. Journal of aquatic animal health, 28(4), 209–213.
• Sartor, C., Limouzin-Perotti, F., Legré, R., Casanova, D., Bongrand, M. C., Sambuc, R., & Drancourt, M. (2002). Nosocomial Infections with Aeromonas hydrophila from Leeches. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 35(1), E1–E5. Hoare, C.A., 1972. The Trypanosomes of Mammals. Blackwell Scientific Publications, Oxford.
• Sawyer, R. T. (1986). Leech biology and behavior. Oxford, United Kingdom: Clarendon Press. Siddall M. E. (1995). Phylogeny of adeleid blood parasites with a partial systematic revision of the haemogregarine complex. The Journal of eukaryoticmicrobiology, 42(2), 116–125
• Siddall, M. E. & Desser, S. S. (1992). Alternative leech vectors for frog and turtle trypanosomes. The Journal of parasitology, 78(3), 562–563.
• Siddall, M.E. & Desser, S.S. (1990). Gametogenesis and Sporogonic Development of Haemogregarina balli (Apicomplexa: Adeleina: Haemogregarinidae) in the Leech Placobdella ornata. Journal of Eukaryotic Microbiology, 37, 511-520.
• Siddall, M.E. & Desser, S.S. 1991: Merogonic development of Haemogregarina balli (Apicomplexa, Adeleina, Haemogregarinidae) in the leech Placobdella ornata (Glossiphoniidae), its transmission to a chelonian intermediate host and phylogenetic implications. J. Parasitol, 77, 426–436.
• Sig, A.K., Guney, M., Guclu, A.U., & Ozmen, E. (2017). Medicinal leech therapy-an overall perspective. Integr Med Res, 6(4), 337–343.
• Singh, A.P. (2010). Medicinal leech therapy (Hirudotherapy): a brief overview, Complementary Therapies in Clinical Practice, 16 (4), 213-215.
• Slesak, G., Inthalath, S., Dittrich, S., Paris, D. H. & Newton, P. N. (2015). Leeches as further potential vectors for rickettsial infections. Proceedings of the National Academy of Sciences of the United States of America, 112(48), E6593–E6594.
• Smit, N.J., Joubert, A., Lawton, S.P., Hayes, P.M. & Cook, C.A. (2020). Morphological and molecular characterization of an African freshwater fish trypanosome, including its development in a leech vector. Int. J. Parasitol., 50, 921–929.
• Soltys, M.A., Woo, P.T.K. (1968). Leeches as possible vectors for mammalian trypanosomes. Transactions of The Royal Society of Tropical Medicine and Hygiene, 62, (1), 154–156.
• Su, B. X., Wang, J. F., Yang, T. B., Hide, G., Lai, D. H. & Lun, Z. R. (2022). A new species of mammalian trypanosome, Trypanosoma (Megatrypanum) bubalisi sp. nov., found in the freshwater leech Hirudinaria manillensis. International journal for parasitology, 52(4), 253–264.
• Tessler, M., de Carle, D., Voiklis, M. L., Gresham, O. A., Neumann, J. S., Cios, S., &Siddall, M. E. (2018). Worms that suck: Phylogenetic analysis of Hirudinea solidifies the position of Acanthobdellida and necessitates the dissolution of Rhynchobdellida. Molecular phylogenetics and evolution, 127, 129–134.
• Thakur I, Reddy B, Patil S (2016). Hirudotherapy in dentistry. International Journal of Oral Health Sciences, 6(2), 65‒69.
• Trovato, M. J., & Agarwal, J. P. (2008). Successful replantation of the ear as a venous flap. Ann Plast Surg, 61, 164-8.
• Verriere, B., Sabatier, B., Carbonelle, E., Mainardi, J.I., Prognon, P., Whitaker, I., Lantieri, L., & Hivelin, M. (2016). Medicinal leech therapy and Aeromonas spp. infection. Eur J Clin Microbiol Infect Dis, 35, 1001-1006.
• Walter, J., & Ley, R. (2011) The human gut microbiome: ecology and recent evolutionary changes. Annu Rev Microbiol, 65, 411-29.
• Wells, M.D., Ralph, T., Manktelow, R.T., Boyd, J.E. & Bowen, V. (1993). The Medical leech: an old treatment revisited. Microsurgery, 14, 183-6.
• Whitaker, I.S., Rao, J., Izadi, D., & Butler, P.E. (2004). Historicalarticle: Hirudomedicinalis: ancientoriogins of, and trends in theuse of medicinal leeches through out history. Br J Oral Maxillo fac Surg, 42, 133–7. White, G. B. (2002). Leeches and leech infestations. In: Cook, G. C., Zumla, A. I., edi. Manson‘s tropical diseases. 21st edn. London, UK; Saunders, 599-600.
• Whitlock, M. R., O'Hare, P. M., Sanders, R., & Morrow, N. C. (1983). The medicinal leech and its use in plastic surgery: a possible cause for infection. British journal of plastic surgery, 36(2), 240–244.
• Woo, P. T. K. (2006). Fish diseases and disorders, volume 1. Protozoan and metazoan infections. CABI, Oxfordshire, UK.
• Worthen, P. L., Gode, C. J. & Graf, J. (2006). Culture-independent characterization of the digestive-tract microbiota of the medicinal leech reveals a tripartite symbiosis. Applied and environmental microbiology, 72(7), 4775–4781.
• Zaidi, S. M., Jameel, S. S., Zaman, F., Jilani, S., Sultana, A. & Khan, S. A. (2011). A systematic overview of the medicinal importance of sanguivorous leeches. Alternative medicine review : a journal of clinical therapeutic, 16(1), 59–65.
• Zhou, S. H., Xiao, X., Sun, Y. N., Xu, X. H., Ding, X., Zhang, S. Y., Zhang, M., Lv, W. L. & Gao, Q. H. (2019). Ehrlichia species in pond-farmed leeches (Hirudinaria sp.) in Hubei Province, China. PloS one, 14(4), e0215082.
• Nehili, M., Ilk, C., Mehlhorn, H., Ruhnau, K., Dick, W. & Njayou, M. (1994). Experiments on the possible role of leeches as vectors of animal and human pathogens: a light and electron microscopy study. Parasitology Research, 80(4), 277–290.
• Nelson, M.C., & Graf, J. (2012). Bacterial symbioses of the medicinal leech Hirudo verbana. Gut Microbes, 3(4), 322-31.
• O'Donoghue, P. (2017). Haemoprotozoa: Making biological sense of molecular phylogenies. International Journal for Parasitology: Parasites and Wildlife, 6(3), 241-256.
• Okka B. (2013) Hirudotherapy from Past to Present. European Journal of Basic Medical Sciences, 3(3), 61-65.
• Petrauskiene, L. (2003). Water and sediment toxicity assessment by use of behavioural responses of medicinal leeches. Environment International, 28, 729-36.
• Pietrzak, A., Kanitakis, J., Tomasiewicz, K., Wawrzycki, B., Kozłowska-Łój, J., Dybiec, E. & Chodorowska, G. (2012). Cutaneous complications of improper leech application. Annals of Agricultural and Environmental Medicine,19(4), 790–792
• Porshinsky, B. S., Saha, S., Grossman, M. D., Beery Ii, P. R., & Stawicki, S. P. (2011). Clinical uses of the medicinal leech: a practical review. Journal of Postgraduate Medicine, 57(1), 65–71.
• Qandei, S. S. (1962). An experimental study of the life cycle of Trypanosoma danilewskyi in the leech, Hemiclepsis matginuta. The Journal of Protozoology, 9, 254–258.
• Ruppé, E., Cherkaovi, A., Wagner, N., La Scala, G.C., Beaulieu, J.Y., Girard, M., Frey, J., Lazarevic, & V., Schrenzel, J. (2018). In vivo selection of a multidrug resistant Aeromonas salmonicida during medicinal leech therapy. New Microbes and New Infections, 21, 23-27.
• Saglam, N., Saunders, R., Lang, S. A., & Shain D. H. (2016). A new species of Hirudo (Annelida: Hirudinidae): historical biogeography of Eurasian medicinal leeches. BMC Zoology, 1, 5.
• Saglam, N., Saunders, R., Shain, D. H., & Saidel, W. M. (2020). Detailed ultrastructure of the Hirudo (Annelida: Hirudinea) salivary gland. Micron (Oxford, England : 1993), 136, 102887.
• Sağlam, N. (2000). Sülük biyolojisi ve yetiştirme teknikleri, ticari balık türlerinin biyolojisi ve yetiştirme teknikleri hizmet içi eğitim semineri, 1‐5 Mayıs. Ankara, Türkiye: Tarım ve Köyişleri Bakanlığı, Tarımsal Üretim ve Geliştirme Gn. Md. Su Ürünleri Daire Başkanlığı, 51‐6.
• Sağlam, N. (2004). Tatlı Su ve Deniz Sülükleri Tanı Anahtarı. Elazığ, Türkiye: Fırat Üniversitesi Basım Evi. Sağlam, N. (2018). The effects of environmental factors on leeches. Advances in Agriculture and Environmental Science, 1(1), 1-3.
• Sağlam, N. (2019). Tıbbi sülük türleri Hirudo sulukii ve Hirudo verbana’nın iç ve dış morfolojik özellikleri. Türkiye Parazitoloji Dergisi, 43(4), 204-9.
• Sağlam, N. & Sarıeyyüpoğlu, M. (1998). Tatlısu Sülüğü (Nephelopsis obscura)'nün Biyolojisi, Morfolojisi, Bazı Kimyasal Maddelerle Kontrolü ve Alabalığa (Oncorhynchusmykiss) Olan Etkisi. Fırat Üniversitesi Fen ve Mühendislik Bilimleri Dergisi, 10(2), 105-123.
• Salimi, B. & Abdi, K. (2016). Detection of Infectious Pancreatic Necrosis Virus from the Leeches Hemiclepsis marginata and Hirudo medicinalis. Journal of Aquatic Animal Health, 28(4), 209–213.
• Sartor, C., Limouzin-Perotti, F., Legré, R., Casanova, D., Bongrand, M. C., Sambuc, R., & Drancourt, M. (2002). Nosocomial Infections with Aeromonas hydrophila from Leeches. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 35(1), E1–E5. 
• Hoare, C.A., 1972. The Trypanosomes of Mammals. Blackwell Scientific Publications, Oxford.
• Sawyer, R. T. (1986). Leech biology and behavior. Oxford, United Kingdom: Clarendon Press.
• Siddall M. E. (1995). Phylogeny of adeleid blood parasites with a partial systematic revision of the haemogregarine complex. The Journal of Eukaryoticmicrobiology, 42(2), 116–125
• Siddall, M. E. & Desser, S. S. (1992). Alternative leech vectors for frog and turtle trypanosomes. The Journal of parasitology, 78(3), 562–563.
• Siddall, M.E. & Desser, S.S. (1990). Gametogenesis and Sporogonic Development of Haemogregarina balli (Apicomplexa: Adeleina: Haemogregarinidae) in the Leech Placobdella ornata. Journal of Eukaryotic Microbiology, 37, 511-520.
• Siddall, M. E. & Desser, S. S. 1991: Merogonic development of Haemogregarina balli (Apicomplexa, Adeleina, Haemogregarinidae) in the leech Placobdella ornata (Glossiphoniidae), its transmission to a chelonian intermediate host and phylogenetic implications. Journal of Parasitology, 77, 426–436.
• Sig, A. K., Guney, M., Guclu, A. U., & Ozmen, E. (2017). Medicinal leech therapy-an overall perspective. Integrative Medicine Research, 6(4), 337–343.
• Singh, A.P. (2010). Medicinal leech therapy (Hirudotherapy): a brief overview, Complementary Therapies in Clinical Practice, 16 (4), 213-215.
• Slesak, G., Inthalath, S., Dittrich, S., Paris, D. H. & Newton, P. N. (2015). Leeches as further potential vectors for rickettsial infections. Proceedings of the National Academy of Sciences of the United States of America, 112(48), E6593–E6594.
• Smit, N.J., Joubert, A., Lawton, S.P., Hayes, P.M. & Cook, C.A. (2020). Morphological and molecular characterization of an African freshwater fish trypanosome, including its development in a leech vector. International Journal for Parasitology, 50, 921–929.
• Soltys, M.A., Woo, P.T.K. (1968). Leeches as possible vectors for mammalian trypanosomes. Transactions of The Royal Society of Tropical Medicine and Hygiene, 62(1), 154–156.
• Su, B. X., Wang, J. F., Yang, T. B., Hide, G., Lai, D. H. & Lun, Z. R. (2022). A new species of mammalian trypanosome, Trypanosoma (Megatrypanum) bubalisi sp. nov., found in the freshwater leech Hirudinaria manillensis. International Journal for Parasitology, 52(4), 253–264.
• Tessler, M., de Carle, D., Voiklis, M. L., Gresham, O. A., Neumann, J. S., Cios, S., &Siddall, M. E. (2018). Worms that suck: Phylogenetic analysis of Hirudinea solidifies the position of Acanthobdellida and necessitates the dissolution of Rhynchobdellida. Molecular Phylogenetics and Evolution, 127, 129–134.
• Thakur I, Reddy B, Patil S (2016). Hirudotherapy in dentistry. International Journal of Oral Health Sciences, 6(2), 65‒69.
• Trovato, M. J., & Agarwal, J. P. (2008). Successful replantation of the ear as a venous flap. Annals of Plastic Surgery , 61, 164-8.
• Verriere, B., Sabatier, B., Carbonelle, E., Mainardi, J.I., Prognon, P., Whitaker, I., Lantieri, L., & Hivelin, M. (2016). Medicinal leech therapy and Aeromonas spp. infection. European Journal of Clinical Microbiology & Infectious Diseases, 35, 1001-1006.
• Walter, J., & Ley, R. (2011) The human gut microbiome: ecology and recent evolutionary changes. Annual Review of Microbiology, 65, 411-29.
• Wells, M. D., Ralph, T., Manktelow, R. T., Boyd, J. E. & Bowen, V. (1993). The Medical leech: an old treatment revisited. Microsurgery, 14, 183-6.
• Whitaker, I. S., Rao, J., Izadi, D., & Butler, P. E. (2004). Historicalarticle: Hirudomedicinalis: ancientoriogins of, and trends in theuse of medicinal leeches through out history. British Journal of Oral & Maxillofacial Surgery, 42, 133–137.
• White, G. B. (2002). Leeches and leech infestations. In: Cook, G. C., Zumla, A. I., edi. Manson‘s tropical diseases. 21st edn. London, UK; Saunders, 599-600.
• Whitlock, M. R., O'Hare, P. M., Sanders, R., & Morrow, N. C. (1983). The medicinal leech and its use in plastic surgery: a possible cause for infection. British Journal of Plastic Surgery, 36(2), 240–244.
• Woo, P. T. K. (2006). Fish diseases and disorders, volume 1. Protozoan and metazoan infections. CABI, Oxfordshire, UK.
• Worthen, P. L., Gode, C. J. & Graf, J. (2006). Culture-independent characterization of the digestive-tract microbiota of the medicinal leech reveals a tripartite symbiosis. Applied and Environmental Microbiology, 72(7), 4775–4781.
• Zaidi, S. M., Jameel, S. S., Zaman, F., Jilani, S., Sultana, A. & Khan, S. A. (2011). A systematic overview of the medicinal importance of sanguivorous leeches. Alternative Medicine Review : A Journal of Clinical Therapeutic, 16(1), 59–65.
• Zhou, S. H., Xiao, X., Sun, Y. N., Xu, X. H., Ding, X., Zhang, S. Y., Zhang, M., Lv, W. L. & Gao, Q. H. (2019). Ehrlichia species in pond-farmed leeches (Hirudinaria sp.) in Hubei Province, China. PloS one, 14(4), e0215082.