SN-AIL'MENT OF THE ALIMENTARY CANAL

Snail-borne parasitic diseases are important worldwide, particularly in the underdeveloped and developing countries. Snails play a very important role in these diseases as the parasites undergo several developmental stages within the snails. We report a case which is a first of its kind being reported in the world where a patient has passed alive snails in the stool. An 80 year old farmer on long term PPI therapy presented with Pain abdomen, loose stools and vomitings since 3 days. He was febrile, hypotensive with abdominal tenderness on examination. We fluid resuscitated and started him on empirical antibiotic therapy (Inluding Metronidazole) in view of septic shock. On day-3 he passed around 15-20 alive snails in the stools. Ultrasound revealed three echogenic foreign bodies moving within sigmoid colon, rectum and large intestine. He was started on extedned spectrum antibiotic coverage for sepsis along with Inj.Metaclopramide. Evaluation was done to look for other snail borne parasitic diseases which was negative. Cultures were negative. After an extensive literature search we found niclosamide to be a molluscicide but couldn't procure it. He was treated for the sepsis and AKI (required hemodialysis) and was discharged on day 15 after stabilisation. With the history of being from a flood affected area, the patient might have had accidental consumption of snail eggs or snail through contaminated water or food. Patient being on a long term proton pump inhibitor therapy might have aided in the survival of eggs or snail in the stomach. The patient responded to antibiotics and anti parasitic drugs complemented with adjunctive therapy. This case presents its importance as the first reported case of human snail infestation in the world. niclosamide was the only drug that was found to be a molluscicide according to the literature available. The availability of the drug was an issue encountered.