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Fatal Human Ascariasis Following Secondary Massive Infection

More than 796 Ascaris lumbricoides worms weighing 550 g were recovered at autopsy from a 2-year-old black South African girl. Most of the worms were taken from necrotic small intestine, but worms were also in the stomach, esophagus, intrahepatic and extrahepatic bile ducts, and gallbladder. The worms had caused torsion and gangrene of the ileum, which was interpreted as the cause of death. Worms were formalin-fixed and individually weighed. There were 796 intact worms and 112 appreciably large (>0.2 g) fragments of worms. Statistical analysis of the weights revealed 2 distinct populations of worms: 16 large worms (0.5–2.3 g) and 778 small worms (0.03–0.95 g). The difference in weight between these 2 groups of worms was significant (male and female worms treated separately; P < 0.05 to P < 0.001). These observations reveal that the patient acquired a massive and fatal infection with A. lumbricoides while hosting a relatively light worm burden.

Accepted for publication October 28, 1985.