ESCHERICHIA-COLI LOBAR PNEUMONIA - FATAL INFECTION IN A PATIENT WITH MENTAL-RETARDATION

Lobar pneumonia due to Escherichia coli is rare, Most lobar pneumonias are caused by either streptococcus pneumoniae or Klebsiella pneumonia e, and most E coli pneumonias are bronchopneumonias. We report an acut e fulminant course of E coli lobar pneumonia in a 37-year-old patient who was profoundly retarded, institutionalized, and nonimmunosuppresse d and who died within 2 days of developing initial symptoms. Antemorte m blood and postmortem blood and lung specimens isolated pure cultures of E coli, The source of infection in E coli lobar pneumonia is not c lear in this patient or in the few cases that have been reported, We p ostulate that nasopharyngeal colonization of E coli in those who are i nstitutionalized with mental retardation may predispose these patients to E coli pneumonia. Our case illustrates features of pneumonias that are unique in the institutionalized, mentally retarded patient popula tion (ie, the relatively high prevalence of nasopharyngeal colonizatio n of E coli, a higher incidence of E coli pneumonia than in other inst itutionalized populations, the often fulminant course of the disease), as well as the need for early, aggressive treatment including antibio tics effective against gram-negative bacteria.