Pneumococcal bacteraemia--a continuing challenge.
In a retrospective study of pneumococcal bacteraemia in a large district hospital over an eight-year period 103 cases were identified. Although all age groups were represented, an unexpectedly large number of cases occurred among elderly males. The overall case fatality rate was 34 per cent, ranging from 13 per cent in children to 42 per cent in the elderly. Most children had preexisting disease and did have pneumonia. Pre-existing diseases were of three main types: (i) disorders of the respiratory system; (ii) disorders of metabolism; (iii) disorders of the immune system. Six patients had no spleen. Almost all patients received appropriate antibiotics. Most deaths occurred during the first 48 h of treatment. The prospects for the prevention of fatal pneumococcal bacteraemia are reviewed in the light of these findings.