To the Editor.
—In his prospective study on bacteremic pneumococcal pneumonia, Dr Esposito1 usefully extended our understanding of this often fatal condition. His case fatality rates of 10% in adults under age 65 years and 17% in persons over age 65 years were impressively low. In a recent retrospective study of 103 cases of pneumococcal bacteremia seen at a district hospital in Birmingham (England), my colleagues and I2 noted bacteremic pneumococcal pneumonia in 26 patients aged 20 to 60 years and 38 patients over age 60 years. The case fatality rates in the two groups were 27% and 47%, respectively (P>.1), despite the administration of appropriate antibiotics in almost all cases.It is possible that the lower mortality rates in Dr Esposito's study resulted from earlier hospitalization and/ or more aggressive treatment. Like Dr Esposito, we found that virtually all our patients had major underlying disease, usually