Cunninghamella bertholletiae infection mimicking myocardial infarction.

The incidence of pneumococcal bacteremia or meningitis in the period 1991–1994 was 8.3–9.2 cases per 100,000 personyears (table 1). In 1996, the incidence increased significantly to 14.8 cases per 100,000 person-years, and in 1997 to 13.3 (P = ); but in 1998 it returned to 8.9 cases per 100,000 person.0001 years. The incidence for the age group >65 years was approximately 4-fold higher and showed the same trend. The average number of pneumococcal isolates per 1000 blood cultures was 8.7 in the 2 years with the highest incidence of invasive pneumococcal disease, in contrast to 6.1 in the other years (table 1). The gradual increase in the number of blood cultures in our study did not explain the sudden increase in invasive pneumococcal isolates in 1996 and 1997 [3]. The mean incidence of 23 cases per 100,000 person-years for the age category 0–1 year (table 1) was much lower than the incidence of 136 cases per 100,000 person-years reported by Pastor et al. [4]. An explanation may be that children with severe illness in the Netherlands are preferably admitted to specialized children’s hospitals that are not served by the laboratories participating in our surveillance. No trends in the distribution of pneumococcal serotypes [1], changes in the occurrence of influenza viruses (table 1), or other respiratory viruses were noted. However, the higher incidence of invasive pneumococcal infections in 1996 and 1997 for the age group >65 years coincided with relatively severe winters, as shown by the winter severity index (table 1).