Diarrhea with fever was a significant complaint in 26 of 280 (9.3%) of non-SS children with S. pneumoniae bacteremia and four of 30 (13%) children with sickle syndromes and S. pneumoniae bacteremia. Two additional children with sickle-cell disease and S. pneumoniae bacteremia developed diarrhea within hours of hospital admission; four of the six died. The mortality rate among 24 additional SS patients with S. pneumoniae bacteremia without diarrhea was 12.5% (3/24). Only one of 26 non-SS patients with diarrhea and S. pneumoniae bacteremia died; shs was surgically asplenic and had fulminant 9-hour course. The seasonality of the diarrhea cases was similar to our overall experience, and the serotypes associated with the diarrhea cases were also representative of our overall experience. Although predominantly seen in infants, the oldest non-SS patient was 12 years, and the oldest SS patient was nine years.