Coccidioidomycosis and pregnancy.
Pregnant women with respiratory symptoms of pleuritic pain and productive cough should undergo evaluation for coccidioidomycosis. This should include a history of travel or residency in endemic areas and careful assessment for toxic erythema, erythema nodosum, or erythema multiforme. To confirm a diagnosis of this disease, a sputum culture, wet mount, and serological tests should be performed. The risk of dissemination, which is highest in the second and third trimesters, can be estimated by a complement-fixation titer. In disseminated cases aggressive treatment with amphotericin B has improved the previously reported high maternal and neonatal mortality rate. Fortunately, case reports do not indicate that transplacental spread occurs. Reactivation or exacerbation of a chronic low-grade infection during pregnancy may occur in patients treated for prior disseminated disease (32, 34). Interestingly, both of the reported cases of reactivation or exacerbation occurred in insulin-dependent diabetics.
Peterson
C M
CM
Department of Medicine, Maricopa Medical Center, Phoenix, Arizona.
Schuppert
K
K
Kelly
P C
PC
Pappagianis
D
D
D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage; D003047:Coccidioidomycosis / Q000175:diagnosis* / Q000188:drug therapy; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000188:drug therapy; D004892:Erythema Multiforme / Q000175:diagnosis / Q000188:drug therapy; D004893:Erythema Nodosum / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005313:Fetal Death; D006801:Humans; D007332:Insulin Infusion Systems; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy; D011262:Pregnancy Trimester, Second; D011254:Pregnancy in Diabetics / Q000175:diagnosis* / Q000188:drug therapy
D000666:Amphotericin B