Coccidioidomycosis During Pregnancy: A Review and Recommendations for Management

The severity and risk for dissemination of coccidioidomycosis are increased when infection is acquired during pregnancy. Azole antifungals are potentially teratogenic when given in the first trimester. These issues are reviewed and guidance regarding management of coccidioidomycosis during pregnancy is provided.Pregnancy is an established risk factor for the development of severe and disseminated coccidioidomycosis, particularly when infection is acquired during the later stages of gestation. Although recent studies suggest that the incidence of symptomatic coccidioidomycosis during pregnancy is decreasing and that outcome has improved, management is complicated by the observations that azole antifungal agents can be teratogenic when given to some women, particularly at high doses, early in pregnancy. This article summarizes the data on these issues and offers guidance on the management of coccidioidomycosis during pregnancy.