Treatment of Acute Pulmonary Coccidioidomycosis in Pregnancy
Clinical Scenario
This protocol addresses the initial nonmeningeal coccidioidal infection arising in a pregnant patient. The intersection of active pulmonary coccidioidomycosis and pregnancy introduces management considerations that differ substantially from the non-pregnant setting.
Key Comorbidity
Pregnancy is the central comorbidity in this scenario. Management recommendations for initial nonmeningeal coccidioidal infection differ by trimester, requiring careful clinical judgment that accounts for both maternal treatment needs and fetal safety.
Treatment Overview
Antifungal management in this scenario is trimester-dependent. Intravenous antifungal therapy is the recommended approach in early pregnancy, while a different class of antifungal agents may be considered as pregnancy progresses — with careful attention to teratogenicity.
Full regimen details, complete alternatives, sequencing criteria, and monitoring guidance are available in the structured protocol below.
References
DOI: 10.1093/cid/ciw360
- For women who develop initial nonmeningeal coccidioidal infection during their first trimester of pregnancy, intravenous AmB is recommended (strong, moderate).
- Other options include no therapy with close monitoring (weak, low), or an azole antifungal after educating the mother regarding potential teratogenicity (weak, low).
- After the first trimester of pregnancy, an azole antifungal, such fluconazole or itraconazole, can be considered (strong, low).
- A final alternative would be to administer intravenous AmB throughout pregnancy (weak, moderate).
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