Infections Caused by Fungi and Higher Bacteria

Abstract

Deeply invasive and disseminated infections caused by fungi and higher bacteria are very uncommon complications of pregnancy. Candidiasis, aspergillosis, and zygomycosis usually occur only in severely immunocompromised patients; such women are often less than normally fertile. Pregnancy requires a degree of health that is protective against disease caused by these microorganisms. Blastomycosis, cryptococcosis, histoplasmosis, and sporotrichosis are endemic diseases of low incidence. Their rarity decreases the likelihood of coincidental occurrence during pregnancy. Coccidioidomycosis is the only exception to these generalities; it poses a special threat to pregnant women living in endemic areas of the desert Southwest.¹ Pregnancy increases 50- to 100-fold the rate of dissemination of previously contracted pneumonia. Similarly, infection acquired during pregnancy is 50–100 times more likely to hematogenously disseminate than is infection acquired by nongravid women. Coccidioidomycosis is also unique in terms of the frequency with which it involves the placenta; this occurs in about one-fourth of the cases of disseminated disease, but fetal involvement is rare. The only mycosis to cause fetal disease with any regularity is candidiasis, which may also involve the cord and membranes.