{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T21:50:20Z","timestamp":1776981020955,"version":"3.51.4"},"reference-count":42,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2007,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Coccidioidomycosis is a fungal infection contracted through the inhalation of airborne spores, which are most frequently present in desert areas of the southwestern United States and Mexico. Primary immune response to infection is by T\n                    <jats:sub>H<\/jats:sub>\n                    1, a subset of helper T cells. Although pulmonary symptoms are most common, hematogenous systemic spread can also occur. Pregnancy is a well-noted risk factor for disseminated\n                    <jats:italic>Coccidioides<\/jats:italic>\n                    infection. The objective of this review is to provide an overview of coccidioidomycosis and to review immunologic and hormonal factors that increase risk of dissemination in pregnancy. Dissemination may occur more frequently in pregnant patients than in nonpregnant women because of shifts in T-cell immunity, changes in cytokine production, and increased hormone levels. There is disagreement regarding the precise incidence of systemic spread in pregnancy, but most sources agree that risk is substantially increased and vigilance must be high in patients with exposures in endemic areas.\n                  <\/jats:p>","DOI":"10.5858\/2007-131-652-dcip","type":"journal-article","created":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T20:43:24Z","timestamp":1613076204000},"page":"652-655","source":"Crossref","is-referenced-by-count":18,"title":["Disseminated Coccidioidomycosis in Pregnancy"],"prefix":"10.5858","volume":"131","author":[{"given":"Jody E.","family":"Hooper","sequence":"first","affiliation":[{"name":"From the Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center (Drs Hooper and Pepkowitz), and the Department of Pathology and Laboratory Medicine, UCLA Medical Center (Dr Lu), Los Angeles, Calif"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qun","family":"Lu","sequence":"additional","affiliation":[{"name":"From the Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center (Drs Hooper and Pepkowitz), and the Department of Pathology and Laboratory Medicine, UCLA Medical Center (Dr Lu), Los Angeles, Calif"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel H.","family":"Pepkowitz","sequence":"additional","affiliation":[{"name":"From the Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center (Drs Hooper and Pepkowitz), and the Department of Pathology and Laboratory Medicine, UCLA Medical Center (Dr Lu), Los Angeles, Calif"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3906","reference":[{"key":"i1543-2165-131-4-652-b1","article-title":"Coccidioidomycosis.","author":"Pappagianis, D.","unstructured":"Pappagianis, D. and F. W.Chandler. Coccidioidomycosis.In: Pathology of Infectious Diseases. Stamford, Conn: Appleton & Lange; 1997:977\u2013987."},{"key":"i1543-2165-131-4-652-b2","series-title":"Infect Dis Clin North Am","first-page":"41","article-title":"Coccidioidomycosis.","volume":"17","author":"Chiller, T. M.","year":"2003","unstructured":"Chiller, T. M., J. N.Galgiani, and D. A.Stevens. Coccidioidomycosis.Infect Dis Clin North Am2003. 17:41\u201357."},{"key":"i1543-2165-131-4-652-b3","series-title":"Obstet Gynecol","first-page":"236","article-title":"Coccidioidomycosis in pregnancy during an epidemic in California.","volume":"95","author":"Caldwell, J. W.","year":"2000","unstructured":"Caldwell, J. W., E. L.Arsura, W. B.Kilgore, A. L.Garcia, V.Reddy, and R.Johnson. Coccidioidomycosis in pregnancy during an epidemic in California.Obstet Gynecol2000. 95:236\u2013239."},{"key":"i1543-2165-131-4-652-b4","series-title":"Crit Care Med","first-page":"62","article-title":"Septic shock in coccidioidomycosis.","volume":"26","author":"Arsura, E. L.","year":"1998","unstructured":"Arsura, E. L., P. L.Bellinghausen, W. B.Kilgore, J.Abraham, and R. H.Johnson. Septic shock in coccidioidomycosis.Crit Care Med1998. 26:62\u201365."},{"key":"i1543-2165-131-4-652-b5","series-title":"Medicine","first-page":"149","article-title":"Coccidiodomycosis: a descriptive survey of a reemerging disease: clinical characteristics and current controversies.","volume":"83","author":"Crum, N. F.","year":"2004","unstructured":"Crum, N. F., E. R.Lederman, C. M.Stafford, J. S.Parrish, and M. R.Wallace. Coccidiodomycosis: a descriptive survey of a reemerging disease: clinical characteristics and current controversies.Medicine2004. 83:149\u2013175."},{"key":"i1543-2165-131-4-652-b6","series-title":"Clin Infect Dis","first-page":"708","article-title":"Risk factors for severe pulmonary and disseminated coccidioidomycosis: Kern County, California, 1995\u20131996.","volume":"32","author":"Rosenstein, N. E.","year":"2001","unstructured":"Rosenstein, N. E., K. W.Emery, and B.Werner. et al. Risk factors for severe pulmonary and disseminated coccidioidomycosis: Kern County, California, 1995\u20131996.Clin Infect Dis2001. 32:708\u2013715."},{"key":"i1543-2165-131-4-652-b7","article-title":"Coccidioidomycosis in patients with hematologic malignancies.","author":"Blair, J. E.","unstructured":"Blair, J. E., J. D.Smilack, and S. M.Caples. Coccidioidomycosis in patients with hematologic malignancies.Arch Intern Med. 2005;165:113\u2013117."},{"key":"i1543-2165-131-4-652-b8","series-title":"Postgrad Med","first-page":"76","article-title":"Treatment for coccidioidomycosis in pregnancy?","volume":"109","author":"Busowski, J. D.","year":"2001","unstructured":"Busowski, J. D. and A.Safdar. Treatment for coccidioidomycosis in pregnancy?Postgrad Med2001. 109:76\u201377."},{"key":"i1543-2165-131-4-652-b9","series-title":"Obstet Gynecol","first-page":"815","article-title":"Reactivation of coccidioidomycosis in pregnancy.","volume":"79","author":"Walker, M. P. R.","year":"1992","unstructured":"Walker, M. P. R., C. Z.Brody, and R.Resnik. Reactivation of coccidioidomycosis in pregnancy.Obstet Gynecol1992. 79:815\u2013817."},{"issue":"7258","key":"i1543-2165-131-4-652-b10","series-title":"BMJ","first-page":"424","article-title":"Th1 and Th2 responses: what are they?","volume":"321","author":"Berger, A.","year":"2000","unstructured":"Berger, A.\n          \n          Th1 and Th2 responses: what are they?\n          BMJ\n          2000. 3217258:424."},{"key":"i1543-2165-131-4-652-b11","series-title":"Infect Immunol","first-page":"3923","article-title":"Cellular immune suppressor activity resides in lymphocyte cell clusters adjacent to granulomata in human coccidioidomycosis.","volume":"73","author":"Li, L.","year":"2005","unstructured":"Li, L., S. M.Dial, M.Schmelz, M. A.Rennels, and N. M.Ampel. Cellular immune suppressor activity resides in lymphocyte cell clusters adjacent to granulomata in human coccidioidomycosis.Infect Immunol2005. 73:3923\u20133928."},{"key":"i1543-2165-131-4-652-b12","series-title":"Hum Reprod Update","first-page":"347","article-title":"The immunology of successful pregnancy.","volume":"9","author":"Veenstra van Nieuwenhoven, A. L.","year":"2003","unstructured":"Veenstra van Nieuwenhoven, A. L., M. J.Heineman, and M. M.Faas. The immunology of successful pregnancy.Hum Reprod Update2003. 9:347\u2013357."},{"key":"i1543-2165-131-4-652-b13","series-title":"J Clin Invest","first-page":"15","article-title":"A noninflammatory pathway for pregnancy loss: innate immune activation?","volume":"114","author":"Salmon, J.","year":"2004","unstructured":"Salmon, J.\n          \n          A noninflammatory pathway for pregnancy loss: innate immune activation?\n          J Clin Invest\n          2004. 114:15\u201317."},{"key":"i1543-2165-131-4-652-b14","series-title":"Chest","first-page":"709","article-title":"The maternal immune response in coccidioidomycosis: is pregnancy a risk factor for serious infection?","volume":"100","author":"Barbee, R. A.","year":"1991","unstructured":"Barbee, R. A., M. J.Hicks, D.Grosso, and C.Sandel. The maternal immune response in coccidioidomycosis: is pregnancy a risk factor for serious infection?Chest1991. 100:709\u2013715."},{"key":"i1543-2165-131-4-652-b15","series-title":"Am J Reprod Immunol","first-page":"129","article-title":"Estrogen and progesterone modulate monocyte cell cycle progression and apoptosis.","volume":"49","author":"Thongngarm, T.","year":"2003","unstructured":"Thongngarm, T., J. K.Jenkins, K.Ndebele, and R. W.McMurray. Estrogen and progesterone modulate monocyte cell cycle progression and apoptosis.Am J Reprod Immunol2003. 49:129\u2013138."},{"key":"i1543-2165-131-4-652-b16","series-title":"Pediatr Infect Dis J","first-page":"171","article-title":"Coccidioides immitis infection of the neonate: two routes of infection.","volume":"18","author":"Linsangan, L. C.","year":"1999","unstructured":"Linsangan, L. C. and L. A.Ross. Coccidioides immitis infection of the neonate: two routes of infection.Pediatr Infect Dis J1999. 18:171\u2013173."},{"key":"i1543-2165-131-4-652-b17","series-title":"Clin Diagn Lab Immunol","first-page":"195","article-title":"Lymphocyte, monocyte, and natural killer cell reference ranges in postpartal women.","volume":"4","author":"Gennaro, S.","year":"1997","unstructured":"Gennaro, S., W.Fehder, P.Gallagher, S.Miller, S. D.Douglas, and D. E.Campbell. Lymphocyte, monocyte, and natural killer cell reference ranges in postpartal women.Clin Diagn Lab Immunol1997. 4:195\u2013201."},{"key":"i1543-2165-131-4-652-b18","series-title":"Ann Rheum Dis","first-page":"839","article-title":"Pregnancy in patients with rheumatic disease: anti-inflammatory cytokines increase in pregnancy and decrease post partum.","volume":"64","author":"Ostenson, M.","year":"2005","unstructured":"Ostenson, M., F.Forger, J. L.Nelson, A.Schuhmacher, G.Hebisch, and P. M.Villager. Pregnancy in patients with rheumatic disease: anti-inflammatory cytokines increase in pregnancy and decrease post partum.Ann Rheum Dis2005. 64:839\u2013844."},{"key":"i1543-2165-131-4-652-b19","series-title":"J Immunol","first-page":"2020","article-title":"Reversal of coccidioidal anergy in vivo by dendritic cells from patients with disseminated coccidioidomycosis.","volume":"169","author":"Richards, J. O.","year":"2002","unstructured":"Richards, J. O., N. M.Ampel, and D. F.Lake. Reversal of coccidioidal anergy in vivo by dendritic cells from patients with disseminated coccidioidomycosis.J Immunol2002. 169:2020\u20132025."},{"key":"i1543-2165-131-4-652-b20","series-title":"Infect Immunol","first-page":"3010","article-title":"A recombinant \u03b2-1,3-glucanosyltranferase homolog of Coccidioides posadasii protects mice against coccidioidomycosis.","volume":"71","author":"Delgado, N.","year":"2003","unstructured":"Delgado, N., J.Xue, J.Yu, C. Y.Hung, and G.Cole. A recombinant \u03b2-1,3-glucanosyltranferase homolog of Coccidioides posadasii protects mice against coccidioidomycosis.Infect Immunol2003. 71:3010\u20133019."},{"key":"i1543-2165-131-4-652-b21","series-title":"Clin Microbiol Rev","first-page":"804","article-title":"Coccidioidomycosis: host response and vaccine development.","volume":"17","author":"Cox, R. A.","year":"2004","unstructured":"Cox, R. A. and D. M.Magee. Coccidioidomycosis: host response and vaccine development.Clin Microbiol Rev2004. 17:804\u2013839."},{"key":"i1543-2165-131-4-652-b1","article-title":"Coccidioidomycosis.","author":"Pappagianis, D.","unstructured":"Pappagianis, D. and F. W.Chandler. Coccidioidomycosis.In: Pathology of Infectious Diseases. Stamford, Conn: Appleton & Lange; 1997:977\u2013987."},{"key":"i1543-2165-131-4-652-b2","series-title":"Infect Dis Clin North Am","first-page":"41","article-title":"Coccidioidomycosis.","volume":"17","author":"Chiller, T. M.","year":"2003","unstructured":"Chiller, T. M., J. N.Galgiani, and D. A.Stevens. Coccidioidomycosis.Infect Dis Clin North Am2003. 17:41\u201357."},{"key":"i1543-2165-131-4-652-b3","series-title":"Obstet Gynecol","first-page":"236","article-title":"Coccidioidomycosis in pregnancy during an epidemic in California.","volume":"95","author":"Caldwell, J. W.","year":"2000","unstructured":"Caldwell, J. W., E. L.Arsura, W. B.Kilgore, A. L.Garcia, V.Reddy, and R.Johnson. Coccidioidomycosis in pregnancy during an epidemic in California.Obstet Gynecol2000. 95:236\u2013239."},{"key":"i1543-2165-131-4-652-b4","series-title":"Crit Care Med","first-page":"62","article-title":"Septic shock in coccidioidomycosis.","volume":"26","author":"Arsura, E. L.","year":"1998","unstructured":"Arsura, E. L., P. L.Bellinghausen, W. B.Kilgore, J.Abraham, and R. H.Johnson. Septic shock in coccidioidomycosis.Crit Care Med1998. 26:62\u201365."},{"key":"i1543-2165-131-4-652-b5","series-title":"Medicine","first-page":"149","article-title":"Coccidiodomycosis: a descriptive survey of a reemerging disease: clinical characteristics and current controversies.","volume":"83","author":"Crum, N. F.","year":"2004","unstructured":"Crum, N. F., E. R.Lederman, C. M.Stafford, J. S.Parrish, and M. R.Wallace. Coccidiodomycosis: a descriptive survey of a reemerging disease: clinical characteristics and current controversies.Medicine2004. 83:149\u2013175."},{"key":"i1543-2165-131-4-652-b6","series-title":"Clin Infect Dis","first-page":"708","article-title":"Risk factors for severe pulmonary and disseminated coccidioidomycosis: Kern County, California, 1995\u20131996.","volume":"32","author":"Rosenstein, N. E.","year":"2001","unstructured":"Rosenstein, N. E., K. W.Emery, and B.Werner. et al. Risk factors for severe pulmonary and disseminated coccidioidomycosis: Kern County, California, 1995\u20131996.Clin Infect Dis2001. 32:708\u2013715."},{"key":"i1543-2165-131-4-652-b7","article-title":"Coccidioidomycosis in patients with hematologic malignancies.","author":"Blair, J. E.","unstructured":"Blair, J. E., J. D.Smilack, and S. M.Caples. Coccidioidomycosis in patients with hematologic malignancies.Arch Intern Med. 2005;165:113\u2013117."},{"key":"i1543-2165-131-4-652-b8","series-title":"Postgrad Med","first-page":"76","article-title":"Treatment for coccidioidomycosis in pregnancy?","volume":"109","author":"Busowski, J. D.","year":"2001","unstructured":"Busowski, J. D. and A.Safdar. Treatment for coccidioidomycosis in pregnancy?Postgrad Med2001. 109:76\u201377."},{"key":"i1543-2165-131-4-652-b9","series-title":"Obstet Gynecol","first-page":"815","article-title":"Reactivation of coccidioidomycosis in pregnancy.","volume":"79","author":"Walker, M. P. R.","year":"1992","unstructured":"Walker, M. P. R., C. Z.Brody, and R.Resnik. Reactivation of coccidioidomycosis in pregnancy.Obstet Gynecol1992. 79:815\u2013817."},{"issue":"7258","key":"i1543-2165-131-4-652-b10","series-title":"BMJ","first-page":"424","article-title":"Th1 and Th2 responses: what are they?","volume":"321","author":"Berger, A.","year":"2000","unstructured":"Berger, A.\n          \n          Th1 and Th2 responses: what are they?\n          BMJ\n          2000. 3217258:424."},{"key":"i1543-2165-131-4-652-b11","series-title":"Infect Immunol","first-page":"3923","article-title":"Cellular immune suppressor activity resides in lymphocyte cell clusters adjacent to granulomata in human coccidioidomycosis.","volume":"73","author":"Li, L.","year":"2005","unstructured":"Li, L., S. M.Dial, M.Schmelz, M. A.Rennels, and N. M.Ampel. Cellular immune suppressor activity resides in lymphocyte cell clusters adjacent to granulomata in human coccidioidomycosis.Infect Immunol2005. 73:3923\u20133928."},{"key":"i1543-2165-131-4-652-b12","series-title":"Hum Reprod Update","first-page":"347","article-title":"The immunology of successful pregnancy.","volume":"9","author":"Veenstra van Nieuwenhoven, A. L.","year":"2003","unstructured":"Veenstra van Nieuwenhoven, A. L., M. J.Heineman, and M. M.Faas. The immunology of successful pregnancy.Hum Reprod Update2003. 9:347\u2013357."},{"key":"i1543-2165-131-4-652-b13","series-title":"J Clin Invest","first-page":"15","article-title":"A noninflammatory pathway for pregnancy loss: innate immune activation?","volume":"114","author":"Salmon, J.","year":"2004","unstructured":"Salmon, J.\n          \n          A noninflammatory pathway for pregnancy loss: innate immune activation?\n          J Clin Invest\n          2004. 114:15\u201317."},{"key":"i1543-2165-131-4-652-b14","series-title":"Chest","first-page":"709","article-title":"The maternal immune response in coccidioidomycosis: is pregnancy a risk factor for serious infection?","volume":"100","author":"Barbee, R. A.","year":"1991","unstructured":"Barbee, R. A., M. J.Hicks, D.Grosso, and C.Sandel. The maternal immune response in coccidioidomycosis: is pregnancy a risk factor for serious infection?Chest1991. 100:709\u2013715."},{"key":"i1543-2165-131-4-652-b15","series-title":"Am J Reprod Immunol","first-page":"129","article-title":"Estrogen and progesterone modulate monocyte cell cycle progression and apoptosis.","volume":"49","author":"Thongngarm, T.","year":"2003","unstructured":"Thongngarm, T., J. K.Jenkins, K.Ndebele, and R. W.McMurray. Estrogen and progesterone modulate monocyte cell cycle progression and apoptosis.Am J Reprod Immunol2003. 49:129\u2013138."},{"key":"i1543-2165-131-4-652-b16","series-title":"Pediatr Infect Dis J","first-page":"171","article-title":"Coccidioides immitis infection of the neonate: two routes of infection.","volume":"18","author":"Linsangan, L. C.","year":"1999","unstructured":"Linsangan, L. C. and L. A.Ross. Coccidioides immitis infection of the neonate: two routes of infection.Pediatr Infect Dis J1999. 18:171\u2013173."},{"key":"i1543-2165-131-4-652-b17","series-title":"Clin Diagn Lab Immunol","first-page":"195","article-title":"Lymphocyte, monocyte, and natural killer cell reference ranges in postpartal women.","volume":"4","author":"Gennaro, S.","year":"1997","unstructured":"Gennaro, S., W.Fehder, P.Gallagher, S.Miller, S. D.Douglas, and D. E.Campbell. Lymphocyte, monocyte, and natural killer cell reference ranges in postpartal women.Clin Diagn Lab Immunol1997. 4:195\u2013201."},{"key":"i1543-2165-131-4-652-b18","series-title":"Ann Rheum Dis","first-page":"839","article-title":"Pregnancy in patients with rheumatic disease: anti-inflammatory cytokines increase in pregnancy and decrease post partum.","volume":"64","author":"Ostenson, M.","year":"2005","unstructured":"Ostenson, M., F.Forger, J. L.Nelson, A.Schuhmacher, G.Hebisch, and P. M.Villager. Pregnancy in patients with rheumatic disease: anti-inflammatory cytokines increase in pregnancy and decrease post partum.Ann Rheum Dis2005. 64:839\u2013844."},{"key":"i1543-2165-131-4-652-b19","series-title":"J Immunol","first-page":"2020","article-title":"Reversal of coccidioidal anergy in vivo by dendritic cells from patients with disseminated coccidioidomycosis.","volume":"169","author":"Richards, J. O.","year":"2002","unstructured":"Richards, J. O., N. M.Ampel, and D. F.Lake. Reversal of coccidioidal anergy in vivo by dendritic cells from patients with disseminated coccidioidomycosis.J Immunol2002. 169:2020\u20132025."},{"key":"i1543-2165-131-4-652-b20","series-title":"Infect Immunol","first-page":"3010","article-title":"A recombinant \u03b2-1,3-glucanosyltranferase homolog of Coccidioides posadasii protects mice against coccidioidomycosis.","volume":"71","author":"Delgado, N.","year":"2003","unstructured":"Delgado, N., J.Xue, J.Yu, C. Y.Hung, and G.Cole. A recombinant \u03b2-1,3-glucanosyltranferase homolog of Coccidioides posadasii protects mice against coccidioidomycosis.Infect Immunol2003. 71:3010\u20133019."},{"key":"i1543-2165-131-4-652-b21","series-title":"Clin Microbiol Rev","first-page":"804","article-title":"Coccidioidomycosis: host response and vaccine development.","volume":"17","author":"Cox, R. A.","year":"2004","unstructured":"Cox, R. A. and D. M.Magee. 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