Abstract: Dual Endemic Infection in Pregnancy: Coccidioidal Meningitis with Strongyloidiasis - A Case Report.

Authors

Parker Piorkowski, Caitlin Hof

Published in

South Dakota medicine : the journal of the South Dakota State Medical Association. Volume 79. Issue suppl 5. Pages s42.

Abstract

Coccidioidomycosis and strongyloidiasis are endemic to the Southwestern United States, Mexico, and Central and South America. Pregnancy-related immunosuppression increases the risk of dissemination of coccidioidomycosis, including meningitis, and can uncover asymptomatic infections such as strongyloidiasis. Coinfection during pregnancy is rarely reported and presents diagnostic and therapeutic challenges.
A 33-year-old pregnant patient at 26 weeks' gestation presented with headache and fever and was started on broad-spectrum antibiotics for fever of unknown origin. Brain MRI raised concern for stroke versus infection, prompting lumbar puncture. Cerebrospinal fluid showed an elevated opening pressure and protein, leukocytosis, and low glucose. A meningitis panel was negative, but antimicrobial therapy was continued and a stroke workup was completed. Head and neck imaging uncovered a superior lower lobe cavitary pulmonary lesion. The differential diagnosis included central nervous system tuberculosis or endemic fungal infection. QuantiFERON-TB Gold testing was negative; however, empiric therapy for CNS tuberculosis and amphotericin B were initiated. Later, bronchoscopy was used to rule out Mycobacterium tuberculosis. During admission, the patient developed progressive hydrocephalus. An external ventricular drain was placed, followed by transition to a ventriculopleural shunt. Plasma microbial cell-free DNA testing (Karius) returned positive for Coccidioides posadasii, later confirmed on CSF fungal culture. Strongyloides antibody testing was also positive. Due to high-dose steroid exposure in the setting of increased intracranial pressure and concern for Strongyloides hyperinfection, ivermectin was initiated. Antifungal therapy was transitioned to lifelong fluconazole for suppression and prophylaxis.
In pregnancy, treatment modalities must be weighed against the risks to the developing fetus, including the selection of antimicrobials and neurosurgical interventions. Early multidisciplinary evaluation of severe infection is critical to promote positive outcomes for both the mother and the fetus. This patient continued to recover and went on to deliver a healthy baby at 30 weeks' gestation.

PMID:
42526013
Bibliographic data and abstract were imported from PubMed on 30 Jul 2026.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.