Cryptococcosis and pregnancy

A 28-year-old Caucasian woman developed overt symptoms of cryptococcal meningitis the day following delivery of a normal term child. The diagnosis of cryptococcal meningitis was substantiated by culture of Cryptococcus neoformans from spinal fluid. The patient was treated with amphotericin for 3 months (total dose 1,960 mg. intravenously and 9.5 mg. intrathecally) with complete recovery. Nine definitely proved cases of CNS cryptococcosis during or immediately following pregnancy have been reported. A review of these cases suggests that if the woman lives to term delivery neither the cryptococcal infection itself nor treatment of the pregnant mother with amphotericin has a serious deleterious effect on the infant. However, in no case was amphotericin given during the first trimester of pregnancy. It is suggested that the high glucocorticoid levels during pregnancy serve the dual role of increasing susceptibility and possibly even dissemination of cryptococcosis while masking its signs and symptoms.