Does transplacental spread of coccidioidomycosis occur? Report of a neonatal fatality and review of the literature.

A neonatal death due to unsuspected coccidioidomycosis was studied. A critical review of the 12 neonatal fatalities and two survivals now reported strongly opposes the concept of transplacental spread. Associated with 35 maternal fatalities in the literature are 16 cases of placentitis and five neonatal deaths; none of the neonatal deaths, however, were associated with placentitis. Three of these five had predominantly intrathoracic disease, as did those neonates whose rapid deaths were unassociated with maternal coccidioidomycosis. Transpartum aspiration of infected decidua or postpartum inhalation is the probable initial pathogenic event in neonatal coccidioidomycosis.