My research is focussed on the topic of chronic pulmonary aspergillosis (CPA). I am an academic clinician based at the UK National Aspergillosis Centre at Wythenshawe Hospital. This is a world-leading research centre for this neglected condition, which has a 5-year mortality of at least 38%, but is treatable with azole antifungal drugs and sometimes amenable to surgical cure.
My first main research focus has been assessment and validation of Aspergillus-specific IgG testing for use in CPA diagnosis. I have collaborated with labs in Netherlands, Belgium and France and worked with Gulu University in Uganda to establish the accuracy of commercially avaialable assays for CPA diagnosis and to identify optimal diagnostic cut-offs for use in this field. This work provides a crucial foundation for all other work in the field.
My second research focus has been on measuring the prevalence of CPA secondary to tuberculosis. Working with colleagues in Uganda I have establshed that CPA complicates 4.9 - 6.5% of all cases of pulmonary tuberculosis and 26% of cases with caviation on chest X-ray. This provides the first proof that CPA represents a previously unrecognised global public health problem.
I have established which clinical and radiological features are associated with CPA and demonstrated that chest X-ray can be used to exclude CPA in this context and that the combination of chest X-ray and serology can diagnose CPA with acceptable accuracy in low resource settings.
I am now developing futher studies to measure CPA prevalence in other groups and to determine the best strategies for screening and diagnosis in at-risk populations. I am actively engaged with organisations such as the Global Action Fund for Fungal Infections (GAFFI) and CPANet, the European CPA research network to establish consensus definitions for CPA diagnosis and trial outcomes and to set up new collaborative studies