ID:IOTS - Infectious Disease Insight Of Two Specialists 119. The Moulds: Aspergillus part 2, invasive and chronic disease
Sep 8, 2025
Iain Page, consultant in infectious diseases focusing on chronic pulmonary aspergillosis. Darius Armstrong-James, infectious diseases and medical mycology specialist at Imperial. They discuss why Aspergillus matters in clinical care. They cover diagnostic strategies like imaging, culture and serology. They debate management of invasive and chronic disease, resistance and current and upcoming antifungal therapies.
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Accidental Mycology Career Led To Niche Expertise
- Darius Armstrong-James accidentally entered mycology via a PhD opportunity after an aborted trypanosome fellowship application.
- He highlights UK gaps in formal mycology training and the career benefits of specialising in a neglected field.
Career Pivot From TB Research To CPA Clinical Work
- Ian Page's path to CPA began with a PhD linking TB and CPA and field work in Uganda measuring post-TB CPA prevalence.
- Clinical exposure at the UK National Aspergillosis Centre then led him to pursue CPA as a clinical focus.
Host Immunity Shapes Aspergillus Disease Spectrum
- Aspergillus causes a spectrum of lung disease determined mainly by host response rather than organism exposure.
- Diseases range from fulminant invasive aspergillosis in profoundly immunosuppressed patients to chronic cavitary disease and allergic presentations in those with underlying lung disease.