Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Response

Christina Baggott, Charles Sharp, Nidhi Bhatt, Martin Plummeridge and Huzaifa Adamali
Download PDF
DOI: https://doi.org/10.7861/clinmedicine.16-3-302a
Clin Med June 2016
Christina Baggott
North Bristol Lung Centre, Southmead Hospital, Bristol, UK
Roles: Respiratory specialist registrar
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Charles Sharp
Academic Respiratory Unit, University of Bristol, Bristol, UK
Roles: Respiratory specialist registrar
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Nidhi Bhatt
Department of Histopathology, University Hospitals Bristol, Bristol, UK
Roles: Consultant histopathologist
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Martin Plummeridge
North Bristol Lung Centre, Southmead Hospital, Bristol, UK
Roles: Consultant respiratory physician
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Huzaifa Adamali
North Bristol Lung Centre, Southmead Hospital, Bristol, UK
Roles: Consultant respiratory physician
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
Loading

Response

We thank the correspondents for their interest in our lesson of the month ‘A cough that doesn't fit the mould’. The two points highlighted regarding the investigation and treatment of Aspergillus infection are important and highlight the difficulties in diagnosis and then optimal treatment of this infection.

We acknowledge the limitations of the cited normal range for Aspergillus IgG and would agree that this test should not be used in isolation to diagnose invasive Aspergillosis. As stated in our case and in the medical literature,1 a combination of the clinical scenario, blood serologies (including Aspergillus IgG and IgE), radiology, sputum microscopy and culture and tissue biopsy should be used to form the diagnosis. We thank the correspondents for emphasising the important point that a diagnosis of invasive Aspergillus disease must be reached by such a synthesis of clinical information.

The correspondents’ observations regarding the optimal treatment in this case are also important concerns. We agree that voriconazole should not be first-line therapy for clinical presentations such as that reported; our patient initially received physiotherapy and mucus plug removal via bronchoscopy. It was only after this failed to improve his symptoms that voriconazole was added and this, along with a second bronchoscopy resulted in resolution of his right lower lobe collapse.

As is observed, optimal management of cases such as this is uncertain given their rarity and the absence of robust medical literature. Management must be extrapolated from what evidence does exist. A randomised study of treatment for 3 months with voriconazole compared with amphotericin B for invasive aspergillosis resulted in fewer side effects and improved survival.2 This trial was conducted in a group with significant immunocompromise following treatment for haematological malignancy. The study duration in this case, in addition to clinical practice in other areas of pulmonary aspergillosis, led to the decision to treat for 3 months. Such decisions must be made in the context of the clinical case. Further studies are needed both to determine the need for treatment and also whether shorter courses of therapy may be effective.

  • © 2016 Royal College of Physicians

References

  1. ↵
    1. Kosmidis C
    , Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax 2015;70:270–7.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Herbrecht R
    , Denning DW, Patterson TF, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002;347: 408–15.
    OpenUrlCrossRefPubMed
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Response
Christina Baggott, Charles Sharp, Nidhi Bhatt, Martin Plummeridge, Huzaifa Adamali
Clinical Medicine Jun 2016, 16 (3) 302; DOI: 10.7861/clinmedicine.16-3-302a

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Response
Christina Baggott, Charles Sharp, Nidhi Bhatt, Martin Plummeridge, Huzaifa Adamali
Clinical Medicine Jun 2016, 16 (3) 302; DOI: 10.7861/clinmedicine.16-3-302a
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Response
    • References
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • JAK-inhibition as a therapeutic strategy for refractory primary systemic vasculitides
  • Response
  • Functional disorders and chronic pain
Show more Letters to the editor

Similar Articles

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians