Bony invasion is common and, since the disease may have spread from involved sinuses, the sinuses may be abnormal. Definitive diagnosis requires a biopsy. Often there is a history of prior sinus infection that was treated with broad-spectrum antibacterial therapy. As in other sites, Aspergillus tends to invade locally. Computed tomography of the sinuses will usually show bony erosion, and penetration into adjacent tissues such as the brain or the orbit can occur.
Diagnosis is made by biopsy.
Occasionally, culture from a patient with chronic sinusitis may grow Aspergillus species. The absence of bony invasion on biopsy samples or computed tomographic scans may represent colonization and may not require aggressive therapy. Although Aspergillus infections are more likely to be localized than other fungal infections in AIDS, dissemination to many organs can occur. Renal involvement has also been described, both in the context of disseminated infection and in occasional patients presenting with localized renal aspergillomas that cause obstruction of the urinary system. As previously mentioned, the prognosis of patients with aspergillosis is poor, in part because of the fungal infection itself and in part because it tends to occur in patients with very advanced AIDS who have many other complications of end-stage HIV infection.