The two noninvasive forms, mycetoma and AFS, while not life threatening, certainly cannot be considered benign. This is likely to change as physicians learn more about the disease. People with allergies, both adults and children, appear to be more susceptible to AFS than those who do not have atopic disease. Patients with AFS are immunocompetent, most have allergic rhinitis, and many have asthma. The ailment usually manifests as chronic intractable sinusitis.
Patients tend to be veterans of multiple courses of antibiotics.
However, AFS responds poorly to antibacterial treatment, and patients return time and again with the characteristic sinus pain and pressure, nasal congestion, heavy discharge, fatigue, and purulent postnasal drip. As in the first identified cases, patients frequently have undergone at least one sinus surgery to little avail. The disease often goes undiagnosed because the typical character and sinus contents may not be recognized and organisms in surgical pathology specimens may be missed. For example, routine hematoxylin-eosin stains of surgical material do not detect the small quantities of hyphae present. The geographic vulnerability to AFS detected in the U.S. suggests that some endemic fungi are particularly troublesome.