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We report on 10 cases of mucormycosis, as defined by The European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG) standards of invasive fungal diseases, among patients with a recent history of neutropenia, prolonged use of corticosteroids and treatment with immunosuppressants. They were all observed at the Ain Shams University Specialized Hospital in Cairo, Egypt, during the year 2010. These cases were categorized as 50% proven and 50% probable, with none considered to be possible mucormycosis. The median age of the patients discussed in this report was 50 years (range 22-68 years), of which 80% were male and 20% were female. Uncontrolled diabetes with ketoacidosis was noted in 60% of cases, while 40% of the patients had undergone liver transplantations. Pulmonary mucormycosis was the predominant presentation as it was noted in 80% of cases, but there was only 20% sinus involvement. Members of the genus Lichtheimia were the most common etiologic agents (40% of all cases), whereas Rhizopus ssp. were recovered from 30% of cases, Syncephalastrum spp. in 20%, and 10% of patients were infected with Rhizomucor. Liposomal formulation of amphotericin B (LAMB) was successfully used to treat all the cases described in this report. We concluded that the incidence of mucormycosis was relatively high during the study period in this one-center study and that additional studies looking into the diagnosis and the control of mucormycosis in Egypt are required.

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Keywords: AmpC β-lactamase, extended-spectrum β-lactamases (ESBLs), Klebsiella spp., modified double-disc synergy test (MDDST), double-disc synergy test (DDST), phenotypic confirmatory test (E-test), modified three-dimensional test (MTDT)The detection of extended spectrum -lactamases (ESBL(S)) in Gram-negative bacteria that produce AmpC -lactamases is problematic. In the present study, the performance of modified double-disc synergy test (MDDST) that employs a combination of cefepime and piperacillin-tazobactam for the detection of ESBL(S) Klebsiella producing AmpC -lactamases was evaluated and compared with doubledisc synergy test (DDST). E-test phenotypic confirmatory and modified three-dimensional tests (MTDT) were adopted for more data confidence. A total of 100 clinical isolates of Klebsiella, which met the CLSI (2012) screening criteria as having broth microdilution (BMD) MIC > or =2 mg mL -1 for at least one extended-spectrum cephalosporin [ceftazidime (CAZ), cefotaxime (CTX) and cefpodoxime], were accurately-selected for the study. MDDST detected ESBLs in 62 out of the100 studied isolates with 100 % sensitivity and specificity, whereas DDST detected ESBLs in only 52 isolates with 92.9 % sensitivity and 100 % specificity. E-test could detect ESBLs in 62 isolates, while as many as 34/62 ESBL positive isolates were confirmed to be AmpC beta-lactamase positive by the MTDT. MDDST and E-Test could detect ESBLs in all the 34 AmpC positive isolates, whereas DDST detects ESBLs in only 26 isolates. The study recommended MDDST as superior to DDST for the detection of ESBLs in AmpC -lactamase-producing Klebsiella spp. and this was confirmed by MTDT and E-Tests.

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