Another death possibly linked to rare fungus
Ella Lee and Danny Mok
Health authorities are investigating the death of a leukaemia patient who could have succumbed to a rare fungal infection that has struck several patients at Queen Mary Hospital, where it has killed a six-year-old boy and led to a one-week suspension of the bone marrow transplant unit.
The 48-year-old man was admitted to Queen Mary on November 11 and later discharged. On December 27, complaining of blood in his stool, he was admitted to United Christian Hospital, where he suffered massive bleeding and died on January 1.
News of the possible connection to the fungal infection came yesterday as the pharmacy chief for Queen Mary said the bone marrow transplant unit might have avoided suspension if the drug able to control the infection had been stocked earlier.
William Chui Chun-ming, head of pharmacy services for the Hospital Authority's Hong Kong West cluster, which includes Queen Mary Hospital, appealed to doctors to communicate better with his department in case of a sudden demand for drugs.
The hospital revealed on Wednesday that three patients had suffered from gastrointestinal mucormycosis, an infection in the intestines caused by spores from a group of fungi called murorales. One six-year-old boy died. Three other suspected cases were also identified.
The case revealed yesterday by United Christian Hospital would be transferred to the Coroner's Court and an autopsy report was pending, a UCH spokeswoman said.
Queen Mary Hospital is still investigating the source of infection, which could be linked to contaminated prepacked food such as bread or biscuits. The fungus is harmless to people with normal immunity but could be fatal to those with depressed immune systems.
The five patients have been put on a drug called posaconazole, the only treatment for the infection. The hospital has only a small stock of free samples of the drug.
The hospital decided on Wednesday to suspend its bone marrow transplant services for a week until it could get supplies of the drug from overseas.
Mr Chui said the transplant unit started using the drug in mid-January and formally asked the pharmacy department to buy the medicine on Monday - only for one patient.
'We did not know that several other patients have also been put on the medication until the Wednesday press conference,' he said. 'We hope there is better communication in the future so medical services will not be affected because of a shortage of medicine.'
The pharmacy department yesterday also issued an internal memo to remind doctors to dispense all medicine through pharmacists. Mr Chui said posaconazole had been directly dispensed by hospital doctors to patients. 'We understand that some doctors may not be able to follow the strict guidelines during an emergency situation,' he said. 'If the drug is dispensed by us, we can better monitor the demand.'
The head of Hong Kong University's bone marrow transplant unit, Raymond Liang Hin-suen, said yesterday suspension of its programme was not solely the result of the shortage of the drug. 'A shortage of medicine is not the only reason we have to suspend. We also have to make sure all patients who come to our unit are safe and we have to test their stool samples before conducting a bone marrow transplant on them. That is why we have to postpone two to three transplants for a week.'
The outbreak began in November, when a six-year-old boy with leukaemia died 23 days after developing a distended abdomen. Last month, an 11-year-old boy with leukaemia developed gangrenous appendicitis due to the disease. On Wednesday, a 38-year-old man, also a leukaemia patient, was diagnosed with gangrenous appendicitis. Three suspected cases have also been identified.
'All the cases came very suddenly. We have taken immediate action,' Professor Liang said.
Mucormycosis is caused by the mucorales fungi. The aggressive, opportunistic infection was first described in 1885
1 The fungi spores (above) ? which are everywhere ? enter body through mouth and nose
2 Spores germinate in nose and throat
3 Fungus then directly invades blood vessels. Infection most commonly affects nose, sinuses, eyes and brain
4 Less commonly, infection occurs in gastrointestinal tract
Infected and dead tissue must be removed, but even with surgery and antifungal drugs, many patients die