Queen Mary suspends bone marrow transplants; two other leukaemia patients ill A six-year-old boy was killed and two other leukaemia patients made ill by an outbreak of a rare fungal infection in at Queen Mary Hospital. Another three patients from the hospital's bone marrow transplant unit are suspected of being infected. The hospital has suspended its bone marrow transplants for a week and activated a series of infection controls in response to the outbreak. Head of microbiology at the University of Hong Kong Yuen Kwok-yung revealed yesterday the three leukaemia patients suffered from a rare disease called gastrointestinal mucormycosis, an infection in the intestines caused by spores from a group of fungi called murorales. The hospital is chasing the source of the infection, which could have come from contaminated food, including prepacked items such as bread or biscuits. The two surviving patients with confirmed cases of the disease had eaten prepackaged food. Professor Yuen appealed to all patients with a low immunity to eat only boiled or very well cooked food. The hospital has tested 100 food items and found murorales in two prepacked food items patients had brought into the hospital. The fungus is commonly found in the environment, food and wood. It is harmless to people with normal immunity. Most patients who develop the disease have suppressed immunity due to leukaemia or lymphoma or through undergoing chemotherapy. Most cases occur by the spores entering the body through the lungs, skin or tongue and infection may spread to other parts of the body such as the brain. The disease has a mortality rate of more than 50 per cent. But intestinal infections are very rare. Since 2004, the hospital has found only four cases of the fungus, all in respiratory or skin specimens. 'I have been a microbiologist for 27 years and this is the first time I have seen three cases of intestinal mucormycosis in such a short time,' Professor Yuen said. The outbreak began in November, when a six-year-old boy with leukaemia died 23 days after developing a distended abdomen. Hit intestines were found to be badly damaged. Last month, an 11-year-old boy with leukaemia developed gangrenous appendicitis due to the disease. Yesterday, a 38-year-old man, also a leukaemia patient, was diagnosed with gangrenous appendicitis. Professor Yuen said tests on stool samples from patients at the bone marrow transplant unit found three more people with the fungus. They are regarded as suspected cases. A retrospective review also found a 57-year-old man with lymphoma who had died also had the disease. But it is uncertain if it had killed him. The two confirmed and three suspected cases are being treated with a drug called posaconazole. It is the only medicine now available for treating the disease but has not been registered in Hong Kong. The patients are in stable condition. Professor Yuen said the hospital was using sample drugs and it had decided to suspend bone marrow transplants for a week and stop taking new cases until it could ensure enough supply of the medicine. Murorales spores can be killed if they are boiled for more than one minute at 80 degrees Celsius. Pre-packed food may still contain spores. To step up infection controls, the hospital will provide only well-cooked food to cancer patients and will prohibit the use of wooden chopsticks. Tongue suppressors used for oral examinations will be sterilised. Raymond Liang Hin-suen, the university's head of bone marrow transplant services, said about three patients had had transplants postponed in the coming week or two. Professor Liang said the hospital would review the situation in one week to decide if bone marrow transplants could be resumed. Ho Yin-ming, chairman of the Hong Kong Adult Blood Cancer Group, said the situation was worrying. 'We hope the source can be found soon or the patients now at the hospital are still subject to the risk.'