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Iseki S, Yamaguchi S, Ozaki Y, Uemura Y. Mushroom poisoning with cardiogenic shock caused by Russula subnigricans successfully treated with mechanical circulatory support devices: a case report. Eur Heart J Case Rep 2024; 8:ytae337. [PMID: 39045520 PMCID: PMC11263874 DOI: 10.1093/ehjcr/ytae337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/29/2024] [Accepted: 07/03/2024] [Indexed: 07/25/2024]
Abstract
Background Mushroom poisoning caused by the ingestion of Russula subnigricans has been reported to cause rhabdomyolysis and cardiac dysfunction, leading to death. There have been few reports of cardiogenic shock induced by mushroom poisoning that was successfully treated using mechanical circulatory support devices. Case Summary A 38-year-old man presented with gastrointestinal symptoms a day after consuming a curry made with forest-collected mushrooms and was admitted with a diagnosis of rhabdomyolysis. Despite appropriate fluid management for severe rhabdomyolysis, the patient experienced anuria and cardiogenic shock with a remarkably reduced left ventricular ejection function, followed by the development of ventricular fibrillation. Mechanical support using Impella CP, veno-arterial extracorporeal membranous oxygenation (VA-ECMO), and continuous haemodiafiltration were administered for cardiogenic shock and severe rhabdomyolysis. His cardiac and renal function gradually improved, and the patient was successfully weaned off VA-ECMO on day 4, Impella CP on day 5, and renal replacement therapy on day 23. The left ventricular ejection fraction returned to normal without any neurological, respiratory, or renal sequelae. The remaining mushroom samples were identified as R. subnigricans by polymerase chain reaction testing. Discussion This is the first reported case of cardiogenic shock caused by R. subnigricans poisoning, successfully treated with Impella CP and VA-ECMO. The optimal use of mechanical circulatory support devices plays an important role in the treatment of cardiogenic shock caused by mushroom toxicity.
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Affiliation(s)
- Shota Iseki
- Cardiovascular Center, Anjo Kosei Hospital, Anjo, Aichi, 446-8602, Japan
| | - Shogo Yamaguchi
- Cardiovascular Center, Anjo Kosei Hospital, Anjo, Aichi, 446-8602, Japan
| | - Yuta Ozaki
- Cardiovascular Center, Anjo Kosei Hospital, Anjo, Aichi, 446-8602, Japan
| | - Yusuke Uemura
- Cardiovascular Center, Anjo Kosei Hospital, Anjo, Aichi, 446-8602, Japan
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Balice G, Boksebeld M, Barrier Q, Boccalini S, Kassai-Koupai B, Paret N, Grenet G. Mushroom Poisoning-Related Cardiac Toxicity: A Case Report and Systematic Review. Toxins (Basel) 2024; 16:265. [PMID: 38922159 PMCID: PMC11209194 DOI: 10.3390/toxins16060265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
We encountered a case of mushroom intoxication complicated by "toxic-like" myocarditis. Because of the lack of systematized knowledge on this subject, we performed a systematic review of the literature on cardiac toxicity in mushroom poisoning (MP). The aim of this study was to identify and describe the severity, the causal relationship, and the mushroom species involved in other reported cardiac events associated with MP. We included 39 studies in our review. We found 106 cases of cardiac events associated with MP, including 18 deaths. A wide variety of cardiac manifestations were reported, ranging from the simple elevation of cardiac enzymes (n = 61) to ventricular tachycardia (n = 14), acute heart failure (n = 18), and myocarditis (n = 7). Causal relationship between cardiac manifestations and mushroom poisoning was assessed for 42 patients, applying the algorithm validated by the French Toxicovigilance Coordination Committee. Twenty-three cases (54.8%) had a "possible" causal relationship, eight cases (19%) a "probable" relationship, and ten cases (23.8%) a "very probable" relationship. Several fungal genera were involved in reported cases, including Amanita but also rarer ones like Russula and Tricholoma. In conclusion, we showed that cases of cardiac toxicity following MP have been documented in the existing literature, and for some of them, we assessed a strong causal relationship.
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Affiliation(s)
- Giuseppe Balice
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, 69003 Lyon, France; (M.B.); (B.K.-K.); (N.P.); (G.G.)
| | - Maxime Boksebeld
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, 69003 Lyon, France; (M.B.); (B.K.-K.); (N.P.); (G.G.)
| | - Quentin Barrier
- Fédération de Cardiologie Médicale, Hôpital Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France
| | - Sara Boccalini
- Service de Radiologie Cardiovasculaire et Thoracique, Hôpital Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France
| | - Behrouz Kassai-Koupai
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, 69003 Lyon, France; (M.B.); (B.K.-K.); (N.P.); (G.G.)
- Centre d’Investigation Clinique de Lyon (CIC1407 INSERM), Hospices Civils de Lyon, 69500 Bron, France
- Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Université Lyon 1, CNRS, 69100 Villeurbanne, France
| | - Nathalie Paret
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, 69003 Lyon, France; (M.B.); (B.K.-K.); (N.P.); (G.G.)
| | - Guillaume Grenet
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, 69003 Lyon, France; (M.B.); (B.K.-K.); (N.P.); (G.G.)
- Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Université Lyon 1, CNRS, 69100 Villeurbanne, France
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Chun MS, Min MK, Ryu JH, Lee DS, Lee MJ, Hyun T, Shon SW. Mortality Cases of Mushroom Poisoning with Russula subnigricans. Wilderness Environ Med 2023; 34:372-376. [PMID: 37210234 DOI: 10.1016/j.wem.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 05/22/2023]
Abstract
Mushroom poisoning is increasing worldwide, as well as the incidence of fatal mushroom poisoning. Several new syndromes associated with mushroom poisoning have been described in the literature. Notably, 1 of the newly identified mushroom poisonings is Russula subnigricans poisoning. R subnigricans can be classified as causing a delayed-onset rhabdomyolytic syndrome as patients with this severe poisoning present with severe rhabdomyolysis, acute kidney injury, and cardiomyopathy. However, there are only a few reports on the toxicity of R subnigricans. We recently treated 6 patients with R subnigricans mushroom poisoning, of whom 2 died. The 2 patients showed severe rhabdomyolysis, metabolic acidosis, acute renal failure, electrolyte imbalance, and irreversible shock, which caused their deaths. Mushroom poisoning should be considered in the evaluation of rhabdomyolysis of unknown origin. In addition, in cases of mushroom poisoning with severe rhabdomyolysis, R subnigricans poisoning should be promptly identified.
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Affiliation(s)
- Mo Se Chun
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, School of Medicine Pusan National University, Yangsan, Korea
| | - Mun Ki Min
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, School of Medicine Pusan National University, Yangsan, Korea.
| | - Ji Ho Ryu
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, School of Medicine Pusan National University, Yangsan, Korea
| | - Dae Sub Lee
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, School of Medicine Pusan National University, Yangsan, Korea
| | - Min Jee Lee
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, School of Medicine Pusan National University, Yangsan, Korea
| | - Taegyu Hyun
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, School of Medicine Pusan National University, Yangsan, Korea
| | - Seung Woo Shon
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, School of Medicine Pusan National University, Yangsan, Korea
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Vaibhav V, Meshram R, S Y, Jha N, Khorwal G. Mushroom Poisoning: A Case Series With a Literature Review of Cases in the Indian Subcontinent. Cureus 2023; 15:e39550. [PMID: 37378168 PMCID: PMC10292043 DOI: 10.7759/cureus.39550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Mushroom is a fungus widely used as an edible in various parts of the world, especially in hilly regions with damp climates. Nevertheless, when picked from the wild to use as a vegetable, it has proved fatal for people ingesting it due to a lack of knowledge for distinguishing between poisonous and non-poisonous mushrooms by the people of the local community. Three cases presented as emergencies from a single household comprising a 13-year-old girl and both her grandparents following the ingestion of mushrooms picked from a nearby forest area. Luckily the parents of the girl were out for work, so they survived and helped identify the mushroom. Most cases are not reported or documented, and data are present mainly in the form of case reports.
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Affiliation(s)
- Vikas Vaibhav
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, IND
| | - Raviprakash Meshram
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, IND
| | - Yashpal S
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, IND
| | - Nishi Jha
- Pathology and Laboratory Medicine, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, IND
| | - Gitanjali Khorwal
- Anatomy, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, IND
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5
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Min MK, Lee D, Shon SW, Ryu JH, Wang I, Lee MJ, Chun M, Hyun T. Russula subnigricans Poisoning Causes Severe Rhabdomyolysis That Could be Misdiagnosed as Non-ST Segment Elevation Myocardial Infarction. Wilderness Environ Med 2022; 33:324-328. [PMID: 35589501 DOI: 10.1016/j.wem.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 11/21/2022]
Abstract
Mushroom poisoning and subsequently the number of patients visiting emergency rooms are increasing, as well as the proportion of fatal mushroom poisonings. Myocytic mushroom poisoning is one of the new clinical classifications. This report documents the course of a family with Russula subnigricans poisoning complicated by severe rhabdomyolysis, including a case that was misdiagnosed as myocardial infarction. A 64-y-old man visited our hospital with symptoms including substernal chest discomfort, nausea, vomiting, and myalgia, lasting for 12 h. His laboratory tests showed elevated serum high-sensitive troponin I. He was diagnosed with non-ST segment elevation myocardial infarction. After that, 2 family members who ate mushrooms together were transferred from a local emergency room with the diagnosis of rhabdomyolysis. Consequently, rhabdomyolysis due to mushroom poisoning was diagnosed. They were hospitalized in the intensive care unit. After admission, conservative management, including primary fluid resuscitation, was performed, and the patients were discharged without complications. R subnigricans poisoning was revealed after investigation and should be considered in mushroom poisoning with rhabdomyolysis. Early recognition and intensive supportive care are important for mushroom poisoning patients.
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Affiliation(s)
- Mun Ki Min
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Daesup Lee
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
| | - Seung Woo Shon
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji Ho Ryu
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Iljae Wang
- Department of Emergency Medicine, Pusan National University Hospital, Busan, Korea
| | - Min Jee Lee
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Mose Chun
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Taegyu Hyun
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
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6
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Long P, Jiang Z, He Z, Chen Z. Development of a loop-mediated isothermal amplification assay for the rapid detection of Russula subnigricans and Russula japonica. Front Microbiol 2022; 13:918651. [PMID: 36081806 PMCID: PMC9445624 DOI: 10.3389/fmicb.2022.918651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Russula subnigricans is the only deadly species in the genus Russula with a mortality rate of more than 50%, and Russula japonica is the most common poisonous species, making rapid species identification in mushroom poisoning incidents extremely important. The main objective of this study was to develop a rapid, specific, sensitive, and simple loop-mediated isothermal amplification (LAMP) assay for the detection of R. subnigricans and R. japonica. Two sets of species-specific LAMP primers targeting internal transcribed spacer (ITS) regions were designed to identify R. subnigricans and R. japonica. The results demonstrated that while LAMP could specifically detect R. subnigricans and R. japonica, the polymerase chain reaction (PCR) could not distinguish R. subnigricans from Russula nigricans. In addition, the results demonstrated that, compared to electrophoresis-LAMP and real-time quantitative LAMP (RT-qLAMP), the detection sensitivity of HNB-LAMP (a mixture of LAMP with hydroxy naphthol blue (HNB) dye) for R. subnigricans could reach 0.5 pg/μl and was 100-fold higher than that of PCR. The LAMP reaction could be completed in 45 min, which is much faster than the conventional PCR. In the future, LAMP can be used a quick, specific, and sensitive detection tool in various fields.
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He MQ, Wang MQ, Chen ZH, Deng WQ, Li TH, Vizzini A, Jeewon R, Hyde KD, Zhao RL. Potential benefits and harms: a review of poisonous mushrooms in the world. FUNGAL BIOL REV 2022. [DOI: 10.1016/j.fbr.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Lee S, Yu JS, Lee SR, Kim KH. Non-peptide secondary metabolites from poisonous mushrooms: overview of chemistry, bioactivity, and biosynthesis. Nat Prod Rep 2022; 39:512-559. [PMID: 34608478 DOI: 10.1039/d1np00049g] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Covering: up to June 2021A wide variety of mushrooms have traditionally been recognized as edible fungi with high nutritional value and low calories, and abundantly produce structurally diverse and bioactive secondary metabolites. However, accidental ingestion of poisonous mushrooms can result in serious illnesses and even death. Chemically, mushroom poisoning is associated with secondary metabolites produced in poisonous mushrooms, causing specific toxicity. However, many poisonous mushrooms have not been fully investigated for their secondary metabolites, and the secondary metabolites of poisonous mushrooms have not been systematically summarized for details such as chemical composition and biosynthetic mechanisms. The isolation and identification of secondary metabolites from poisonous mushrooms have great research value since these compounds could be lethal toxins that contribute to the toxicity of mushrooms or could provide lead compounds with remarkable biological activities that can promote advances in other related disciplines, such as biochemistry and pharmacology. In this review, we summarize the structures and biological activities of secondary metabolites identified from poisonous mushrooms and provide an overview of the current information on these metabolites, focusing on their chemistry, bioactivity, and biosynthesis.
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Affiliation(s)
- Seulah Lee
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea. .,Division of Life Sciences, Korea Polar Research Institute, KIOST, Incheon 21990, Republic of Korea
| | - Jae Sik Yu
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea.
| | - Seoung Rak Lee
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea. .,Department of Chemistry, Princeton University, New Jersey, 08544, USA
| | - Ki Hyun Kim
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea.
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9
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Diaz JH. Nephrotoxic Mushroom Poisoning: Global Epidemiology, Clinical Manifestations, and Management. Wilderness Environ Med 2021; 32:537-544. [PMID: 34629291 DOI: 10.1016/j.wem.2021.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/19/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022]
Abstract
Because mushroom poisonings are increasing worldwide after ingestions of known, newly described, and formerly considered edible species, the objectives of this review are to describe the global epidemiology of nephrotoxic mushroom poisonings, to identify nephrotoxic mushrooms, to present a toxidromic approach to earlier diagnoses of nephrotoxic mushroom poisonings based on the onset of acute renal failure, and to compare the outcomes of renal replacement management strategies. Internet search engines were queried with the keywords to identify scientific articles on nephrotoxic mushroom poisonings and their management during the period of 1957 to the present. Although hepatotoxic, amatoxin-containing mushrooms cause most mushroom poisonings and fatalities, nephrotoxic mushrooms, most commonly Cortinarius species, can cause acute renal insufficiency and failure. Several new species of nephrotoxic mushrooms have been identified, including Amanita proxima and Tricholoma equestre in Europe and Amanita smithiana in the United States and Canada. In addition, the edible, hallucinogenic mushroom Psilocybe cubensis has been noted recently via mass spectrometry as a rare cause of acute renal insufficiency. Renal replacement therapies including hemodialysis are often indicated in the management of nephrotoxic mushroom poisonings, with renal transplantation reserved for extracorporeal treatment failures.
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Affiliation(s)
- James H Diaz
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
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10
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Wennig R, Eyer F, Schaper A, Zilker T, Andresen-Streichert H. Mushroom Poisoning. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 117:701-708. [PMID: 33559585 DOI: 10.3238/arztebl.2020.0701] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/03/2020] [Accepted: 09/17/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Poisonous mushrooms are eaten by mushroom hunters out of ignorance, after misidentification as edible mushrooms, or as a psychoactive drug. Mushroom poisoning commonly leads to consultation with a poison information center and to hospitalization. METHODS This review is based on pertinent publications about the syndromes, toxins, and diagnostic modalities that are presented here, which were retrieved by a selective search in PubMed. It is additionally based on the authors' longstanding experience in the diagnosis and treatment of mushroom intoxication, expert consultation in suspected cases, macroscopic identification of wild mushrooms, and analytic techniques. RESULTS A distinction is usually drawn between mushroom poisoning with a short latency of less than six hours, presenting with a gastrointestinal syndrome whose course is usually relatively harmless, and cases with a longer latency of six to 24 hours or more, whose course can be life-threatening (e.g., phalloides, gyromitra, orellanus, and rhabdomyolysis syndrome). The DRG diagnosis data for Germany over the period 2000-2018 include a total of 4412 hospitalizations and 22 deaths due to the toxic effects of mushroom consumption. 90% of the fatalities were due to the death cap mushroom (amatoxins). Gastrointestinal syndromes due to mushroom consumption can be caused not only by poisonous mushrooms, but also by the eating of microbially spoiled, raw, or inadequately cooked mushrooms, or by excessively copious or frequent mushroom consumption. CONCLUSION There are few analytic techniques available other than the qualitative demonstration of amatoxins. Thus, the diagnosis is generally made on the basis of the clinical manifestations and their latency, along with meticulous history-taking, assisted by a mushroom expert, about the type(s) of mushroom that were consumed and the manner of their preparation.
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Affiliation(s)
- Robert Wennig
- Luxembourg: Prof. Dr. Robert Wennig (formerly Laboratoire National de Santé- Toxicologie, Université du Luxembourg-Campus Limpertsberg); Department of Clinical Toxicology & Poison Control Center Munich, Klinikum rechts der Isar, School of Medicine, Technical University of Munich; GIZ-Nord Poisons Centre,Göttingen University Hospital Faculty of Medicine and University Hospital Cologne and Department of Forensic Toxicology,University Hospital Cologne
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Trakulsrichai S, Jeeratheepatanont P, Sriapha C, Tongpoo A, Wananukul W. Myotoxic Mushroom Poisoning in Thailand: Clinical Characteristics and Outcomes. Int J Gen Med 2020; 13:1139-1146. [PMID: 33235487 PMCID: PMC7680089 DOI: 10.2147/ijgm.s271914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/04/2020] [Indexed: 01/04/2023] Open
Abstract
Purpose To describe the clinical characteristics and outcomes of myotoxic mushroom poisoning in Thailand. Patients and Methods We performed a retrospective cohort study of cases of myotoxic mushroom poisoning from the Ramathibodi Poison Center Toxic Exposure Surveillance System during a 5-year period (2012-2016). Results Forty-one cases were included. Most (53.7%) were male with the average age of 49 years. In three cases, the mushrooms were identified as Russula species by an experienced mycologist. Common presenting symptoms were gastrointestinal (GI) symptoms and myalgia. The median onset of GI symptoms and symptoms suggesting rhabdomyolysis after consuming mushrooms was 2 hours (0.17-24 hours) and 24-48 hours (2-120 hours), respectively. Eight patients who ate the mushrooms together with other patients with rhabdomyolysis had GI symptoms but did not develop rhabdomyolysis. For patients with rhabdomyolysis, acute kidney injury (AKI) and hyperkalaemia occurred in 51.5% and 33.3% of cases, respectively. Median initial and maximum creatine phosphokinase (CPK) levels in patients with rhabdomyolysis were 31,145 and 47,861 U/L, respectively. Fifteen of 17 patients who were investigated for troponin levels had elevated troponin. Three patients had a low ejection fraction. Most patients (95.1%) were admitted to hospital, with a median stay of 5 days. The mortality rate was 26.8%. Treatments included intravenous fluid, urine alkalinization, haemodialysis and peritoneal dialysis. Among patients with rhabdomyolysis, AKI, hyperkalaemia during hospitalisation, maximum CPK level, maximum creatinine level and initial and maximum potassium levels were the factors found to be significantly different between patients who died and those who survived. Conclusion Myotoxic mushroom poisoning had a high mortality rate. Most patients had early or delayed onset of clinical symptoms after mushroom ingestion. Some patients developed severe cardiovascular effects. Early detection, close monitoring (especially serum potassium, creatinine, CPK and cardiac effect) and good supportive care were the main treatment modalities.
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Affiliation(s)
- Satariya Trakulsrichai
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.,Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Peerawich Jeeratheepatanont
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Charuwan Sriapha
- Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Achara Tongpoo
- Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Winai Wananukul
- Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.,Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Yu F, Zhang Y, Liang J. The mitochondrial genome of a wild toxic mushroom, Russula subnigricans. MITOCHONDRIAL DNA PART B-RESOURCES 2019; 4:4126-4127. [PMID: 33366349 PMCID: PMC7707660 DOI: 10.1080/23802359.2019.1692719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Russula subnigricans is a wild toxic mushroom in the world. In this study, we present the 60,949 bp mitochondrial genome of R. subnigricans with a GC content of 21%. The mtDNA assembly consists of 60 genes, which including 14 standard protein-coding genes, two rRNA genes, 25 tRNA genes and 19 free-standing open reading frames (ORFs). Phylogenetic analysis was performed using 14 protein-coding genes, the results showed that the R. subnigricans had high homology with other Russula species.
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Affiliation(s)
- Fei Yu
- Key Laboratory of State Forestry Administration on Tropical Forestry Research, Research Institute of Tropical Forestry, Chinese Academy of Forestry, Guangzhou, China
| | - Yongjie Zhang
- College of Life Science, Shanxi University, Taiyuan, China
| | - Junfeng Liang
- Key Laboratory of State Forestry Administration on Tropical Forestry Research, Research Institute of Tropical Forestry, Chinese Academy of Forestry, Guangzhou, China
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Govorushko S, Rezaee R, Dumanov J, Tsatsakis A. Poisoning associated with the use of mushrooms: A review of the global pattern and main characteristics. Food Chem Toxicol 2019; 128:267-279. [DOI: 10.1016/j.fct.2019.04.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 02/07/2023]
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14
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White J, Weinstein SA, De Haro L, Bédry R, Schaper A, Rumack BH, Zilker T. Mushroom poisoning: A proposed new clinical classification. Toxicon 2019; 157:53-65. [DOI: 10.1016/j.toxicon.2018.11.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 10/30/2018] [Accepted: 11/07/2018] [Indexed: 01/19/2023]
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15
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Li Y, Mu M, Yuan L, Zeng B, Lin S. Challenges in the early diagnosis of patients with acute liver failure induced by amatoxin poisoning: Two case reports. Medicine (Baltimore) 2018; 97:e11288. [PMID: 29979397 PMCID: PMC6076086 DOI: 10.1097/md.0000000000011288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Acute liver failure (ALF) induced by amatoxin-containing mushrooms accounts for more than 90% of deaths in patients suffering from mushroom poisoning. However, due to the fact that most hospitals cannot identify the species of mushrooms involved, or detect amatoxins, the early diagnosis of amatoxin intoxication remains a significant challenge in clinical practice. PATIENT CONCERNS Two patients were had ingested wild mushrooms 15 hours before admission. Six hours prior to admission they experienced nausea, vomiting, weakness, abdominal pain and diarrhea. The species of mushrooms they had consumed could not be identified. DIAGNOSES According to their delayed gastroenteritis, the two patients were clinically diagnosed with amatoxin poisoning. One week after the patients were discharged, the species of the mushrooms was identified as Amanita fuliginea and the diagnosis was confirmed. INTERVENTIONS The two patients were treated with silibinin, penicillin G and plasma exchange. OUTCOMES Although the two patients progressed to ALF they fully recovered and were discharged on day 10 after admission. LESSONS Our case reports suggested that patients with unidentified wild mushroom intoxication with delayed gastroenteritis could be clinically diagnosed with amatoxin poisoning; in such cases, liver coagulation function should be frequently evaluated. Early diagnosis and treatment are crucial for survival in patients with ALF induced by amatoxin poisoning.
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陆 湛, 陈 艳, 黄 波, 彭 升, 王 倩, 刘 丹, 王 华. [Mixed amanita phalloides poisoning with rhabdomyolysis: analysis of 4 cases]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:635-638. [PMID: 29891465 PMCID: PMC6743900 DOI: 10.3969/j.issn.1673-4254.2018.05.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Indexed: 06/08/2023]
Abstract
We report the clinical characteristics, treatments and outcomes of 4 rare cases of mixed amanita fuliginea and amanita rimosa poisoning with rhabdomyolysis, and review the research progress in the intoxication mechanism and treatment. The latent time of amanita poisoning, defined as the period from the ingestion of poisonous mushroom to the onset of gastrointestinal symptoms, was about 8 days, and the severity of poisoning was associated with the amount of mushroom ingested. All the 4 patients developed multiple organ dysfunctions within 3 to 4 days after mushroom ingestion, predominantly in the liver, kidney and central nervous system accompanied with acute gastrointestinal injury and rhabdomyolysis. The treatment measures included persistent hemofiltration and intermittent hemoperfusion once daily for 5-7 days, and plasma exchange was administered in 2 cases for 1 or 2 times. High-dose vitamin C, glucose and corticosteroid were also given to the patients. After the treatments, two patients were cured and the other two died due to an excess intake of poisonous mushroom and lack of early preemptive therapies. Early emetic, gastric lavage, catharsis, fluid infusion and diuresis are critical to interrupt the enterohepatic circulation of amanita phalloides toxins and prevent the development of multiple organ dysfunction. Enhanced hemofiltration and sequential plasma therapy might effectively eliminate toxin from the blood to protect against further organ damages.
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Affiliation(s)
- 湛 陆
- 南方医科大学珠江医院重症医学科,广东 广州 510282Intensive Care Unit, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
- 钦州市第一人民医院重症医学科,广西 钦州 535000Intensive Care Unit, First Municipal Hospital of Qinzhou, Qinzhou 535000, China
| | - 艳波 陈
- 南方医科大学珠江医院重症医学科,广东 广州 510282Intensive Care Unit, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
- 广东药科大学第一附属医院内二科,广东 广州 510080First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, China
| | - 波 黄
- 南方医科大学珠江医院重症医学科,广东 广州 510282Intensive Care Unit, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 升 彭
- 南方医科大学珠江医院重症医学科,广东 广州 510282Intensive Care Unit, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 倩文 王
- 南方医科大学珠江医院重症医学科,广东 广州 510282Intensive Care Unit, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 丹蕾 刘
- 南方医科大学珠江医院重症医学科,广东 广州 510282Intensive Care Unit, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 华 王
- 南方医科大学珠江医院重症医学科,广东 广州 510282Intensive Care Unit, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
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Cervellin G, Comelli I, Rastelli G, Sanchis-Gomar F, Negri F, De Luca C, Lippi G. Epidemiology and clinics of mushroom poisoning in Northern Italy: A 21-year retrospective analysis. Hum Exp Toxicol 2017; 37:697-703. [DOI: 10.1177/0960327117730882] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Limited information exists about epidemiology and management of mushroom poisoning. We analyzed and described epidemiology, clinical presentation, and clinical course of mushroom-poisoned patients admitted to emergency departments (EDs) of the Province of Parma, Italy. Methods: Data from the database of mycological service were matched with clinical information retrieved from hospitals’ database, from January 1, 1996 to December 31, 2016. Results: Mycologist consultation was obtained in 379/443 identified mushroom poisonings. A remarkable seasonality was found, with significant peak in autumn. Thanks to the collaboration, the implicated species could be identified in 397 cases (89.6%); 108 cases (24.4%) were due to edible mushrooms, Boletus edulis being the most represented (63 cases). Overall, 408 (92%) cases presented with gastrointestinal toxicity. Twenty cases of amatoxin poisoning were recorded (11 Amanita phalloides and 9 Lepiota brunneoincarnata). One liver transplantation was needed. We observed 13 cases of cholinergic toxicity and 2 cases of hallucinogenic toxicity. Finally, 46 cases were due to “mixed” toxicities, and a total of 69 needed hospitalization. Conclusions: Early identification and management of potentially life-threatening cases is challenging in the ED, so that a mycologist service on call is highly advisable, especially during periods characterized by the highest incidence of poisoning.
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Affiliation(s)
- G Cervellin
- Emergency Department, University Hospital of Parma, Parma, Italy
| | - I Comelli
- Emergency Department, University Hospital of Parma, Parma, Italy
| | - G Rastelli
- Emergency Department, Hospital of Fidenza, Fidenza, Parma, Italy
| | - F Sanchis-Gomar
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - F Negri
- Mycological Consultation Service, Local Health Agency of Parma, Parma, Italy
| | - C De Luca
- Mycological Consultation Service, Local Health Agency of Parma, Parma, Italy
| | - G Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Cervellin G, Comelli I, Benatti M, Sanchis-Gomar F, Bassi A, Lippi G. Non-traumatic rhabdomyolysis: Background, laboratory features, and acute clinical management. Clin Biochem 2017; 50:656-662. [PMID: 28235546 DOI: 10.1016/j.clinbiochem.2017.02.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 12/11/2022]
Abstract
Rhabdomyolysis is a relatively rare condition, but its clinical consequences are frequently dramatic in terms of both morbidity and mortality. Although no consensus has been reached so far about the precise definition of this condition, the term rhabdomyolysis describes a rapid breakdown of striated, or skeletal, muscle. It is hence characterized by the rupture and necrosis of muscle fibers, resulting in release of cell degradation products and intracellular elements within the bloodstream and extracellular space. Notably, the percentage of patients with rhabdomyolysis who develop acute kidney injury, the most dramatic consequence, varies from 13% to over 50% according to both the cause and the clinical and organizational setting where they are diagnosed. Despite direct muscle injury (i.e., traumatic rhabdomyolysis) remains the most common cause, additional causes, frequently overlapping, include hypoxic, physical, chemical or biological factors. The conventional triad of symptoms includes muscle pain, weakness and dark urine. The laboratory diagnosis is essentially based on the measurement of biomarkers of muscle injury, being creatine kinase (CK) the biochemical "gold standard" for diagnosis, and myoglobin the "gold standard" for prognostication, especially in patients with non-traumatic rhabdomyolysis. The essential clinical management in the emergency department is based on a targeted intervention to manage the underlying cause, combined with infusion of fluids and eventually sodium bicarbonate. We will present and discuss in this article the pathophysiological and clinical features of non-traumatic rhabdomyolysis, focusing specifically on Emergency Department (ED) management.
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Affiliation(s)
| | - Ivan Comelli
- Emergency Department, Academic Hospital of Parma, Parma, Italy
| | - Mario Benatti
- Emergency Department, Academic Hospital of Parma, Parma, Italy
| | - Fabian Sanchis-Gomar
- NYU Langone Medical Center, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, USA; Department of Physiology, Faculty of Medicine, University of Valencia and Fundación Investigación Hospital Clínico Universitario de Valencia, Instituto de Investigación INCLIVA, Valencia, Spain
| | - Antonella Bassi
- Laboratory of Clinical Chemistry and Hematology, University Hospital of Verona, Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Chemistry, University of Verona, Verona, Italy
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