1
|
La Rosa L, Corrias S, Pintor I, Cosentino S. Epidemiology and clinical aspect of mushroom poisonings in South Sardinia: A 10-year retrospective analysis (2011-2021). Food Sci Nutr 2024; 12:430-438. [PMID: 38268883 PMCID: PMC10804087 DOI: 10.1002/fsn3.3793] [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: 05/30/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 01/26/2024] Open
Abstract
Mushroom poisoning is a severe problem of public health, however, information about its epidemiology and management is still limited. This is the first study focused on Sardinia that investigates data about mushroom poisoning describing epidemiology, clinical presentation, seasonality, and the most common involved species. In this retrospective study, we analyzed data recovered from the database of Mycological Inspectorates during a 10-year period (2011-2021). Overall, 164 cases of mushroom poisoning have been identified, with significant peaks in autumn. The highest number of episodes of intoxication were recorded in Cagliari (64), followed by Carbonia (55) and Sanluri (45), although the annual distribution of cases among the provinces varied considerably in the study period. Thanks to the expertise of the Mycological Inspectorate service, the implicated species have been identified in 162 cases (98.78%); 81 cases were caused by toxic species, 60 by edible, and 45 by not edible species. Omphalotus olearius and Agaricus xanthodermus were the most represented toxic species (22% and 18%, respectively); Boletus aereus (18%) was the most frequent edible species, while Boletaceae were the prevalent not edible mushrooms. The data collected in South Sardinia over a period of 10-years demonstrate how a correct and rapid recognition of mushroom poisoning is important to improve the prognosis of patients, however, there are still problems of lack of knowledge, on the part of the population, on the existence of the consultancy services. Because most illnesses from poisonous mushroom ingestion are preventable, increased public awareness about the potential dangers of mushroom poisoning is mandatory.
Collapse
Affiliation(s)
- Laura La Rosa
- Department of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | - Serafina Corrias
- Department of PreventionFood Hygiene and Nutrition Service, ASL CagliariCagliariItaly
| | - Iginio Pintor
- Department of PreventionFood Hygiene and Nutrition Service, ASL CagliariCagliariItaly
| | - Sofia Cosentino
- Department of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| |
Collapse
|
2
|
Chan TYC, Ng SW, Chan CK, Lee HHC, Mak TWL. Cholinergic Mushroom Poisoning With a Detection of Muscarine Toxin in Urine. J Med Cases 2023; 14:222-226. [PMID: 37435104 PMCID: PMC10332868 DOI: 10.14740/jmc4109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023] Open
Abstract
We report an uncommon case of cholinergic poisoning following an ingestion of wild mushrooms. Two middle-aged patients presented to the emergency unit with acute gastrointestinal symptoms including epigastric pain, vomiting and diarrhea, followed by miosis, palpitations and diaphoresis which were compatible with a cholinergic toxidrome. The patients volunteered a history of taking two tablespoons of cooked wild mushrooms collected in a country park. Mildly elevated liver transaminase was noted in one female patient. Mushroom specimens were sent to a mycologist for identification using morphological analysis. Muscarine, a cholinergic toxin found in mushrooms such as Inocybe and Clitocybe species, was subsequently extracted from and identified in the urine specimens of both patients, using a liquid-chromatography tandem mass spectrometry method. In this report, the variable clinical presentation of cholinergic mushroom poisoning is discussed. Key issues in the management of these cases were presented. In addition to conventional mushroom identification methods, this report also highlights the use of toxicology tests on different biological and non-biological specimens for diagnosis, prognosis and surveillance purposes.
Collapse
Affiliation(s)
- Tina Yee Ching Chan
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Kowloon, Hong Kong Special Administrative Region, China
| | - Sau Wah Ng
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Kowloon, Hong Kong Special Administrative Region, China
| | - Chi Keung Chan
- Hong Kong Poison Information Centre, United Christian Hospital, Kowloon, Special Administrative Region, China
| | - Hencher Han Chih Lee
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Kowloon, Hong Kong Special Administrative Region, China
| | - Tony Wing Lai Mak
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Kowloon, Hong Kong Special Administrative Region, China
| |
Collapse
|
3
|
Spencer PS, Palmer VS, Kisby GE, Lagrange E, Horowitz BZ, Valdes Angues R, Reis J, Vernoux JP, Raoul C, Camu W. Early-onset, conjugal, twin-discordant, and clusters of sporadic ALS: Pathway to discovery of etiology via lifetime exposome research. Front Neurosci 2023; 17:1005096. [PMID: 36860617 PMCID: PMC9969898 DOI: 10.3389/fnins.2023.1005096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/09/2023] [Indexed: 02/17/2023] Open
Abstract
The identity and role of environmental factors in the etiology of sporadic amyotrophic lateral sclerosis (sALS) is poorly understood outside of three former high-incidence foci of Western Pacific ALS and a hotspot of sALS in the French Alps. In both instances, there is a strong association with exposure to DNA-damaging (genotoxic) chemicals years or decades prior to clinical onset of motor neuron disease. In light of this recent understanding, we discuss published geographic clusters of ALS, conjugal cases, single-affected twins, and young-onset cases in relation to their demographic, geographic and environmental associations but also whether, in theory, there was the possibility of exposure to genotoxic chemicals of natural or synthetic origin. Special opportunities to test for such exposures in sALS exist in southeast France, northwest Italy, Finland, the U.S. East North Central States, and in the U.S. Air Force and Space Force. Given the degree and timing of exposure to an environmental trigger of ALS may be related to the age at which the disease is expressed, research should focus on the lifetime exposome (from conception to clinical onset) of young sALS cases. Multidisciplinary research of this type may lead to the identification of ALS causation, mechanism, and primary prevention, as well as to early detection of impending ALS and pre-clinical treatment to slow development of this fatal neurological disease.
Collapse
Affiliation(s)
- Peter S. Spencer
- Department of Neurology, School of Medicine, Oregon Health and Science University, Portland, OR, United States,Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR, United States,*Correspondence: Peter S. Spencer,
| | - Valerie S. Palmer
- Department of Neurology, School of Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Glen E. Kisby
- College of Osteopathic Medicine of the Pacific Northwest, Western University of Health Sciences, Lebanon, OR, United States
| | - Emmeline Lagrange
- Department of Neurology, Reference Center of Neuromuscular Disease and ALS Consultations, Grenoble University Hospital, Grenoble, France
| | - B. Zane Horowitz
- Department of Emergency Medicine, Oregon-Alaska Poison Center, Oregon Health and Science University, Portland, OR, United States
| | - Raquel Valdes Angues
- Department of Neurology, School of Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Jacques Reis
- University of Strasbourg, Faculté de Médecine, Strasbourg, France
| | - Jean-Paul Vernoux
- Normandie Université, UNICAEN, Unité de Recherche Aliments Bioprocédés Toxicologie Environnements, Caen, France
| | - Cédric Raoul
- INM, University of Montpellier, INSERM, Montpellier, France
| | - William Camu
- ALS Reference Center, Montpellier University Hospital and University of Montpellier, INSERM, Montpellier, France
| |
Collapse
|
4
|
Janatolmakan M, Jalilian M, Rezaeian S, Abdi A, Khatony A. Mortality rate and liver transplant in patients with mushroom poisoning: A systematic review & meta-analysis. Heliyon 2022; 9:e12759. [PMID: 36685402 PMCID: PMC9849942 DOI: 10.1016/j.heliyon.2022.e12759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 11/09/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Background Mushroom poisoning is raised as a poor food problem that can cause the death of patients or the need for a liver transplant. Objective This study was conducted with the aim of assessment the mortality rate and liver transplantation in people suffering from mushroom poisoning through a systematic review and meta-analysis. Method The study is designed and conducted based on the PRISMA statement. International databases have been checked for articles up to March 1, 2022. The results of the study are presented with the guidance of Garrard's statement. CMA software was used in meta-analysis. Results Thirty-three articles were selected for this study. The mortality rate reported 0-40% and the results of the meta-analysis showed that the mortality rate was 2.87%. in other hand the mortality rate was 1.4% with studies that reported zero death. Overall, 16 patients had liver transplants, that only 2 died after liver transplants and 14 others survived. Conclusion The death in patients with mushroom poisoning is significant. Patients with liver disorders and patients or kidney disorders are more likely to have a poor prognosis. Liver transplant can be lifesaving. Also, quick referral of patients in the early stages reduces the need for liver transplantation.
Collapse
Affiliation(s)
- Maryam Janatolmakan
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Milad Jalilian
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran,Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran,Corresponding author. Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| |
Collapse
|
5
|
Smędra A, Wochna K, Zawadzki D, Berent J. Medical error in treatment of Amanita phalloides poisoning in pre-hospital care. Scand J Trauma Resusc Emerg Med 2022; 30:20. [PMID: 35305697 PMCID: PMC8933750 DOI: 10.1186/s13049-022-01008-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Geopolitical and climate changes form the background of the current migration crisis. It has many faces. One of them are the tragic cases of poisoning of refugees due to eating wild forest mushrooms for socioeconomic reasons in the Western and Northern European countries. The most serious food poisonings in Europe, but not only, are caused by lamellar mushrooms, the most dangerous being Amanita phalloides. Its poisonous properties can be attributed to α-amanitin, an RNA polymerase II inhibitor. Unfortunately, as it is characterized by a delayed onset of symptoms, A. phalloides poisoning has a high risk of complications. CASE PRESENTATION Our article presents a case of A. phalloides poisoning in a 28-year-old man, in which the responding medical emergency unit made errors in diagnosis and treatment. Since the correct diagnosis was made too late, the typical treatment of A. phalloides poisoning was ineffective. The patient suffered a life-threatening liver failure and needed liver transplant from a deceased donor. CONCLUSIONS Mushroom poisoning is a particularly important problem not only in countries with a mushroom picking tradition, but also-due to the inflow of refugees-in countries where mushroom poisoning was very rare until recently. In such cases it is crucial to quickly implement the correct procedure, as this can prevent the need for liver transplant or even death. This is a particularly important consideration for the first medical professionals to contact the patient, especially in cases where the patient reports mushrooms consumption and presents alarming symptoms of the gastrointestinal tract. Such situations cannot be underestimated and ignored.
Collapse
Affiliation(s)
- Anna Smędra
- Chair and Department of Forensic Medicine, Medical University of Lodz, ul. Sędziowska 18a, 91-304 Lodz, Poland
| | - Katarzyna Wochna
- Chair and Department of Forensic Medicine, Medical University of Lodz, ul. Sędziowska 18a, 91-304 Lodz, Poland
| | - Dariusz Zawadzki
- Department of Emergency Medicine for Children, II Chair of Paediatrics, Medical University of Lodz, Lodz, Poland
| | - Jarosław Berent
- Chair and Department of Forensic Medicine, Medical University of Lodz, ul. Sędziowska 18a, 91-304 Lodz, Poland
| |
Collapse
|
6
|
Chen L, Sun L, Zhang R, Liao N, Qi X, Chen J, Liu T. Epidemiological analysis of wild mushroom poisoning in Zhejiang province, China, 2016-2018. Food Sci Nutr 2022; 10:60-66. [PMID: 35035909 PMCID: PMC8751431 DOI: 10.1002/fsn3.2646] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022] Open
Abstract
Wild mushroom poisoning has been recognized as a global problem threatening human health. In this study, we aimed to explore characteristics of wild mushroom poisoning in Zhejiang province, China. From 2016 to 2018, 429 cases of wild mushroom poisoning were reported, and among them, there were 2 deaths and 84 hospitalizations, with the incidence of 0.2526 per 100,000 and the case fatality rate of 0.47%. Digestive symptoms were found in all cases. Systemic symptoms and signs, neurological symptoms, and urinary symptoms were found in 28.90% (124/429), 11.66% (50/429), and 4.90% (21/429) of the cases, respectively. The proportion of cases with incubation period <6 h was 85.78%, and those with ≥6 h accounted for 14.22%. The peak period of poisoning occurred from June to October annually. Quzhou (Moran's I = 1.242, p < .05) and Lishui (Moran's I = 0.759, p < .05) with mild climate, more mountains, and abundant rainfall were "hot spots" for the incidence of wild mushroom poisoning, showing a state of high-incidence aggregation. Epidemiological analysis showed that there were seasonal, high-incidence areas and high-risk groups in wild mushroom poisoning. The government should give early warning to high-incidence areas and strengthen publicity to high-risk groups before wild mushrooms mature every summer and autumn. In addition, we recommend that ordinary people not pick wild mushrooms outdoors for consumption, because it is difficult to distinguish whether wild mushrooms are poisonous and do not buy wild mushrooms of unknown sources.
Collapse
Affiliation(s)
- Lili Chen
- Department of Nutrition and Food SafetyZhejiang Provincial Center for Disease Control and PreventionHangzhouChina
| | - Liang Sun
- Department of Nutrition and Food SafetyZhejiang Provincial Center for Disease Control and PreventionHangzhouChina
| | - Ronghua Zhang
- Department of Nutrition and Food SafetyZhejiang Provincial Center for Disease Control and PreventionHangzhouChina
| | - Ningbo Liao
- College of Food Science and EngineeringJiangxi Agricultural UniversityNanchangChina
| | - Xiaojuan Qi
- Department of Nutrition and Food SafetyZhejiang Provincial Center for Disease Control and PreventionHangzhouChina
| | - Jiang Chen
- Department of Nutrition and Food SafetyZhejiang Provincial Center for Disease Control and PreventionHangzhouChina
| | - Ting Liu
- Institute of Remote Sensing and Earth SciencesHangzhou Normal UniversityHangzhouChina
| |
Collapse
|
7
|
Wagner S, Thornton S, Oller L, Wilson M, Hudson M. Wild mushroom exposures in Kansas, 2013–2018. TOXICOLOGY COMMUNICATIONS 2021. [DOI: 10.1080/24734306.2021.1893972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Sam Wagner
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Stephen Thornton
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Lisa Oller
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Michelle Wilson
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Michael Hudson
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
8
|
O'Neill-Dee C, Spiller HA, Casavant MJ, Kistamgari S, Chounthirath T, Smith GA. Natural psychoactive substance-related exposures reported to United States poison control centers, 2000-2017. Clin Toxicol (Phila) 2019; 58:813-820. [PMID: 31766893 DOI: 10.1080/15563650.2019.1688341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Context/Objective: To investigate the epidemiology of exposures to psychoactive substances of natural origin in the United States.Methods: Data from the National Poison Data System were retrospectively analyzed to investigate exposures to psychoactive substances of natural origin.Results: From January 1, 2000 through December 31, 2017, there were 67,369 calls to poison control centers in the United States regarding exposures to natural psychoactive substances, equaling an average of 3,743 exposures annually. Individuals >19 years of age (41.4%) and 13-19-year-olds (34.8%) accounted for most exposures with the highest annual rate reported among 13-19-year-olds at 79.4 per million population. The substances most commonly involved were marijuana (46.9%), anticholinergic plants (21.1%), and hallucinogenic mushrooms (15.6%). Kratom, khat, anticholinergic plants, and hallucinogenic mushrooms were the substances with the highest percentages of hospital admission and serious medical outcomes. The overall rate of exposure to natural psychoactive substances per million population increased significantly by 74.1% from 17.6 in 2000 to 30.7 in 2017 (p < 0.001). This increase was driven by a significant 150.0% increase in the rate of exposure to marijuana from 9.9 in 2000 to 24.7 in 2017 (p < 0.001). Despite this overall increase, most substances showed a significant decrease in exposure rate from 2000 to 2017, except for marijuana, nutmeg, and kratom. Kratom demonstrated a significant 4,948.9% increase from 2011 to 2017 and accounted for 8 of the 42 deaths identified in this study.Conclusions: While rates of exposure to most natural psychoactive substances decreased during the 18-year study period, rates for marijuana, nutmeg, and kratom increased significantly.
Collapse
Affiliation(s)
- Connor O'Neill-Dee
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Creighton University School of Medicine, Omaha, NE, USA
| | - Henry A Spiller
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Central Ohio Poison Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Marcel J Casavant
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Central Ohio Poison Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Sandhya Kistamgari
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Thitphalak Chounthirath
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Gary A Smith
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Child Injury Prevention Alliance, Columbus, OH, USA
| |
Collapse
|
9
|
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]
|
10
|
Schmutz M, Carron PN, Yersin B, Trueb L. Mushroom poisoning: a retrospective study concerning 11-years of admissions in a Swiss Emergency Department. Intern Emerg Med 2018; 13:59-67. [PMID: 27988828 DOI: 10.1007/s11739-016-1585-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 11/30/2016] [Indexed: 01/20/2023]
Abstract
Wild mushroom intoxication is an unusual cause of toxic ingestion in Europe. A great diversity of clinical symptoms may arise depending on the variety of wild mushrooms ingested. These initial symptoms are often non-specific, with frequent gastrointestinal symptoms, and have no direct correlation with the outcome. Therefore, management of mushroom poisoning and risk evaluation are a challenge for emergency clinicians. We retrospectively reviewed all cases of mushroom poisoning identified in the ED database spanning 11 years. Demographic and clinical data, time from consumption to symptoms, type of mushrooms, the number of patients presenting at the same time, treatment(s) provided, length of stay, discharge diagnosis, in-hospital mortality, and serious complications were evaluated. We identify 87 cases of mushroom poisoning. The most common symptoms are nausea and vomiting (71 cases, 82%), followed by diarrhea (68%), syncope (10%), abdominal pain (8%), and hallucinations (7%). Sixty-four patients (74%) exhibited early symptoms (appearance <6 h after ingestion) and 23 (26%) late symptoms (appearance >6 h after ingestion). Eleven patients (13%) required hospitalization over 24 h. Patients with late symptoms tended to have longer in-hospital lengths of stay. Only one patient had Amanita phalloides intoxication, with a favorable outcome. Thirty-eight patients (44%) were involved in cluster presentations. Mushroom poisoning is an unusual but potentially severe form of intoxication. Patients presenting with late-appearing symptoms (>6 h) are associated with a higher risk of A. phalloides intoxication, and therefore require specific investigation and management.
Collapse
Affiliation(s)
- Maxime Schmutz
- Emergency Department, Lausanne University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Pierre-Nicolas Carron
- Emergency Department, Lausanne University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Bertrand Yersin
- Emergency Department, Lausanne University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Lionel Trueb
- Emergency Department, Lausanne University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| |
Collapse
|
11
|
Bonacini M, Shetler K, Yu I, Osorio RC, Osorio RW. Features of Patients With Severe Hepatitis Due to Mushroom Poisoning and Factors Associated With Outcome. Clin Gastroenterol Hepatol 2017; 15:776-779. [PMID: 28189696 DOI: 10.1016/j.cgh.2016.11.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 11/18/2016] [Accepted: 11/27/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Acute liver failure after ingestion of toxic mushrooms is a significant medical problem. Most exposures to toxic mushrooms produce no symptoms or only mild gastroenteritis, but some lead to severe hepatic necrosis and fulminant hepatic failure requiring liver transplantation. We aimed to assess mortality from mushroom poisoning and identify variables associated with survival and liver transplantation. METHODS We collected information from 27 patients (13 male; median age, 47 years) admitted to the emergency department within 24 hours of ingesting wild mushrooms. They developed severe liver injury (serum levels of transaminases greater than 400 IU/L) and were treated with activated charcoal and N-acetylcysteine at a tertiary medical center in San Francisco, California from January 1997 through December 2014. Viral hepatitis, autoimmune liver disease, acetaminophen, salicylate toxicity, and chronic liver diseases were ruled out for all patients. We analyzed patient demographics, time since ingestion, presenting symptoms, laboratory values, and therapies administered. A good outcome was defined as survival without need for liver transplant. A poor outcome was defined as death or liver transplant. Positive predictive values were calculated, and the χ2 test was used to analyze dichotomous variables. RESULTS Liver injury was attributed to ingestion of Amanita phalloides in 24 patients and Amanita ocreata in 3 patients. Twenty-four of the patients ingested mushrooms with meals and 3 patients for hallucinogenic purpose. At 24-48 hours after ingestion, all patients had serum levels of alanine aminotransferase ranging from 554 to 4546 IU/L (median, 2185 IU/L). Acute renal impairment developed in 5 patients. Twenty-three patients survived without liver transplantation, and 4 patients had poor outcomes (1 woman underwent liver transplantation on day 20 after mushroom ingestion, and 3 women died of hepatic failure). Of the 23 patients with peak levels of total bilirubin of 2 mg/dL or more during hospitalization, only 4 had a poor outcome. Peak serum level of aspartate aminotransferase less than 4000 IU/L, peak international normalized ratio less than 2, and a value of serum factor V greater than 30% identified patients with good outcomes with 100% positive predictive value; if these peak values were used as a cutoff, 10 of 27 patients (37%), 7 of 27 patients (26%), and 6 of 12 patients (50%), respectively, could have avoided transfer to a transplant center. CONCLUSIONS In an analysis of 27 patients with hepatocellular damage due to mushroom (Amanita) poisoning and peak levels of total bilirubin greater than 2 mg/dL, the probability of liver transplantation or death is 17%, fulfilling Hy's law. Patients with peak levels of aspartate aminotransferase less than 4000 IU/L can be monitored in a local hospital, whereas patients with higher levels should be transferred to liver transplant centers. Women and older patients were more likely to have a poor outcome than men and younger patients.
Collapse
Affiliation(s)
- Maurizio Bonacini
- Department of Gastroenterology and Hepatology, California Pacific Medical Center, San Francisco, California.
| | | | - Ira Yu
- National Kidney and Transplant Institute, Manila, Philippines
| | | | - Robert W Osorio
- Department of Transplantation, California Pacific Medical Center, San Francisco, California
| |
Collapse
|
12
|
Erenler AK, Doğan T, Koçak C, Ece Y. Investigation of Toxic Effects of Mushroom Poisoning on the Cardiovascular System. Basic Clin Pharmacol Toxicol 2016; 119:317-21. [PMID: 26879235 DOI: 10.1111/bcpt.12569] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 02/08/2016] [Indexed: 12/14/2022]
Abstract
Mushroom poisoning (MP) is a public health problem in many countries. It is well known that consumption of wild mushrooms may cause serious toxicity on renal, hepatic and brain functions. In the literature, however, studies investigating cardiotoxic effects of MP are rare. In this study, we evaluated laboratory and ECG findings of patients and sought for possible toxic effects of MP on the cardiovascular system. During a 2-year period, 175 patients with MP were included in the study. The majority of the poisonings occurred in early summertime. The most common complaint was found to be nausea and vomiting followed by mental status alterations. Methods of treatment were mainly based on gastric lavage, activated charcoal and supportive therapy. The most common ECG abnormalities in the patients with MP were sinus tachycardia, sinus arrhythmia, ST/T inversion, 1st degree AV block and QT prolongation, respectively. Cardiac markers of the patients were found to be normal. Then, patients were divided into two subgroups according to symptom onset after consumption (less than 6 hr and more than 6 hr). When the two groups were compared, prevalence of tachycardia was significantly higher in Group II. Additionally, the interval between mushroom consumption and onset of symptoms was strongly correlated with blood pressure (BP). As this interval prolonged, BP of the patients tended to increase. In conclusion, according to our results, although mechanisms need to be clarified, MP causes hypertension and ECG alterations, particularly tachycardia in patients with late-onset symptoms.
Collapse
Affiliation(s)
- Ali Kemal Erenler
- Department of Emergency Medicine, Çorum Education and Research Hospital, Hitit University, Çorum, Turkey
| | - Tolga Doğan
- Department of Cardiology, Çorum Education and Research Hospital, Hitit University, Çorum, Turkey
| | - Cem Koçak
- Department of Statistics, Çorum Education and Research Hospital, Hitit University, Çorum, Turkey
| | - Yasemin Ece
- Department of Emergency Medicine, Çorum Education and Research Hospital, Hitit University, Çorum, Turkey
| |
Collapse
|
13
|
Abstract
Background: The American Association of Poison Control Center (AAPCC) shows that in 2012 there were 0.3% of human exposures involving mushrooms. Only 17% of 6600 cases were then identified by the species. The present retrospective study was designed to identify the epidemiology of mushroom poisoning in adults admitted to Krakow’s Department of Clinical Toxicology (DCT) from 2002 to 2009. Materials and Methods: This study was conducted retrospectively after examining the files of 457 adult patients with wild mushroom poisoning. Mycological analysis was made and the species of the poisoning-inducing mushroom was determined. Furthermore, the circumstances related to the mushroom gathering, transport, storage, preparation, and consumption have been analyzed. Results: The analysis revealed that in 400 (87.53%) out of 457 cases, the clinical symptoms were caused by ingestion of identified edible mushroom species. The main reason for edible mushroom poisoning is associated with their incorrect processing after harvest. The analysis of the circumstances of mushroom collection, transport, and storage shows that the largest percentage of poisoning was connected with long-term storage of mushroom dishes, collecting, and storing them in plastic bags, and long storage of mushrooms. Conclusion: Based on spore analysis of the gastric content, edible mushrooms were responsible for the great majority of mushroom poisoning cases admitted to the DCT. The toxicity of edible mushroom is associated with proceeding with them during collection, transport, and storage. The medical history should be supplemented by questions concerning these circumstances. The identification of the mushroom by a mycologist is highly desirable.
Collapse
Affiliation(s)
- T Gawlikowski
- Department of Clinical Toxicology, Jagiellonian University Medical College, Krakow, Poland
| | - M Romek
- Department of Cytology and Histology, Institute of Zoology Jagiellonian University, Krakow, Poland
| | - L Satora
- Department of Physiology and Reproduction of Animals, University of Rzeszow, Rzeszow, Poland
| |
Collapse
|