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Yao Y, Zhang YZ, Liang JQ, Liu F, Li ZF, Li HJ, Xu F. Mushroom poisoning of Panaeolus subbalteatus from Ningxia, northwest China, with species identification and tryptamine detection. Toxicon 2024; 247:107849. [PMID: 38971474 DOI: 10.1016/j.toxicon.2024.107849] [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: 05/13/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
Mushroom poisoning is a significant contributor to foodborne disease outbreaks in China. This study focuses on two Panaeolus subbalteatus poisoning incidents accompanied by epidemiological investigations, species identification, and toxin detection in Ningxia, northwest China. In these two poisoning incidents, some patients exhibited gastrointestinal or neurological symptoms approximately 0.5 h after ingestion of a large amount of wild mushroom. Specifically, in Case 1, one of the three patients experienced nausea, vomiting, and numbness in the throat and limbs; in Case 2, one patient reported dizziness and an abnormal sense of direction. Through morphological and phylogenetic analyses, mushroom specimens were identified as P. subbalteatus. Psilocybin and psilocin were detected in mushroom samples, and only psilocin was detected in biological samples by liquid chromatography-triple quadrupole-linear ion trap mass spectrometry screening. The average psilocybin and psilocin contents in mushroom samples were 1532.2-1760.7 and 114.5-136.0 mg/kg (n = 3), respectively. Moreover, only psilocin was detected in blood and urine samples, with average concentrations 0.5-1.2 ng/mL (n = 3) and 2.5-3.1 ng/mL (n = 3), respectively. These findings provide technical support for managing similar incidents in the future.
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Affiliation(s)
- Yi Yao
- School of Public Health, Ningxia Key Laboratory of Environmental Factors and Chronic Diseases Control, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yi-Zhe Zhang
- National Institute of Occupational Health and Poison Control, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Jia-Qi Liang
- National Institute of Occupational Health and Poison Control, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Feng Liu
- Physical and Chemical Department, Ningxia Hui Autonomous Region Center for Disease Control and Prevention, Yinchuan, Ningxia, China
| | - Zhong-Feng Li
- National Institute of Occupational Health and Poison Control, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Hai-Jiao Li
- National Institute of Occupational Health and Poison Control, Chinese Centre for Disease Control and Prevention, Beijing, China.
| | - Fei Xu
- School of Public Health, Ningxia Key Laboratory of Environmental Factors and Chronic Diseases Control, Ningxia Medical University, Yinchuan, Ningxia, China; Physical and Chemical Department, Ningxia Hui Autonomous Region Center for Disease Control and Prevention, Yinchuan, Ningxia, China.
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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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Ur Rahman H, Yasir Shah S, Ali MA, Riazullah, Khan AB. Acute Liver Injury From Mushroom Ingestion: A Timely Intervention in Mushroom Poisoning. Cureus 2023; 15:e45818. [PMID: 38698879 PMCID: PMC11065392 DOI: 10.7759/cureus.45818] [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: 09/22/2023] [Indexed: 05/05/2024] Open
Abstract
Mushroom poisoning, known as mycetism, represents a pressing health concern worldwide. Although the majority of mushroom ingestions are benign, select species like "Amanita phalloides" can induce catastrophic liver damage, culminating in acute liver failure. In this report, we detail a case involving a 35-year-old female who presented to the emergency department exhibiting symptoms of nausea, vomiting, abdominal pain, and palpitations merely six hours post-ingestion of "Amanita phalloides." Accurate identification of the specific mushroom species consumed proves challenging in over 90% of poisoning incidents, underscoring the necessity for clinical vigilance. While many mushroom exposures lead to mild gastrointestinal symptoms, recognizing the potential for severe outcomes is paramount for timely and effective intervention.
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Affiliation(s)
| | | | | | - Riazullah
- Internal Medicine, Naseer Teaching Hospital, Peshawar, PAK
| | - Abu Baker Khan
- Internal Medicine, Ayub Teaching Hospital, Abbottabad, PAK
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Janatolmakan M, Ganji MR, Ahmadi-Jouybari T, Rezaeian S, Ghowsi M, Khatony A. Demographic, clinical, and laboratory findings of mushroom-poisoned patients in Kermanshah province, west of Iran. BMC Pharmacol Toxicol 2022; 23:72. [PMID: 36163273 PMCID: PMC9513882 DOI: 10.1186/s40360-022-00614-1] [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: 01/04/2022] [Revised: 03/13/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022] Open
Abstract
Background Mushroom poisoning can cause gastrointestinal, renal, and hepatic symptoms and even death. This descriptive study examined the demographic, clinical, and laboratory findings of patients with fungal poisoning, a type of fungus causing the poisoning, and the incidence and mortality rates of fungal poisoning in Kermanshah province, western Iran, from 2014 to 2018. Methods The medical records of 193 patients with mushroom poisoning from 2014 to 2018 were evaluated. The liver and kidney function tests, electrolytes, abdominal and pelvic ultrasound, chest x-ray, coagulation tests, and coagulation factors (fibrinogen, prothrombin) were assessed. Data were collected from the medical records of patients admitted to the Poisoning Center of Imam Khomeini Hospital in Kermanshah, Iran using a researcher-made checklist. Data were analyzed by SPSS (version 16) using descriptive statistics, including mean, standard deviation, and frequency distribution tables. Trend analysis for proportion was done by chi-square statistics in STATA-14 software (ptrend command). Results Of cases, 51.3% were male, 92.6% were city dwellers, 38.3% were aged 21–40 years, and 92.5% were poisoned during the spring. The fungus that caused poisoning was Amanita virosa. The gastrointestinal, nervous, and visual systems were the most common systems involved. The most common gastrointestinal symptoms included nausea and vomiting (72.0%) and abdominal pain (71.0%). Vertigo (11.9%) and headache (9.3%) were the most common neurological symptoms. The most common visual manifestation was blurred vision (7.8%). Of cases, 23.7% had metabolic acidosis. The increased alkaline phosphatase level was the most common liver disorder in 98.7% of the cases. Increased blood urea nitrogen and creatinine levels were also reported in 21.0% and 17.7% of the cases, respectively. The serum lactic dehydrogenase and creatine phosphokinase levels also increased in 99.3% and 30.2% of the patients, respectively. The mortality rate was 1.6% (n = 3). Conclusion The fungal poisoning diagnosis should always be considered in young patients referred to the emergency department with gastrointestinal complaints, a history of consuming wild self-picked mushrooms, and high liver and kidney test values. Since most fungal poisonings occur in the spring, it is necessary to inform the community of the dangers of consuming self-picked wild mushrooms, especially in this season.
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Affiliation(s)
- Maryam Janatolmakan
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Rouhi Ganji
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Touraj Ahmadi-Jouybari
- Clinical Research Development Center of Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahnaz Ghowsi
- Social Development and Health Promotion Research Center, Health Institute, 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.
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Le Daré B, Pelletier R, Couette A, Morel I, Gicquel T. Magic truffle intoxication: A case report. EMERGENCY CARE JOURNAL 2022. [DOI: 10.4081/ecj.2022.10347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Unusual forms of hallucinogenic mushrooms are emerging, which may delay diagnosis and compromise optimal management. Here, we discuss clinical and biological findings in a case of “magic mushroom” intoxication in a 20-year-old man who was brought to hospital emergency department in a state of euphoria, disorientation, intense visual hallucinations, episodic amnesia and agitation requiring physical restraint. The patient’s family brought intact specimens of the consumed product, without any health professional being able to identify it. Toxicological screening detected psilocin in urine and in the unknown mushrooms, allowing guiding the mushroom identification towards the Psilocybes genus. Ten hours post-ingestion, the patient was discharged asymptomatic. We believe that recognition of the unusual form of hallucinogenic mushroom presented here by emergency physicians might contribute to better diagnosis and subsequent optimal management, especially since hallucinogenic substances are not routinely tested in toxicological analyses.
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Kotts WJ, Gamble DT, Dawson DK, Connor D. Psilocybin-induced takotsubo cardiomyopathy. BMJ Case Rep 2022; 15:e245863. [PMID: 35580942 PMCID: PMC9115013 DOI: 10.1136/bcr-2021-245863] [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] [Accepted: 01/15/2022] [Indexed: 11/03/2022] Open
Abstract
We present a case of takotsubo cardiomyopathy following recreational ingestion of Psilocybe semilanceata (known as 'magic mushrooms'). The patient presented with respiratory distress and pulmonary oedema responding to standard medical measures. Investigations included: echocardiogram, cardiac MRI and angiogram. Based on our search, we suggest this is only the second recognised case in the published literature.
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Affiliation(s)
- Wiktoria Julia Kotts
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - David T Gamble
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Dana K Dawson
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - David Connor
- Emergency Department, Aberdeen Royal Infirmary, Aberdeen, UK
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Hackl B, Todt H, Kubista H, Hilber K, Koenig X. Psilocybin Therapy of Psychiatric Disorders Is Not Hampered by hERG Potassium Channel-Mediated Cardiotoxicity. Int J Neuropsychopharmacol 2021; 25:280-282. [PMID: 34871422 PMCID: PMC9017764 DOI: 10.1093/ijnp/pyab085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/24/2021] [Accepted: 12/13/2021] [Indexed: 11/12/2022] Open
Abstract
Psilocybin, a hallucinogen contained in "magic" mushrooms, holds great promise for the treatment of various psychiatric disorders, and early clinical trials are encouraging. Adverse cardiac events after intake of high doses of psilocybin and a trial reporting QT interval prolongation in the electrocardiogram attributed to the drug's main metabolite, psilocin, gave rise to safety concerns. Here we show that clinical concentrations of psilocin do not cause significant human ether-a-go-go-related gene (hERG) potassium channel inhibition, a major risk factor for adverse cardiac events. We conclude that hERG channel blockage by psilocin is not liable for psilocybin- associated cardiotoxic effects.
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Affiliation(s)
- Benjamin Hackl
- Department of Neurophysiology and -Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Hannes Todt
- Department of Neurophysiology and -Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Helmut Kubista
- Department of Neurophysiology and -Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Karlheinz Hilber
- Department of Neurophysiology and -Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria,Correspondence: Karlheinz Hilber, PhD, Department of Neurophysiology and -Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Schwarzspanierstraße 17, 1090 Vienna, Austria ()
| | - Xaver Koenig
- Department of Neurophysiology and -Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
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