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Sezer F, Elmazoğlu Z, Esendağlı G, İlhan SÖ, Karasu Ç. Protection against α-Amanitin-induced liver toxicity: Efficacy of pomegranate seed oil and black cumin oil. Toxicon 2024; 247:107854. [PMID: 38977085 DOI: 10.1016/j.toxicon.2024.107854] [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: 04/15/2024] [Revised: 07/05/2024] [Accepted: 07/05/2024] [Indexed: 07/10/2024]
Abstract
The consumption of mushrooms containing α-Amanitin (α-A) can lead to severe liver damage. In this study, toxicological experiments were conducted to confirm the protective effects of pomegranate seed oil (PSO) and black cumin oil (BCO) against α-A-induced hepatotoxicity. Rats exposed once to α-A (3 mg/kg bw, i.p.) or saline alone (0.1 ml, i.p.) were either left untreated or treated with PSO or BCO at a dose of 2 ml/kg bw/day by oral gavage on the same day, and the treatment was continued for 7 days. Serum aminotransferases (ALT and AST), alkaline phosphatase (ALP) and total protein levels were measured and the active caspase 3 (cl-caspase 3) was evaluated by western blotting in the liver. Serum ALT, AST and ALP levels tended to decrease in the α-A exposed group, but no statistically significant difference was found compared to the saline group (p > 0.05). PSO and BCO did not affect serum liver function tests in rats exposed to saline or α-A. α-A toxicity was demonstrated by a significant decrease in serum total protein level (p < 0.05), a significant increase in liver cl-caspase 3 expression (p < 0.05), and structural liver damage mainly characterized by mononuclear inflammation and steatosis. When α-A exposed rats were treated with BCO, the increase in cl-caspase 3 was not inhibited, on the contrary BCO increased cl-caspase 3 in healthy rats (p < 0.05). PSO significantly ameliorated α-A-induced cl-caspase 3 increase and inflammatory histopathology in the liver. Both PSO and BCO completely prevented α-A-induced protein degradation. The findings indicate that PSO and BCO may protect liver functions against α-A-induced hepatotoxicity, encouraging future comprehensive studies to test them at different doses and frequency.
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Affiliation(s)
- Fatih Sezer
- Department of Medical Pharmacology, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | | | - Güldal Esendağlı
- Department of Pathology, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Sevil Özger İlhan
- Department of Medical Pharmacology, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Çimen Karasu
- Department of Medical Pharmacology, Faculty of Medicine, Gazi University, Ankara, Turkey.
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2
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Su H, Jiang ZH, Hsu YW, Wang YC, Chen YY, Wu DC, Shiea J, Lee CW. Rapid identification of mushroom toxins by direct electrospray probe mass spectrometry for emergency care. Anal Chim Acta 2024; 1296:342343. [PMID: 38401934 DOI: 10.1016/j.aca.2024.342343] [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: 10/05/2023] [Revised: 12/22/2023] [Accepted: 02/04/2024] [Indexed: 02/26/2024]
Abstract
Mushroom poisoning occurs frequently after the ingestion of toxic wild mushrooms misidentified as edible species. The goal of this study is to develop a mass spectrometric platform to bypass the need for morphological recognition of poisonous mushrooms by experts and rapidly identify the toxins in the mushrooms for emergency care. Trace mushroom toxins were collected by penetrating and removing the mushrooms surface for 3 mm with a direct electrospray probe (DEP). The analytes on the DEP were then dissolved in the solution (70% isopropanol containing 0.1% acetic acid) flowing out of a solvent reservoir on the DEP. Electrospray ionization was induced from the sample solution as a high electric field was generated between the DEP and MS inlet. The obtaining mass spectrometric results were further analyzed with principal component analysis (PCA) to classify mushroom toxins. The mass spectrometric platform for detecting mushroom toxins was assessed for its sensitivity, precision, and efficiency by determining its limit-of-detection (LOD), repeatability, and turnaround time, respectively. As a result, the LODs of the mushroom toxins in pure methanol and spiked in human vomitus by DEP/MS were within 0.001-0.5 ng/μL and 0.01-1 ng/μL, respectively. Linear responses of the mushroom toxins in pure methanol with concentrations between 0.01 and 5 ng/μL (R2 between 0.9922 and 0.998) were obtained. The repeatability of the approach (n = 10) was shown in the low relative standard deviation value (<15%) from ten repeat analysis of mushroom toxins standard solution. The corresponding toxic compounds were identified through matching of the obtained mass spectrometric data with those provided by its companion database library of mushroom toxins. Since no time-consuming pretreatment of the samples is required, identification of mushroom toxins with DEP/MS was complete within 1 min. This will be helpful for the emergency physicians to make correct clinical judgment and prescribe appropriate medical treatment in a timely manner.
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Affiliation(s)
- Hung Su
- Department of Chemistry, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Zong-Han Jiang
- Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Yi-Wen Hsu
- Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Yu-Chi Wang
- Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Yun-Yi Chen
- Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jentaie Shiea
- Department of Chemistry, National Sun Yat-Sen University, Kaohsiung, Taiwan; Rapid Screening Research Center for Toxicology and Biomedicine, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Medicinal and Applied Chemistry, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Chi-Wei Lee
- Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan; Rapid Screening Research Center for Toxicology and Biomedicine, National Sun Yat-Sen University, Kaohsiung, Taiwan.
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Coskun NC, Buyucek S. The effects of CDP-choline treatment in Amanita phalloides mushroom toxicosis. Toxicon 2024; 241:107688. [PMID: 38484849 DOI: 10.1016/j.toxicon.2024.107688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 03/18/2024]
Abstract
Amanita phalloides poisoning is known to be the most fatal case among mushroom poisoning cases. Its main mechanism of toxicity is that it leads to cell death by the irreversible binding of its toxins to the DNA-dependent RNA polymerase II enzyme. This study was planned to analyze the effects of the CDP-choline molecule on Amanita phalloides mushroom poisoning cases. The extract of the Amanita phalloides mushroom was taken and intraperitoneally administered to male Wistar Albino rats at a dose of 0.3 g/kg. In the experiment phase, the rats were divided into three groups of CDP-choline treatment according to the doses of 100 mg/kg, 250 mg/kg, and 500 mg/kg, and one control group was administered a 1 ml/kg dose of 0.9% isotonic NaCl solution. The treatments were then administered intraperitoneally at the 2nd hour, and at the 6th hour, the rats were sacrificed. The degree of damage in the liver and kidney tissues of the rats was evaluated histopathologically. It was concluded that CDP-choline reduced or prevented the damage that occurred in the liver significantly and dose-dependently in the toxicosis picture caused by Amanita phalloides, and it showed a tendency to lower or prevent the damage in the kidney, albeit not significantly.
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Affiliation(s)
- Nuri Cenk Coskun
- Duzce University, Medical School Pharmacology Department, 81620, Duzce, Turkey.
| | - Seyma Buyucek
- Department of Pathology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
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Anbardar MH, Soleimani N, Kazemi K, Jafarpour Z, Hasani M, Mohammadzadeh S, Torfehnezhad P, Jafarian S, Farhadi M, Sardari MS. Severe Hepatotoxicity in Mushroom Poisoning by Lepiota brunneoincarnata from Complete Recovery to Liver Transplantation: A Case Series with Review on Liver Function Tests and Liver Histopathology. Int J Hepatol 2024; 2024:2797712. [PMID: 38288080 PMCID: PMC10824578 DOI: 10.1155/2024/2797712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/28/2023] [Accepted: 01/12/2024] [Indexed: 01/31/2024] Open
Abstract
Background In spite of the scientific evidence supporting health advantages of mushrooms, some of them are seriously poisonous. The clinical picture of mushroom intoxication ranges from minor gastrointestinal symptoms to organ failure, such as liver failure and death. Method We provided demographics, clinicopathological characteristics, applied treatments, and outcomes of mushroom poisoning by Lepiota species in a series of 18 cases that were referred from Kermanshah and Lorestan provinces to Abu-Ali-Sina Hospital, Shiraz, Iran. Clinical and paraclinical data were collected by taking history and reviewing of medical documents. Pathologic findings were extracted through a review of hematoxylin and eosin pathologic slides. Results The patients were between the ages of 18 and 67 years, composed of ten females and eight males. The most frequent clinical manifestations were nausea and vomiting followed by abdominal pain. Four cases presented decreased consciousness on admission. One of them passed away. Three other cases underwent liver transplantation, two of them died after transplantation, and one fully recovered without any major issues. All instances had elevated ALT levels, which ranged from 44 to 9,140 IU/L (mean: 3259 ± 2476), with most of them also having concurrent AST elevations (mean: 1,361 ± 1,532). Only few patients had modest elevations in alkaline phosphatase. Total and direct bilirubin elevations up to 47.6 and 24 mg/dL, respectively, were found in most cases. Decreased total protein and albumin concentrations and increased BUN and creatinine levels were observed in some patients. In addition, some instances revealed increased LDH, increased WBC, decreased hemoglobin, and decreased platelet count. Most patients had increased prothrombin time; hematuria and positive stool occult blood were observed in few patients. Histopathologic examination of three explanted livers revealed massive necrosis with moderate to severe macrovesicular steatosis, significant ductular reaction, and parenchymal inflammation. Other patients followed a recovery process with a considerable drop in liver enzymes, especially ALT, during hospitalization utilizing conservative treatment. They had no liver problems or relevant issues after a two-year follow-up. Conclusion In our study, highly elevated liver enzymes with a significantly high ALT/AST ratio were observed in cases of mushroom poisoning by Lepiota species, leading to fulminant liver failure and death in some cases. These laboratory findings were correlated with liver necrosis and macrovesicular steatosis in explanted livers.
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Affiliation(s)
- Mohammad Hossein Anbardar
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pathology, Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Neda Soleimani
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pathology, Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kourosh Kazemi
- Department of Surgery, Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Jafarpour
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Hasani
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahand Mohammadzadeh
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pathology, Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parnia Torfehnezhad
- Department of Pathology, Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedighe Jafarian
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Farhadi
- Department of Pathology, Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mina Salari Sardari
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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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.
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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
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Meng H, Chen Z, Chen L, Tang W, He F, Yan X, Lin X, Se X, Xie M, Li Z, Lu L, Yu X. An outbreak of Amanita exitialis poisoning. Clin Toxicol (Phila) 2023; 61:270-275. [PMID: 36919497 DOI: 10.1080/15563650.2022.2159830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND The mushroom Amanita exitialis is reported to cause acute liver injury. It is found in Southern China, and has been previously associated with a high incidence of mortality. METHODS We described a series of 10 patients with Amanita exitialis poisoning admitted to The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) in April 2022. Patient demographics, clinical features, laboratory results, therapeutic interventions, and outcome data were collected. RESULTS Among the 10 patients, 9 survived, while 1 died. Gastrointestinal symptoms were the first to appear (average latency period, 11 ± 4.2 h). Diarrhea was the most common clinical symptom (average duration, 4.4 days). Abdominal distention was an important sign, especially in severely-ill patients. Thrombocytopenia occurred on day 2 after mushroom ingestion and persisted for 3-4 days. Alanine aminotransferase and total bilirubin peaked on days 2-3. CONCLUSION Amanita exitialis poisoning is characterized by gastrointestinal symptoms and liver injury. In the patient who died, acute hepatic failure led to hepatic encephalopathy and cerebral edema. Abdominal distension accompanied by thrombocytopenia was common in critically ill patients in this outbreak.
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Affiliation(s)
- Hui Meng
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - ZhaoYin Chen
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - LanChun Chen
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - WeiXin Tang
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - Fang He
- Department of Health Management, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - XianRang Yan
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - XiaoHong Lin
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - XiaoLong Se
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - MingFei Xie
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - ZhanHan Li
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - LiJuan Lu
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - Xuetao Yu
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
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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.
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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.
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8
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Tan JL, Stam J, van den Berg AP, van Rheenen PF, Dekkers BGJ, Touw DJ. Amanitin intoxication: effects of therapies on clinical outcomes - a review of 40 years of reported cases. Clin Toxicol (Phila) 2022; 60:1251-1265. [PMID: 36129244 DOI: 10.1080/15563650.2022.2098139] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIMS Amanita phalloides poisoning causes severe liver damage which may be potentially fatal. Several treatments are available, but their effectiveness has not been systematically evaluated. We performed a systematic review to investigate the effect of the most commonly used therapies: N-acetylcysteine (NAC), benzylpenicillin (PEN), and silibinin (SIL) on patient outcomes. In addition, other factors contributing to patient outcomes are identified. METHODS We searched MEDLINE and Embase for case series and case reports that described patient outcomes after poisoning with amanitin-containing Amanita mushrooms. We extracted clinical characteristics, treatment details, and outcomes. We used the liver item from the Poisoning Severity Score (PSS) to categorize intoxication severity. RESULTS We included 131 publications describing a total of 877 unique cases. The overall survival rate of all patients was 84%. Patients receiving only supportive care had a survival rate of 59%. The use of SIL or PEN was associated with a 90% (OR 6.40 [3.14-13.04]) and 89% (OR 5.24 [2.87-9.56]) survival rate, respectively. NAC/SIL combination therapy was associated with 85% survival rate (OR 3.85 [2.04, 7.25]). NAC/PEN/SIL treatment group had a survival rate of 76% (OR 2.11 [1.25, 3.57]). Due to the limited number of cases, the use of NAC alone could not be evaluated. Additional analyses in 'proven cases' (amanitin detected), 'probable cases' (mushroom identified by mycologist), and 'possible cases' (neither amanitin detected nor mushroom identified) showed comparable results, but the results did not reach statistical significance. Transplantation-free survivors had significantly lower peak values of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total serum bilirubin (TSB), and international normalized ratio (INR) compared to liver transplantation survivors and patients with fatal outcomes. Higher peak PSS was associated with increased mortality. CONCLUSION Based on data available, no statistical differences could be observed for the effects of NAC, PEN or SIL in proven poisonings with amanitin-containing mushrooms. However, monotherapy with SIL or PEN and combination therapy with NAC/SIL appear to be associated with higher survival rates compared to supportive care alone. AST, ALT, TSB, and INR values are possible predictors of potentially fatal outcomes.
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Affiliation(s)
- Jia Lin Tan
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Janine Stam
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Analytical Biochemistry, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Aad P van den Berg
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Patrick F van Rheenen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bart G J Dekkers
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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9
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Characterization of the RAS/RAF/ERK Signal Cascade as a Novel Regulating Factor in Alpha-Amanitin-Induced Cytotoxicity in Huh-7 Cells. Int J Mol Sci 2022; 23:ijms232012294. [PMID: 36293151 PMCID: PMC9603094 DOI: 10.3390/ijms232012294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/05/2022] [Accepted: 10/10/2022] [Indexed: 12/24/2022] Open
Abstract
The well-known hepatotoxicity mechanism resulting from alpha-amanitin (α-AMA) exposure arises from RNA polymerase II (RNAP II) inhibition. RNAP Ⅱ inhibition occurs through the dysregulation of mRNA synthesis. However, the signaling pathways in hepatocytes that arise from α-AMA have not yet been fully elucidated. Here, we identified that the RAS/RAF/ERK signaling pathway was activated through quantitative phosphoproteomic and molecular biological analyses in Huh-7 cells. Bioinformatics analysis showed that α-AMA exposure increased protein phosphorylation in a time-dependent α-AMA exposure. In addition, phosphorylation increased not only the components of the ERK signaling pathway but also U2AF65 and SPF45, known splicing factors. Therefore, we propose a novel mechanism of α-AMA as follows. The RAS/RAF/ERK signaling pathway involved in aberrant splicing events is activated by α-AMA exposure followed by aberrant splicing events leading to cell death in Huh-7 cells.
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10
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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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Grama A, Aldea C, Burac L, Delean D, Boghitoiu D, Bulata B, Nitescu V, Ulmeanu C, Pop TL. Acute liver failure secondary to toxic exposure in children. Arch Med Sci 2022; 18:84-91. [PMID: 35154529 PMCID: PMC8826985 DOI: 10.5114/aoms.2019.87716] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 04/03/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Acute liver failure (ALF) is a syndrome defined by jaundice, coagulopathy (INR > 1.5) and hepatic encephalopathy in patients with no evidence of prior liver disease. Toxins and drugs are a frequent cause of ALF in children. MATERIAL AND METHODS The aim of our study was to establish the causes of toxic ALF in children followed up in our hospital in the period of January 2000 to August 2018. We retrospectively studied all hospital records of patients who developed ALF after mushroom/drug exposure and had been admitted to our hospital, the main pediatric toxicology center in north-western Romania. RESULTS In the last 18 years, 123 patients were admitted to our clinic with toxic ALF (89 patients secondary to mushroom ingestion and 34 patients after drug exposure). In the 2000-2012 period accidental mushroom poisoning was the leading cause of toxic ALF. Unfortunately, during the last years, voluntary drug ingestions have increased dramatically. The most commonly incriminated drug was acetaminophen (52.94%). CONCLUSIONS ALF in mushroom poisoning is associated with a high mortality in children, despite optimal medical therapy. This etiology was one of the most important causes of death in our cohort. The difficulty in accessing emergency liver transplantation is an obstacle common to many Eastern European pediatric centers. Fortunately, in the last 5 years the incidence of mushroom intoxications has decreased in our area. It is worrying that over the last few years there has been an increased incidence of toxic ALF after drug exposure (for suicidal purposes or due to lenient regulations for prescribing hepatotoxic medications).
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Affiliation(s)
- Alina Grama
- 2 Paediatric Clinic, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Cornel Aldea
- Nephrology Clinic, Emergency Clinic Hospital for Children, Cluj-Napoca, Romania
| | - Lucia Burac
- 2 Paediatric Clinic, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Dan Delean
- Nephrology Clinic, Emergency Clinic Hospital for Children, Cluj-Napoca, Romania
| | - Dora Boghitoiu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Bogdan Bulata
- Nephrology Clinic, Emergency Clinic Hospital for Children, Cluj-Napoca, Romania
| | - Violeta Nitescu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Coriolan Ulmeanu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Tudor Lucian Pop
- 2 Paediatric Clinic, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
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Piarroux R, Gabriel F, Grenouillet F, Collombon P, Louasse P, Piarroux M, Normand AC. Using MALDI-ToF mass spectrometry to identify mushroom species: Proof of concept analysis of Amanita genus specimens. Med Mycol 2021; 59:890-900. [PMID: 33891700 DOI: 10.1093/mmy/myab018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/18/2021] [Accepted: 03/09/2021] [Indexed: 11/15/2022] Open
Abstract
Food poisoning caused by toxic mushrooms, such as species in the Amanita genus, occurs frequently around the world. To properly treat these patients, it is important to rapidly and accurately identify the causal species. Matrix-assisted laser desorption/ionization time-of-flight (MALDI-ToF) mass spectrometry is a rapid technique that has been used in medical laboratories for the past three decades to identify bacteria, yeasts, and filamentous fungi.Matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-Tof MS) is a rapid method used for the past three decades to identify microorganisms. In this study, we created and internally validated a MALDI-Tof MS reference database comprising 15 Amanita species frequently encountered in France, and we challenged this database with 38 Amanita specimens from four French locations, using a free online application for MALDI-ToF spectra identifications.Assessment of the database showed that mass spectra can be obtained by analyzing any portion of a carpophore and that all portions enabled identification of the carpophore at the species level. Most carpophores were correctly identified using our database, with the exception of specimens from the Vaginatae section. Decay tests also demonstrated that decayed portions (like those found in the kitchen garbage can) of Amanita phalloides mushrooms could be properly identified using MALDI-ToF MS.Our findings provide important insight for toxicology laboratories that often rely on DNA sequencing to identify meal leftovers implicated in food poisoning. In future developments, this technique could also be used to detect counterfeit mushrooms by including other genera in the reference database. LAY SUMMARY MALDI-ToF MS is a powerful identification tool for microorganisms. We demonstrate that the technique can be applied to Amanita specimens. This will prevent food intoxications as a rapid and definite identification can be obtained, and it can also be used for food remnants.
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Affiliation(s)
| | - Frédéric Gabriel
- Centre Hospitalier Universitaire de Bordeaux, Service de Parasitologie Mycologie, F-33000, Bordeaux, France
| | - Frédéric Grenouillet
- Department of Parasitology and Mycology, University Hospital of Besançon, F-25000, Besançon, France
| | - Patrick Collombon
- Société de Mycologie de Provence, Laboratoire de Botanique - Faculté des Sciences Saint-Charles, F-13331, Marseille, France
| | | | - Martine Piarroux
- Ministère des armées, Centre d'épidémiologie et de santé publique des armées (CESPA), F-13014, Marseille, Paris, France
| | - Anne-Cécile Normand
- AP-HP, Groupe Hospitalier La Pitié-Salpêtrière, Service de Parasitologie Mycologie, F-75013, Paris, France
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ÇALIŞKAN G, ÇİZMECİ EA, ÜNLÜ N, KELEBEK GİRGİN N, ISCİMEN R, KAHVECİ FŞ. From activated charcoal to selective plasma exchange: A retrospective analysis of mushroom poisoning cases treated in the intensive care unit. TURKISH JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.46310/tjim.832864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Assessment of α-amanitin toxicity and effects of silibinin and penicillin in different in vitro models. Toxicol In Vitro 2020; 67:104921. [PMID: 32599260 DOI: 10.1016/j.tiv.2020.104921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 01/26/2023]
Abstract
Silibinin (Sil) is used as hepatoprotective drug and is approved for therapeutic use in amanitin poisoning. In our study we compared Sil-bis-succinate (SilBS), a water-soluble drug approved for i.v.-administration, with Sil solved in ethanol (SilEtOH), which is normally used in research. We challenged monocultures or 3D-microtissues consisting of HepG2 cells or primary hepatocytes with α-amanitin and treated with SILBS, SILEtOH, penicillin and combinations thereof. Cell viability and the integrity of the microtissues was monitored. Finally, the expression of the transporters OATP1B1 and B3 was analyzed by qRT-PCR. We demonstrated that primary hepatocytes were more sensitive to α-amanitin compared to HepG2. Primary hepatocytes cultures were protected by SilBS and SilEtOH independent of penicillin from the cytotoxic effects of α-amanitin. Subsequent studies of the expression profile of the transporters OATP1B1/B3 revealed that primary hepatocytes do express both whereas in HepG2 cells they were hardly detectable. Our study showed that SilBS has significant advantage over SilEtOH with no additional benefit of penicillin. Moreover, HepG2 cells may not represent an appropriate model to investigate Amanita phalloides poisoning in vitro with focus on OATP transporters since these cells are lacking sensitivity towards α-amanitin probably due to missing cytotoxicity-associated transporters suggesting that primary hepatocytes should be preferred in this context.
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15
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Lateral flow immunoassay (LFIA) for the detection of lethal amatoxins from mushrooms. PLoS One 2020; 15:e0231781. [PMID: 32302363 PMCID: PMC7164595 DOI: 10.1371/journal.pone.0231781] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/31/2020] [Indexed: 11/28/2022] Open
Abstract
The mushroom poison that causes the most deaths is the class of toxins known as amatoxins. Current methods to sensitively and selectively detect these toxins are limited by the need for expensive equipment, or they lack accuracy due to cross-reactivity with other chemicals found in mushrooms. In this work, we report the development of a competition-based lateral flow immunoassay (LFIA) for the rapid, portable, selective, and sensitive detection of amatoxins. Our assay clearly indicates the presence of 10 ng/mL of α-AMA or γ-AMA and the method including extraction and detection can be completed in approximately 10 minutes. The test can be easily read by eye and has a presumed shelf-life of at least 1 year. From testing 110 wild mushrooms, the LFIA identified 6 out of 6 species that were known to contain amatoxins. Other poisonous mushrooms known not to contain amatoxins tested negative by LFIA. This LFIA can be used to quickly identify amatoxin-containing mushrooms.
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Reisinger A, Rabensteiner J, Hackl G. Diagnosis of acute intoxications in critically ill patients: focus on biomarkers - part 2: markers for specific intoxications. Biomarkers 2020; 25:112-125. [PMID: 32011177 DOI: 10.1080/1354750x.2020.1725787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In medical intensive care units, acute intoxications contribute to a large proportion of all patients. Epidemiology and a basic overview on this topic were presented in part one. The purpose of this second part regarding toxicological biomarkers in the ICU setting focuses on specific poisons and toxins. Following the introduction of anion and osmol gap in part one, it's relevance in toxic alcohols and other biomarkers for these poisonings are presented within this publication. Furthermore, the role of markers in the blood, urine and cerebrospinal fluid for several intoxications is evaluated. Specific details are presented, amongst others, for cardiovascular drug poisoning, paracetamol (acetaminophen), ethanol, pesticides, ricin and yew tree intoxications. Detailed biomarkers and therapeutic decision tools are shown for carbon monoxide (CO) and cyanide (CN-) poisoning. Also, biomarkers in environmental toxicological situations such as mushroom poisoning and scorpion stings are presented.
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Affiliation(s)
- Alexander Reisinger
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Gerald Hackl
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Taban S, Dursun B. Mantar zehirlenmesine bağlı rabdomiyoliz zemininde ağır böbrek, karaciğer ve kalp hasarı. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.531730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Management and Social Problems Linked to the Human Use of European Urban and Suburban Forests. FORESTS 2019. [DOI: 10.3390/f10110964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This review regards the management and social problems in European urban and suburban forests linked to their maintenance and human use. They can be divided into major categories: forest management problems (e.g., the low priority of urban forestry, various or diffused urban forest management, lack of management plans or lack of sufficient funds); the social reception of forest works and forests (e.g., emotional reactions to total clear-cutting, negative evaluation of logging traces, negative evaluation of poor tourist infrastructure, specific expectations concerning a model forest: e.g., tall, of low density, mixed, old); and relations between forest users (problems related to e.g., crowding, fast-moving people, the presence of dogs, littering, thefts or noisy behaviour). Here, special attention is paid to problems and negative interactions, as they are challenges to forest management, as well as to the development of plans, strategies, and policies, both in relation to existent forests and those planned in various parts of Europe. Taking into account the feelings and expectations of forest users concerning forests, forest works/management, and infrastructure, as well as their attitude to other forest users, may reduce conflicts concerning various kinds of forest perception and use, and (with the support of societal education) may help to increase the sense of social responsibility for the “shared” forests. The presented findings are expected to be practical and useful for the management of urban and suburban forests, regardless of the location, as a type of checklist of possible problems, that may prove to be important and up-to-date in a particular location.
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Gül F, Sayan İ, Arıkan H, Karacabey S, Arslantaş MK, Cinel İ. The Role of Transocular Ultrasound in the Assessment of Neurotoxicity-Related Encephalopathy in Mushroom Poisoning. Turk J Anaesthesiol Reanim 2019; 48:62-67. [PMID: 32076682 PMCID: PMC7001805 DOI: 10.5152/tjar.2019.37891] [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: 04/18/2019] [Accepted: 05/29/2019] [Indexed: 11/30/2022] Open
Abstract
Objective Mushroom poisonings can lead to life-threatening organ dysfunctions and neurotoxicity-related encephalopathy. This study aimed to detect increased intracranial pressure by measuring optic nerve sheath diameter (ONSD) ultrasonographically and to determine its association with clinical and laboratory parameters. Methods In this prospective case-control study, we evaluated the patients aged above 18 years who presented to the emergency department with mushroom poisoning. Vital signs, clinical and laboratory parameters and ONSD of both eyes measured with transocular ultrasound were noted at initial admission and the 24th hour. Results We measured ONSD in 26 cases with mushroom poisoning and 26 healthy volunteers. Baseline ONSD measurements of the poisoning group were significantly higher than those of the control group (5.94±0.73 vs. 4.11±0.64, p<0.0001). ONSD values significantly regressed at 24th hour compared with the baseline measurements in the poisoning group (5.94±0.73 vs. 5.06±0.56, p<0.001).The ONSD values were significantly higher in patients who had a clinical picture of encephalopathy compared with patients who didn’t have (6.05±0.72 vs. 4.36±1.03, p<0.001). No significant deterioration was observed in ammonium levels, hepatic and renal functions of the patients. Conclusion We detected increased ONSDs in patients with mushroom poisoning compared with those in the control healthy volunteers. Our findings suggest that ONSD, measured by ultrasonography, may be safely and effectively used to diagnose transient encephalopathy associated with neurotoxicity.
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Affiliation(s)
- Fethi Gül
- Department of Anaesthesiology and Reanimation, Marmara University Pendik Training and Reserach Hospital, İstanbul, Turkey
| | - İsmet Sayan
- Department of Pulmonary and Critical Care Medicine, Marmara University School of Medicine, İstanbul, Turkey
| | - Hüseyin Arıkan
- Department of Pulmonary and Critical Care Medicine, Marmara University School of Medicine, İstanbul, Turkey
| | - Sinan Karacabey
- Department of Traumatology and Emergency Medicine, Marmara University School of Medicine, İstanbul, Turkey
| | - Mustafa Kemal Arslantaş
- Department of Anaesthesiology and Reanimation, Marmara University School of Medicine, İstanbul, Turkey
| | - İsmail Cinel
- Department of Anesthesiology and Reanimation, Division of Critical Care Medicine, Marmara University School of Medicine, İstanbul, Turkey
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Abstract
RATIONALE Approximately 5000 species of wild mushroom are reported worldwide, of which 100 are documented as poisonous and <10 are fatal. The clinical picture of patients with wild mushroom intoxication depends mostly on the type of ingested mushroom, ranging from mild gastrointestinal symptoms to organ failure and death. PATIENT CONCERNS We report 2 children, sister and brother admitted in our clinic for gastrointestinal symptoms: abdominal pain, nausea, vomiting, and diarrhea after wild mushroom ingestion. DIAGNOSIS The laboratory tests revealed hepatic cytolysis syndrome, hyperbilirubinemia, impaired coagulation status, hypoalbuminemia, hypoglycemia, and electrolytic unbalances in both cases. Abdominal ultrasound showed hepatomegaly and ascites. INTERVENTION After admission, both cases received penicillin by vein, activated charcoal, liver protectors, glucose, and electrolytes perfusions. Nevertheless, their status worsened and required the transfer to the pediatric intensive care unit for appropriate supportive measure. Therefore, therapeutic plasma exchange was initiated along with N-acetyl cysteine and hemostatic drugs. OUTCOMES Despite all these therapeutic interventions, both cases developed hepatorenal syndrome and died after a couple of days from ingestion. LESSONS Mushroom poisoning remains a public health problem in developing countries. Preventable strategies and education regarding the consumption of wild type mushrooms are essential for decreasing the morbidity and mortality rates in these areas.
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Affiliation(s)
| | | | - Maria Oana Mărginean
- Department of Paediatric Cardiology, University of Medicine, Pharmacy, Sciences and Technology, Târgu Mures, Romania
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Portalo-Calero F, Arroyo P, Suárez JI, Lozano J. Triangular Test of Amanita Mushrooms by Using Electronic Nose and Sensory Panel. Foods 2019; 8:foods8090414. [PMID: 31540071 PMCID: PMC6769616 DOI: 10.3390/foods8090414] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/05/2019] [Accepted: 09/10/2019] [Indexed: 11/16/2022] Open
Abstract
This work aims to advance understanding of the differentiation of mushroom species through electronic devices that use sensors of various technologies and techniques for pattern recognition, comparing mainly volatile substances that emanate from them. In this first phase, the capacity of human olfaction to differentiate between the smell released by different wild mushrooms of the genus Amanita was analyzed by means of a triangular sensory test, comparing later the data to those obtained for the same samples with an electronic nose in a similar test. The results, still very preliminary, encourage imagining the wide application that these techniques will have and the feedback that this application can suppose for the training of the sense of human olfaction.
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Affiliation(s)
| | - Patricia Arroyo
- Escuela de Ingenierías Industriales, Universidad de Extremadura, 06006 Badajoz, Spain.
| | - José Ignacio Suárez
- Escuela de Ingenierías Industriales, Universidad de Extremadura, 06006 Badajoz, Spain.
| | - Jesús Lozano
- Escuela de Ingenierías Industriales, Universidad de Extremadura, 06006 Badajoz, Spain.
- Instituto Universitario de Investigación en Recursos Agrarios (INURA), Universidad de Extremadura, Avd. De la Investigación, 06006 Badajoz, Spain.
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Pressures and Threats to Nature Related to Human Activities in European Urban and Suburban Forests. FORESTS 2019. [DOI: 10.3390/f10090765] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review regards the pressures and threats linked with the human use of European urban and suburban forests. They can be divided into the following major categories: urban development, fragmentation, and isolation of forests; human pressures on soil and vegetation (e.g., changes in vegetation due to trampling, environmental and especially air pollution); human pressures on animals (e.g., wildlife losses due to collisions, frequent presence of dogs accompanying the visitors); and other threats and damages (e.g., littering and acts of vandalism). The directions of negative relations between people and forests shown in this review draw attention to the high complexity of the discussed issues. Awareness of this complexity (when planning and implementing forest management) can limit or counteract conflicts arising from the use of urban and suburban forests by people. This is of particular importance in the era of progressing urbanization and the evolution of human needs regarding the use of forests.
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Doğan M, Karahan I. Evaluation of complete blood count parameters, cell ratios, and cell volume indices in mushroom poisonings. Hum Exp Toxicol 2019; 38:1127-1131. [PMID: 31215240 DOI: 10.1177/0960327119855131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Mushroom poisoning is still a significant health-care problem, with the potential to affect blood parameters. The present study analyses the effect of mushroom poisoning on complete blood cell parameters, cell ratios, and cell volume indices and the effect of the mentioned parameters on prognosis/hospital length of stay. METHODS The study involved the retrospective assessment of 48 patients who became symptomatic after ingesting mushrooms. Patients who were 18 years and above and who spent at least one day in hospital were included in the study. The control group comprised individuals with similar characteristics to the patient group. The complete blood cell parameters, platelet indices (mean platelet volume, plateletcrit (PCT)), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio levels were compared between the two groups, and these ratios were analyzed for any correlation with length of hospital stay. RESULTS NLR was significantly higher and PCT was significantly lower in the mushroom-poisoned group, while all other parameters were similar between the groups. NLR had a positive correlation and PCT had a negative correlation with length of hospital stay. CONCLUSION NLR and PCT levels can provide information about prognosis and can aid in the prediction of hospital stay in mushroom-poisoned patients. Further investigations are needed to investigate effects of intoxication on hematological system elements.
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Affiliation(s)
- M Doğan
- 1 Department of Internal Medicine, Erol Olçok Training and Research Hospital, Hitit University, Corum, Turkey
| | - I Karahan
- 2 Department of Internal Medicine, School of Medicine, Kırıkkale University, Yahşihan, Kırıkkale, Turkey
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SIRT1 Modulators in Experimentally Induced Liver Injury. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:8765954. [PMID: 31281594 PMCID: PMC6589266 DOI: 10.1155/2019/8765954] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/21/2019] [Accepted: 05/15/2019] [Indexed: 12/11/2022]
Abstract
This article is directed at highlighting the involvement of the endogenous stress sensor SIRT1 (silent information regulator T1) as a possible factor involved in hepatoprotection. The selective SIRT1 modulators whether activators (STACs) or inhibitors are being tried experimentally and clinically. We discuss the modulation of SIRT1 on cytoprotection or even cytotoxicity in the liver chemically injured by hepatotoxic agents in rats, to shed light on the crosstalk between SIRT1 and its modulators. A combination of D-galactosamine and lipopolysaccharide (D-GalN/LPS) downregulated SIRT1 expression, while SIRT1 activators, SRT1720, resveratrol, and quercetin, upregulated SIRT1 and alleviated D-GalN/LPS-induced acute hepatotoxicity. Liver injury markers exhibited an inverse relationship with SIRT1 expression. However, under subchronic hepatotoxicity, quercetin decreased the significant increase in SIRT1 expression to lower levels which are still higher than normal ones and mitigated the liver-damaging effects of carbon tetrachloride. Each of these STACs was hepatoprotective and returned the conventional antioxidant enzymes to the baseline. Polyphenols tend to fine-tune SIRT1 expression towards normal in the liver of intoxicated rats in both acute and subchronic studies. Together, all these events give an impression that the cytoprotective effects of SIRT1 are exhibited within a definite range of expression. The catalytic activity of SIRT1 is important in the hepatoprotective effects of polyphenols where SIRT1 inhibitors block and the allosteric SIRT1 activators mimic the hepatoprotective effects of polyphenols. Our findings indicate that the pharmacologic modulation of SIRT1 could represent both an important move in alleviating hepatic insults and a future major step in the treatment of xenobiotic-induced hepatotoxicity.
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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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Mushroom Poisoning-A 17 Year Retrospective Study at a Level I University Emergency Department in Switzerland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122855. [PMID: 30558129 PMCID: PMC6313731 DOI: 10.3390/ijerph15122855] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/08/2018] [Accepted: 12/10/2018] [Indexed: 11/16/2022]
Abstract
The consequences of mushroom poisoning range from mild, mostly gastrointestinal, disturbances to organ failure or even death. This retrospective study describes presentations related to mushroom poisoning at an emergency department in Bern (Switzerland) from January 2001 to October 2017. Gastrointestinal disturbances were reported in 86% of the 51 cases. The National Poisons Information Centre and mycologists were involved in 69% and 61% of the cases, respectively. Identification of the mushroom type/family was possible in 43% of the cases. The most common mushroom family was Boletaceae (n = 21) and the most common mushrooms Xerocomus chrysenteron (n = 7; four being part of a cluster), Clitocybe nebularis, Lepista nuda and Lactarius semisanguifluus (n = 5 each, four being part of a cluster). Poisonous mushrooms included Amanita phalloides (n = 3, all analytically confirmed), Boletus satanas (n = 3), Amanita muscaria (n = 2) and Amanita pantherina (n = 2). There were no fatalities and 80% of the patients were discharged within 24 h. Mushroom poisoning does not appear to be a common reason for emergency consultation and most presentations were of minor severity and related to edible species (e.g., due to incorrect processing). Nevertheless, poisonous mushrooms and severe complications were also recorded. Collaboration with a poison centre and/or mycologists is of great importance, especially in high risk cases.
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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.
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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.
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Xiang H, Zhou Y, Zhou C, Lei S, Yu H, Wang Y, Zhu S. Investigation and analysis of Galerina sulciceps poisoning in a canteen. Clin Toxicol (Phila) 2017; 56:365-369. [PMID: 29052443 DOI: 10.1080/15563650.2017.1388386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Guizhou Province in China has an abundant resource of wild mushrooms, including numerous poisonous species which contain various toxins. The mortality rate from wild mushroom poisoning has been high in this area in recent years. Galerina sulciceps is a dangerously toxic mushroom which can be fatal if ingested. METHODS we report on an epidemiological investigation of G. sulciceps poisoning which occurred in Duyun City of Guizhou Province. The characteristics of this species, its toxicity, observed clinical features, laboratory data, treatment modality, and prognosis were investigated in order to provide a reference point for the prevention and treatment of this kind of mushroom poisoning. RESULTS Thirteen employees showed toxic symptoms after ingesting wild mushrooms the previous day in a company canteen. Clinical manifestation varied from gastroenteritis to hepatic and renal dysfunction. Most of the 13 patients presented with nausea, vomiting, abdominal pain, diarrhea, and elevated levels of biochemical indices of hepatic and renal function, during which transaminase concentration peaked within 48-72 h. At 48 hours post-ingestion, all patients had hemodialysis, in addition to supportive care for hepatic and renal injury with oral Silibinin and Shenshuaining. All acute renal injury had resolved by day 10, and liver transaminases had trended toward normal in all patients and they were discharged. At follow-up in 30 days, both liver and renal function had completely recovered in all. CONCLUSION This poisoning occurs as a result of unintentional consumption of G. sulciceps, which is relatively rare in mushroom poisonings. All patients recovered fully after timely diagnosis and treatment. To prevent wild mushroom poisoning, the best preventive measure is to educate the public not to gather and eat any unidentified wild mushrooms.
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Affiliation(s)
- Hong Xiang
- a Guizhou Center of Disease Control and Prevention , Guiyang , China
| | - Yajuan Zhou
- a Guizhou Center of Disease Control and Prevention , Guiyang , China
| | - Changlin Zhou
- b Qiannan Center of Disease Control and Prevention , Duyun , China
| | - Shiguang Lei
- a Guizhou Center of Disease Control and Prevention , Guiyang , China
| | - Hong Yu
- a Guizhou Center of Disease Control and Prevention , Guiyang , China
| | - Yafang Wang
- a Guizhou Center of Disease Control and Prevention , Guiyang , China
| | - Shu Zhu
- a Guizhou Center of Disease Control and Prevention , Guiyang , 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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Sun J, Li HJ, Zhang HS, Zhang YZ, Xie JW, Ma PB, Guo C, Sun CY. Investigating and analyzing three cohorts of mushroom poisoning caused by Amanita exitialis in Yunnan, China. Hum Exp Toxicol 2017; 37:665-678. [PMID: 28830233 DOI: 10.1177/0960327117721960] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Amanita exitialis is a lethal mushroom found in China. Knowledge regarding taxonomic characterization, toxin detection, general poisoning conditions, clinical manifestations, laboratory examinations, and clinical treatments for this species is currently lacking. We investigated three A. exitialis mushroom poisoning cohorts in Yunnan Province in 2014 and 2015, involving 10 patients. Mushroom samples were identified by morphological and molecular studies. Ultra performance liquid chromatography-electrospray ionization tandem mass spectrometry was used to detect the peptide toxins in the mushroom samples. Epidemiological information, clinical data, and results of laboratory examinations were collected and analyzed. The mushroom samples were all identified as A. exitialis. The average toxin concentration decreased from the cap to the stipe to the volva, and the average concentration of the peptide toxins decreased in the order of α-amanitin > phallacidin > β-amanitin > γ-amanitin. The latency period between ingestion and the onset of symptoms was 13.9 ± 2.1 h, and the time from ingestion to hospitalization was 49.6 ± 8.5 h. The most common symptoms were nausea and vomiting (100%). Four patients died from fulminant hepatic failure. Laboratory examinations showed that the alanine transaminase, aspartate transaminase, prothrombin time, and activated partial thromboplastin time levels peaked on the third day post-ingestion. Total bilirubin and direct bilirubin values peaked on day 7. The death group and the survival group had a similar variation trend of serological indexes, but the death group had a greater change. A. exitialis is an extremely dangerous mushroom and there is a need to educate the public to avoid picking and eating wild mushrooms that have not been definitively identified.
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Affiliation(s)
- J Sun
- 1 National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China.,2 Yinchuan City Centre for Disease Control and Prevention, Ningxia, People's Republic of China
| | - H-J Li
- 1 National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - H-S Zhang
- 1 National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Y-Z Zhang
- 1 National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - J-W Xie
- 3 State Key Laboratory of Toxicology and Medical Countermeasures, and Laboratory of Toxicant Analysis, Institute of Pharmacology and Toxicology, Academy of Military Medical Sciences, Beijing, People's Republic of China
| | - P-B Ma
- 1 National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - C Guo
- 4 Tengchong Centre for Disease Control and Prevention, Yunnan, People's Republic of China
| | - C Y Sun
- 1 National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
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Abstract
Although death from food is not an uncommon finding in forensic facilities worldwide, the range of underlying lethal mechanisms and associated conditions that should be sought at the time of autopsy is quite disparate. Deaths may occur from i) infectious agents including bacteria, viruses, protozoa, cestodes, nematodes and prions; ii) natural toxins including amanita toxins, tetrodotoxin, ciguatera and scombroid; iii) anaphylaxis; iv) poisoning; v) mechanical issues around airway and gut obstruction and/or perforation; and vi) miscellaneous causes. Food-related deaths are important in terms of global mortality, and thus autopsies need to be comprehensive with full ancillary testing. Medicolegal matters may involve issues concerning likely exposure to infectious agents, possible foods ingested, the declared content and possible components of food, the significance of toxicological analyses, and aspects of duty of care in cases of café coronary syndrome and gastroenteritis while in care.
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Affiliation(s)
- Roger W Byard
- School of Medicine, The University of Adelaide, Level 3 Medical School North Building, Frome Road, Adelaide, South Australia, 5005, Australia.
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32
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Production of a broad-specificity monoclonal antibody and application as a receptor to detection amatoxins in mushroom. Biologicals 2017; 49:57-61. [PMID: 28688778 DOI: 10.1016/j.biologicals.2017.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/18/2017] [Accepted: 06/26/2017] [Indexed: 11/23/2022] Open
Abstract
In this study, we report the production of a monoclonal broad-specificity monoclonal antibody (mAb) specific for amatoxins and development of an indirect competitive immunoassay for detection of amatoxins in mushroom samples. In the assay, the complete antigen (α-amanitin-OVA) was used as coating antigen, and amatoxins as competitor competes with coating antigen to bind with mAb. Using this approach, The half-maximum inhibition concentrations (IC50) of α-amanitin, β-amanitin and γ-amanitin, and limits of detection (LODs, IC15) were 66.3, 97.4, 163.1 ng/mL and 0.91, 0.98, 0.89 ng/mL, respectively. The LODs for α-amanitin, β-amanitin and γ-amanitin in mushroom samples were 4.55, 4.9, and 4.45 ng/mL. The spiked results were also confirmed by HPLC, which showed a good correlation (R2 = 0.996) between the two methods. The results indicated that the developed assay was reliable and suitable for the detection of amatoxins in mushroom samples.
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Alinejad S, Zamani N, Abdollahi M, Mehrpour O. A Narrative Review of Acute Adult Poisoning in Iran. IRANIAN JOURNAL OF MEDICAL SCIENCES 2017; 42:327-346. [PMID: 28761199 PMCID: PMC5523040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Poisoning is a frequent cause of referral to medical emergencies and a major health problem around the world, especially in developing countries. We aimed to review the epidemiology and pattern of adult poisoning in Iran in order to facilitate the early diagnosis and management of poisoning. The pattern of poisoning is different in various parts of Iran. Pharmaceutical compounds were the most common cause of poisoning in most parts of Iran. Pesticide-related toxicities were more common in northern agricultural regions, whereas bites and stings were seen more commonly in southern Iran. Carbon monoxide poisoning was common in cities with many motor vehicles such as Tehran and in colder climates such as in northern and western regions due to inadequately vented gas appliances such as stoves and heaters. Majoon Birjandi (containing cannabis) is a unique substance used in eastern Iran. Poisoning by opioids, tramadol, and pesticides (organophosphate and aluminum phosphide) has remained a common hazard in Iran. Poisoning-associated morbidity and mortality rates vary by region and have changed over time due to the introduction of new drugs and chemicals. Early diagnosis and proper treatment may be lifesaving; thus, understanding the general pattern of poisoning in different regions is important.
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Affiliation(s)
- Samira Alinejad
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Nasim Zamani
- Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Abdollahi
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran,Correspondence: Omid Mehrpour, MD; Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Moallem Avenue, Zip Code: 97178-53577, Birjand, Iran. Tel\Fax: +98 56 32381270
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Wild Mushrooms: An Exclusive Delicacy or Last Meal. Am J Gastroenterol 2017; 112:971-972. [PMID: 28572647 DOI: 10.1038/ajg.2017.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Cho JT, Han JH. A Case of Mushroom Poisoning with Russula subnigricans: Development of Rhabdomyolysis, Acute Kidney Injury, Cardiogenic Shock, and Death. J Korean Med Sci 2016; 31:1164-7. [PMID: 27366018 PMCID: PMC4901012 DOI: 10.3346/jkms.2016.31.7.1164] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/06/2015] [Indexed: 01/06/2023] Open
Abstract
Mushroom exposures are increasing worldwide. The incidence and fatality of mushroom poisoning are reported to be increasing. Several new syndromes in mushroom poisoning have been described. Rhabdomyolytic mushroom poisoning is one of new syndromes. Russula subnigricans mushroom can cause delayed-onset rhabdomyolysis with acute kidney injury in the severely poisoned patient. There are few reports on the toxicity of R. subnigricans. This report represents the first record of R. subnigricans poisoning with rhabdomyolysis in Korea, describing a 51-year-old man who suffered from rhabdomyolysis, acute kidney injury, severe hypocalcemia, respiratory failure, ventricular tachycardia, cardiogenic shock, and death. Mushroom poisoning should be considered in the evaluation of rhabdomyolysis of unknown cause. Furthermore, R. subnigricans should be considered in the mushroom poisoning with rhabdomyolysis.
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Affiliation(s)
- Jong Tae Cho
- Department of Internal Medicine, College of Medicine, Dankook University, Cheonan, Korea
| | - Jin Hyung Han
- Department of Internal Medicine, College of Medicine, Dankook University, Cheonan, Korea
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36
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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.
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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
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37
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Abstract
Although rare, death from amanitin exposure poses a significant health risk and a diagnostic challenge to the clinician due to its rarity. This is one of the few conditions to be voluntarily reported by healthcare professionals. No antidote exists for this poisoning and, perhaps due to its rarity or lack of attention, the United States has lagged behind Europe for almost three decades in treatment, diagnostics and experimentation. This regrettable fact warrants the formation of a centralized agency for education, the advancement of research and the collection of data, to provide better treatment for the population.
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Affiliation(s)
- Michael R Smith
- Department of Surgery, St. Barnabas Hospital, Bronx, NY, USA and
| | - Robert L Davis
- Department of Surgery, Lutheran Medical Center, Brooklyn, NY, USA
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38
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Amanita phalloides poisoning: Mechanisms of toxicity and treatment. Food Chem Toxicol 2015; 86:41-55. [PMID: 26375431 DOI: 10.1016/j.fct.2015.09.008] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 09/08/2015] [Accepted: 09/10/2015] [Indexed: 02/07/2023]
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39
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Yilmaz I, Ermis F, Akata I, Kaya E. A Case Study: What Doses of Amanita phalloides and Amatoxins Are Lethal to Humans? Wilderness Environ Med 2015; 26:491-6. [DOI: 10.1016/j.wem.2015.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 07/16/2015] [Accepted: 08/12/2015] [Indexed: 11/27/2022]
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40
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Kowalczyk M, Sekuła A, Mleczko P, Olszowy Z, Kujawa A, Zubek S, Kupiec T. Practical aspects of genetic identification of hallucinogenic and other poisonous mushrooms for clinical and forensic purposes. Croat Med J 2015; 56:32-40. [PMID: 25727040 PMCID: PMC4364345 DOI: 10.3325/cmj.2015.56.32] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aim To assess the usefulness of a DNA-based method for identifying mushroom species for application in forensic laboratory practice. Methods Two hundred twenty-one samples of clinical forensic material (dried mushrooms, food remains, stomach contents, feces, etc) were analyzed. ITS2 region of nuclear ribosomal DNA (nrDNA) was sequenced and the sequences were compared with reference sequences collected from the National Center for Biotechnology Information gene bank (GenBank). Sporological identification of mushrooms was also performed for 57 samples of clinical material. Results Of 221 samples, positive sequencing results were obtained for 152 (69%). The highest percentage of positive results was obtained for samples of dried mushrooms (96%) and food remains (91%). Comparison with GenBank sequences enabled identification of all samples at least at the genus level. Most samples (90%) were identified at the level of species or a group of closely related species. Sporological and molecular identification were consistent at the level of species or genus for 30% of analyzed samples. Conclusion Molecular analysis identified a larger number of species than sporological method. It proved to be suitable for analysis of evidential material (dried hallucinogenic mushrooms) in forensic genetic laboratories as well as to complement classical methods in the analysis of clinical material.
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Affiliation(s)
- Marek Kowalczyk
- Marek Kowalczyk, Institute of Forensic Research, Westerplatte St. 9, 31-033 Krakow, Poland,
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Kose M, Yilmaz I, Akata I, Kaya E, Guler K. A Case Study: Rare Lepiota brunneoincarnata Poisoning. Wilderness Environ Med 2015; 26:350-4. [PMID: 25771029 DOI: 10.1016/j.wem.2014.12.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 12/24/2014] [Accepted: 12/30/2014] [Indexed: 11/18/2022]
Abstract
Amatoxin poisoning from the genus Lepiota may have a deadly outcome, although this is not seen as often as it is from the genus Amanita. In this report, we present a patient who was poisoned by a sublethal dose of Lepiota brunneoincarnata mushrooms. The patient was hospitalized 12 hours after eating the mushrooms. The patient's transaminase levels increased dramatically starting on day 4. Aspartate transaminase peaked at 78 hours. Starting at 1265 IU/L, alanine transaminase peaked at 90 hours at 5124 IU/L. The patient was discharged on day 8 to outpatient care, and his transaminase levels returned to normal ranges in the subsequent days. A toxin analysis was carried out on the mushrooms that the patient claimed to have eaten. Using reversed-phase high-performance liquid chromatography analysis, an uptake of approximately 19.9 mg of amatoxin from nearly 30 g of mushrooms was calculated. This consisted of 10.59 mg of α-amanitin, 9.18 mg of β-amanitin, and 0.16 mg of γ-amanitin. In conclusion, we present a patient from Turkey who was poisoned by L. brunneoincarnata mushrooms.
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Affiliation(s)
- Murat Kose
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey (Drs Kose and Guler)
| | - Ismail Yilmaz
- Department of Pharmacology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey (Dr Yilmaz).
| | - Ilgaz Akata
- Department of Biology, Faculty of Science, Ankara University, Ankara, Turkey (Dr Akata)
| | - Ertugrul Kaya
- Department of Pharmacology, Faculty of Medicine, Duzce University, Duzce, Turkey (Dr Kaya)
| | - Kerim Guler
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey (Drs Kose and Guler)
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Abstract
Approximately 100 of the known species of mushrooms are poisonous to humans. New toxic mushroom species continue to be identified. Some species initially classified as edible are later reclassified as toxic. This results in a continually expanding list of toxic mushrooms. As new toxic species are identified, some classic teachings about mycetism no longer hold true. As more toxic mushrooms are identified and more toxic syndromes are reported, older classification systems fail to effectively accommodate mycetism. This review provides an update of myscetism and classifies mushroom poisonings by the primary organ system affected, permitting expansion, as new, toxic mushroom species are discovered.
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Carvalho LM, Carvalho F, de Lourdes Bastos M, Baptista P, Moreira N, Monforte AR, da Silva Ferreira AC, de Pinho PG. Non-targeted and targeted analysis of wild toxic and edible mushrooms using gas chromatography–ion trap mass spectrometry. Talanta 2014; 118:292-303. [PMID: 24274300 DOI: 10.1016/j.talanta.2013.09.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 09/12/2013] [Accepted: 09/20/2013] [Indexed: 11/30/2022]
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Jang J, Kim CH, Yoo JJ, Kim MK, Lee JE, Lim AL, Choi JH, Hyun IG, Shim JW, Shin HS, Han J, Seok SJ. An Elderly Man with Fatal Respiratory Failure after Eating a Poisonous Mushroom Podostroma cornu-damae. Tuberc Respir Dis (Seoul) 2013; 75:264-8. [PMID: 24416059 PMCID: PMC3884116 DOI: 10.4046/trd.2013.75.6.264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/14/2013] [Accepted: 09/13/2013] [Indexed: 12/05/2022] Open
Abstract
A 73-year-old, previously healthy man presented with nausea, vomiting, diarrhea, dry mouth and febrile sensation 3 hours after eating boiled wild mushrooms. After admission, he showed progressive severe respiratory distress, pancytopenia, azotemia, hypotension, hypoxemia and consolidation of the entire left lung on chest radiography. With a preliminary diagnosis of necrotizing pneumonia, he underwent left pneumonectomy in order to remove all necrotic lung tissue. Lung histology showed extensive hemorrhagic necrosis, massive inflammatory cell infiltration, prominent proliferation of young fibroblasts and the formation of an early-stage hyaline membrane along the alveolar wall. Despite aggressive treatment, including mechanical ventilation, continuous renal replacement therapy and administration of granulocyte colony stimulating factor and broad spectrum antibiotics, he died on hospitalization day 13. Subsequently, the mushroom was identified as Podostroma cornu-damae. This is the first case of a histological evidence of lung involvement by Podostroma cornu-damae poisoning in Korea.
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Affiliation(s)
- Juah Jang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Cheol-Hong Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Jun Jae Yoo
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Mi Kang Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Jae Eun Lee
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Ah Leum Lim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Jeong-Hee Choi
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - In Gyu Hyun
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Jung Weon Shim
- Department of Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Ho-Seung Shin
- Department of Thoracic and Cardiovascular Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Joungho Han
- Department of Pathology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soon Ja Seok
- Agricultural Microbiology Department, National Academy of Agricultural Science, Rural Development Administration, Suwon, Korea
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Sawada A, Sato H, Inoue E, Otani Y, Hanya G. Mycophagy among Japanese macaques in Yakushima: fungal species diversity and behavioral patterns. Primates 2013; 55:249-57. [PMID: 24338126 DOI: 10.1007/s10329-013-0396-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 10/23/2013] [Indexed: 10/25/2022]
Abstract
Mycophagy (fungus-feeding) by Japanese macaques (Macaca fuscata yakui) in Yakushima has been observed by many researchers, but no detailed information is available on this behavior, including which fungal species are consumed. To provide a general description of mycophagy and to understand how and whether macaques avoid poisonous fungi, we conducted behavioral observation of wild Japanese macaques in Yakushima and used molecular techniques to identify fungal species. The results indicate that the diet of the macaques contains a large variety of fungal species (67 possible species in 31 genera), although they compose a very small portion of the total diet (2.2% of annual feeding time). Fungi which were eaten by macaques immediately after they were picked up were less likely to be poisonous than those which were examined (sniffed, nibbled, carefully handled) by macaques. However, such examining behaviors did not appear to increase the macaques' abilities to detect poisonous fungi. Fungi that were only partially consumed included more poisonous species than those fully consumed with/without examining behavior, yet this was not significant. Taste, therefore, might also play an important role in discriminating poisonous from non-poisonous.
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Affiliation(s)
- Akiko Sawada
- Primate Research Institute, Kyoto University, Kanrin 41-2, Inuyama, Aichi, 484-8506, Japan.
| | - Hirotoshi Sato
- Graduate School of Global Environmental Studies, Kyoto University, Kyoto, Japan
| | - Eiji Inoue
- Graduate School of Science, Kyoto University, Kyoto, Japan
| | - Yosuke Otani
- Primate Research Institute, Kyoto University, Kanrin 41-2, Inuyama, Aichi, 484-8506, Japan
| | - Goro Hanya
- Primate Research Institute, Kyoto University, Kanrin 41-2, Inuyama, Aichi, 484-8506, Japan
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Malheiro R, Guedes de Pinho P, Soares S, César da Silva Ferreira A, Baptista P. Volatile biomarkers for wild mushrooms species discrimination. Food Res Int 2013. [DOI: 10.1016/j.foodres.2013.06.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Koksal O, Armagan E, Inal T, Ayyildiz T, Oner N. A 4 Year Retrospective Analysis of Our Patients with Mushroom Poisoning. HONG KONG J EMERG ME 2013. [DOI: 10.1177/102490791302000206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study presented the demographic, clinical and laboratory data for the patients who presented to our emergency department (ED) with mushroom poisoning. Methods We retrospectively examined the data for adult patients with mushroom poisoning that presented to the ED of Uludag University, Faculty of Medicine between 1 January 2007 and 31 December 2010. Results A total of 53 patients were enrolled in the study. The mean age was 46.58±15.47. 52.8% of the patients were female, while 47.2% were male. These patients were typically admitted in the autumn. The most commonly seen symptoms were gastrointestinal such as nausea and vomiting. The time to symptom onset was <6 hours for 30.2% of the patients and >6 hours in 69.8% of the patients. While 73.5% of the patients received gastric lavage, activated charcoal and intravenous fluid therapy, 15.1% received penicillin, N-acetylcysteine and intravenous fluid therapy. For the remaining patients (11.4%) silibinin, dialysis and plasmapheresis were administered. While 35.8% of the patients were hospitalised, 64.2% were discharged from the ED. The median duration of stay in the ED was 6 hours (range: 1-27 hours); the median duration of stay among inpatients was 6 days (range: 1-36 days). Three of the hospitalised patients died, and two underwent hepatic transplantation. Conclusions Mushroom poisoning remains an important issue that is encountered in rural areas during the rainy autumn season in our region. The condition may be fatal, but can be prevented by early and appropriate treatment.
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Affiliation(s)
| | | | | | - T Ayyildiz
- Uludag University, Department of Gastroenterology, Faculty of Medicine, Bursa, Turkey
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Rocha e Silva M. Pediatrics in Clinics: highlights. Clinics (Sao Paulo) 2012; 67:859-64. [PMID: 22948450 PMCID: PMC3416888 DOI: 10.6061/clinics/2012(08)01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Schenk-Jaeger KM, Rauber-Lüthy C, Bodmer M, Kupferschmidt H, Kullak-Ublick GA, Ceschi A. Mushroom poisoning: a study on circumstances of exposure and patterns of toxicity. Eur J Intern Med 2012; 23:e85-91. [PMID: 22560399 DOI: 10.1016/j.ejim.2012.03.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 03/16/2012] [Accepted: 03/20/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Picking wild mushrooms is a popular pastime in Switzerland. Correct identification of the species is difficult for laypersons. Ingestion of toxic mushrooms may result in serious toxicity, including death. The aim of the study is to analyze and describe the circumstances of exposure to mushrooms, and to define the clinical relevance of mushroom poisoning for humans in Central Europe. MATERIALS AND METHODS We performed a retrospective case study and analyzed all inquiries concerning human exposures to mushrooms (n = 5638, 1.2% of all inquiries) which were reported to the Swiss Toxicological Information Centre between January 1995 and December 2009. RESULTS The most frequent reason for contacting the poison center in cases of adult exposure was toxicity resulting from edible species. Pediatric exposure predominantly occurred from mushrooms found around the home. Severe symptoms have not only been observed after ingestion of non-amatoxin-containing toxic mushrooms, i.e. Boletus sp. and Cortinarius sp., but also after meals of edible species. The mortality of confirmed amatoxin poisonings was high (5/32) compared to other reports. CONCLUSIONS Inquiries regarding mushroom poisoning were a relatively infrequent reason for contacting the poison center. Nevertheless, accidental ingestion of toxic mushrooms can be responsible for severe or fatal poisonings. Although pediatric exposure to mushrooms found around the home has not led to serious toxicity in this study, prevention of exposure is warranted. Inspection of wild mushrooms by a certified mushroom expert or a mycologist seems to be a safe procedure which should be recommended.
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Affiliation(s)
- Katharina M Schenk-Jaeger
- Swiss Toxicological Information Centre, Associated Institute of the University of Zurich, Freiestrasse 16, 8032 Zurich, Switzerland
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