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Balice G, Boksebeld M, Barrier Q, Boccalini S, Kassai-Koupai B, Paret N, Grenet G. Mushroom Poisoning-Related Cardiac Toxicity: A Case Report and Systematic Review. Toxins (Basel) 2024; 16:265. [PMID: 38922159 PMCID: PMC11209194 DOI: 10.3390/toxins16060265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
We encountered a case of mushroom intoxication complicated by "toxic-like" myocarditis. Because of the lack of systematized knowledge on this subject, we performed a systematic review of the literature on cardiac toxicity in mushroom poisoning (MP). The aim of this study was to identify and describe the severity, the causal relationship, and the mushroom species involved in other reported cardiac events associated with MP. We included 39 studies in our review. We found 106 cases of cardiac events associated with MP, including 18 deaths. A wide variety of cardiac manifestations were reported, ranging from the simple elevation of cardiac enzymes (n = 61) to ventricular tachycardia (n = 14), acute heart failure (n = 18), and myocarditis (n = 7). Causal relationship between cardiac manifestations and mushroom poisoning was assessed for 42 patients, applying the algorithm validated by the French Toxicovigilance Coordination Committee. Twenty-three cases (54.8%) had a "possible" causal relationship, eight cases (19%) a "probable" relationship, and ten cases (23.8%) a "very probable" relationship. Several fungal genera were involved in reported cases, including Amanita but also rarer ones like Russula and Tricholoma. In conclusion, we showed that cases of cardiac toxicity following MP have been documented in the existing literature, and for some of them, we assessed a strong causal relationship.
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Affiliation(s)
- Giuseppe Balice
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, 69003 Lyon, France; (M.B.); (B.K.-K.); (N.P.); (G.G.)
| | - Maxime Boksebeld
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, 69003 Lyon, France; (M.B.); (B.K.-K.); (N.P.); (G.G.)
| | - Quentin Barrier
- Fédération de Cardiologie Médicale, Hôpital Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France
| | - Sara Boccalini
- Service de Radiologie Cardiovasculaire et Thoracique, Hôpital Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France
| | - Behrouz Kassai-Koupai
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, 69003 Lyon, France; (M.B.); (B.K.-K.); (N.P.); (G.G.)
- Centre d’Investigation Clinique de Lyon (CIC1407 INSERM), Hospices Civils de Lyon, 69500 Bron, France
- Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Université Lyon 1, CNRS, 69100 Villeurbanne, France
| | - Nathalie Paret
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, 69003 Lyon, France; (M.B.); (B.K.-K.); (N.P.); (G.G.)
| | - Guillaume Grenet
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, 69003 Lyon, France; (M.B.); (B.K.-K.); (N.P.); (G.G.)
- Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Université Lyon 1, CNRS, 69100 Villeurbanne, France
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2
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Wang SH, Li GJ, Phurbu D, He MQ, Zhang MZ, Zhu XY, Li JX, Zhao RL, Cao B. Four new species of Russula from the Xizang Autonomous Region and other provinces of China. Mycology 2023; 15:210-237. [PMID: 38813475 PMCID: PMC11132434 DOI: 10.1080/21501203.2023.2265667] [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: 06/09/2023] [Accepted: 09/27/2023] [Indexed: 05/31/2024] Open
Abstract
Russula is the largest genus in the Russulales and is widespread throughout the world. Almost all Russula species are known to be ectomycorrhizal with high ecological and edible values, and some are lethal poisonous. In this study, four new species belonging to the subgenus Russula crown clade are identified based on morphological and phylogenetic evidence from the Xizang Autonomous Region and other provinces of China. Morphologically, Russula paragraveolens (sect. Polychromae, subsect. Xerampelinae) is mainly characterised by a cherry red to blood red pileus centre, a reddish orange pileus margin; R. pseudograveolens (sect. Polychromae, subsect. Xerampelinae) is characterised by a violet brown to brownish red pileus centre, a pale red to pastel red pileus margin and short basidia; R. shigatseensis (sect. Flavisiccantes, subsect. Lepidinae) is characterised by a brownish orange to madder red pileus centre, pinkish red pileus margin, and having lateral branches or branches of hyphal terminations in pileipellis; R. yadongensis (sect. Tenellae, subsect. Laricinae) is characterised by a dark purplish red pileus centre with brownish purple tints and having isolated to clustered spines of spore ornamentations. Their distinct taxonomic status is confirmed by the positions of the four new species in both the ITS and 4-locus (nucLSU, mtSSU, rpb2, tef1) phylogenetic trees.
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Affiliation(s)
- Shi-Hui Wang
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
- School of Plant Protection, Jilin Agricultural University, Changchun, China
| | - Guo-Jie Li
- Key Laboratory of Vegetable Germplasm Innovation and Utilization of Hebei, Collaborative Innovation Center of Vegetable, College of Horticulture, Hebei Agricultural University, Baoding, China
| | - Dorji Phurbu
- Tibet Plateau Institute of Biology, Lhasa, China
| | - Mao-Qiang He
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Ming-Zhe Zhang
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Xin-Yu Zhu
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Jia-Xin Li
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Rui-Lin Zhao
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Bin Cao
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
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3
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Chun MS, Min MK, Ryu JH, Lee DS, Lee MJ, Hyun T, Shon SW. Mortality Cases of Mushroom Poisoning with Russula subnigricans. Wilderness Environ Med 2023; 34:372-376. [PMID: 37210234 DOI: 10.1016/j.wem.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 05/22/2023]
Abstract
Mushroom poisoning is increasing worldwide, as well as the incidence of fatal mushroom poisoning. Several new syndromes associated with mushroom poisoning have been described in the literature. Notably, 1 of the newly identified mushroom poisonings is Russula subnigricans poisoning. R subnigricans can be classified as causing a delayed-onset rhabdomyolytic syndrome as patients with this severe poisoning present with severe rhabdomyolysis, acute kidney injury, and cardiomyopathy. However, there are only a few reports on the toxicity of R subnigricans. We recently treated 6 patients with R subnigricans mushroom poisoning, of whom 2 died. The 2 patients showed severe rhabdomyolysis, metabolic acidosis, acute renal failure, electrolyte imbalance, and irreversible shock, which caused their deaths. Mushroom poisoning should be considered in the evaluation of rhabdomyolysis of unknown origin. In addition, in cases of mushroom poisoning with severe rhabdomyolysis, R subnigricans poisoning should be promptly identified.
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Affiliation(s)
- Mo Se Chun
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, School of Medicine Pusan National University, Yangsan, Korea
| | - Mun Ki Min
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, School of Medicine Pusan National University, Yangsan, Korea.
| | - Ji Ho Ryu
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, School of Medicine Pusan National University, Yangsan, Korea
| | - Dae Sub Lee
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, School of Medicine Pusan National University, Yangsan, Korea
| | - Min Jee Lee
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, School of Medicine Pusan National University, Yangsan, Korea
| | - Taegyu Hyun
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, School of Medicine Pusan National University, Yangsan, Korea
| | - Seung Woo Shon
- Department of Emergency Medicine, Pusan National University Yangsan Hospital, School of Medicine Pusan National University, Yangsan, Korea
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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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5
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Long P, Jiang Z, He Z, Chen Z. Development of a loop-mediated isothermal amplification assay for the rapid detection of Russula subnigricans and Russula japonica. Front Microbiol 2022; 13:918651. [PMID: 36081806 PMCID: PMC9445624 DOI: 10.3389/fmicb.2022.918651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Russula subnigricans is the only deadly species in the genus Russula with a mortality rate of more than 50%, and Russula japonica is the most common poisonous species, making rapid species identification in mushroom poisoning incidents extremely important. The main objective of this study was to develop a rapid, specific, sensitive, and simple loop-mediated isothermal amplification (LAMP) assay for the detection of R. subnigricans and R. japonica. Two sets of species-specific LAMP primers targeting internal transcribed spacer (ITS) regions were designed to identify R. subnigricans and R. japonica. The results demonstrated that while LAMP could specifically detect R. subnigricans and R. japonica, the polymerase chain reaction (PCR) could not distinguish R. subnigricans from Russula nigricans. In addition, the results demonstrated that, compared to electrophoresis-LAMP and real-time quantitative LAMP (RT-qLAMP), the detection sensitivity of HNB-LAMP (a mixture of LAMP with hydroxy naphthol blue (HNB) dye) for R. subnigricans could reach 0.5 pg/μl and was 100-fold higher than that of PCR. The LAMP reaction could be completed in 45 min, which is much faster than the conventional PCR. In the future, LAMP can be used a quick, specific, and sensitive detection tool in various fields.
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He MQ, Wang MQ, Chen ZH, Deng WQ, Li TH, Vizzini A, Jeewon R, Hyde KD, Zhao RL. Potential benefits and harms: a review of poisonous mushrooms in the world. FUNGAL BIOL REV 2022. [DOI: 10.1016/j.fbr.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lee S, Yu JS, Lee SR, Kim KH. Non-peptide secondary metabolites from poisonous mushrooms: overview of chemistry, bioactivity, and biosynthesis. Nat Prod Rep 2022; 39:512-559. [PMID: 34608478 DOI: 10.1039/d1np00049g] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Covering: up to June 2021A wide variety of mushrooms have traditionally been recognized as edible fungi with high nutritional value and low calories, and abundantly produce structurally diverse and bioactive secondary metabolites. However, accidental ingestion of poisonous mushrooms can result in serious illnesses and even death. Chemically, mushroom poisoning is associated with secondary metabolites produced in poisonous mushrooms, causing specific toxicity. However, many poisonous mushrooms have not been fully investigated for their secondary metabolites, and the secondary metabolites of poisonous mushrooms have not been systematically summarized for details such as chemical composition and biosynthetic mechanisms. The isolation and identification of secondary metabolites from poisonous mushrooms have great research value since these compounds could be lethal toxins that contribute to the toxicity of mushrooms or could provide lead compounds with remarkable biological activities that can promote advances in other related disciplines, such as biochemistry and pharmacology. In this review, we summarize the structures and biological activities of secondary metabolites identified from poisonous mushrooms and provide an overview of the current information on these metabolites, focusing on their chemistry, bioactivity, and biosynthesis.
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Affiliation(s)
- Seulah Lee
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea. .,Division of Life Sciences, Korea Polar Research Institute, KIOST, Incheon 21990, Republic of Korea
| | - Jae Sik Yu
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea.
| | - Seoung Rak Lee
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea. .,Department of Chemistry, Princeton University, New Jersey, 08544, USA
| | - Ki Hyun Kim
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea.
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8
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Wennig R, Eyer F, Schaper A, Zilker T, Andresen-Streichert H. Mushroom Poisoning. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 117:701-708. [PMID: 33559585 DOI: 10.3238/arztebl.2020.0701] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/03/2020] [Accepted: 09/17/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Poisonous mushrooms are eaten by mushroom hunters out of ignorance, after misidentification as edible mushrooms, or as a psychoactive drug. Mushroom poisoning commonly leads to consultation with a poison information center and to hospitalization. METHODS This review is based on pertinent publications about the syndromes, toxins, and diagnostic modalities that are presented here, which were retrieved by a selective search in PubMed. It is additionally based on the authors' longstanding experience in the diagnosis and treatment of mushroom intoxication, expert consultation in suspected cases, macroscopic identification of wild mushrooms, and analytic techniques. RESULTS A distinction is usually drawn between mushroom poisoning with a short latency of less than six hours, presenting with a gastrointestinal syndrome whose course is usually relatively harmless, and cases with a longer latency of six to 24 hours or more, whose course can be life-threatening (e.g., phalloides, gyromitra, orellanus, and rhabdomyolysis syndrome). The DRG diagnosis data for Germany over the period 2000-2018 include a total of 4412 hospitalizations and 22 deaths due to the toxic effects of mushroom consumption. 90% of the fatalities were due to the death cap mushroom (amatoxins). Gastrointestinal syndromes due to mushroom consumption can be caused not only by poisonous mushrooms, but also by the eating of microbially spoiled, raw, or inadequately cooked mushrooms, or by excessively copious or frequent mushroom consumption. CONCLUSION There are few analytic techniques available other than the qualitative demonstration of amatoxins. Thus, the diagnosis is generally made on the basis of the clinical manifestations and their latency, along with meticulous history-taking, assisted by a mushroom expert, about the type(s) of mushroom that were consumed and the manner of their preparation.
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Affiliation(s)
- Robert Wennig
- Luxembourg: Prof. Dr. Robert Wennig (formerly Laboratoire National de Santé- Toxicologie, Université du Luxembourg-Campus Limpertsberg); Department of Clinical Toxicology & Poison Control Center Munich, Klinikum rechts der Isar, School of Medicine, Technical University of Munich; GIZ-Nord Poisons Centre,Göttingen University Hospital Faculty of Medicine and University Hospital Cologne and Department of Forensic Toxicology,University Hospital Cologne
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Trakulsrichai S, Jeeratheepatanont P, Sriapha C, Tongpoo A, Wananukul W. Myotoxic Mushroom Poisoning in Thailand: Clinical Characteristics and Outcomes. Int J Gen Med 2020; 13:1139-1146. [PMID: 33235487 PMCID: PMC7680089 DOI: 10.2147/ijgm.s271914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/04/2020] [Indexed: 01/04/2023] Open
Abstract
Purpose To describe the clinical characteristics and outcomes of myotoxic mushroom poisoning in Thailand. Patients and Methods We performed a retrospective cohort study of cases of myotoxic mushroom poisoning from the Ramathibodi Poison Center Toxic Exposure Surveillance System during a 5-year period (2012-2016). Results Forty-one cases were included. Most (53.7%) were male with the average age of 49 years. In three cases, the mushrooms were identified as Russula species by an experienced mycologist. Common presenting symptoms were gastrointestinal (GI) symptoms and myalgia. The median onset of GI symptoms and symptoms suggesting rhabdomyolysis after consuming mushrooms was 2 hours (0.17-24 hours) and 24-48 hours (2-120 hours), respectively. Eight patients who ate the mushrooms together with other patients with rhabdomyolysis had GI symptoms but did not develop rhabdomyolysis. For patients with rhabdomyolysis, acute kidney injury (AKI) and hyperkalaemia occurred in 51.5% and 33.3% of cases, respectively. Median initial and maximum creatine phosphokinase (CPK) levels in patients with rhabdomyolysis were 31,145 and 47,861 U/L, respectively. Fifteen of 17 patients who were investigated for troponin levels had elevated troponin. Three patients had a low ejection fraction. Most patients (95.1%) were admitted to hospital, with a median stay of 5 days. The mortality rate was 26.8%. Treatments included intravenous fluid, urine alkalinization, haemodialysis and peritoneal dialysis. Among patients with rhabdomyolysis, AKI, hyperkalaemia during hospitalisation, maximum CPK level, maximum creatinine level and initial and maximum potassium levels were the factors found to be significantly different between patients who died and those who survived. Conclusion Myotoxic mushroom poisoning had a high mortality rate. Most patients had early or delayed onset of clinical symptoms after mushroom ingestion. Some patients developed severe cardiovascular effects. Early detection, close monitoring (especially serum potassium, creatinine, CPK and cardiac effect) and good supportive care were the main treatment modalities.
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Affiliation(s)
- Satariya Trakulsrichai
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.,Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Peerawich Jeeratheepatanont
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Charuwan Sriapha
- Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Achara Tongpoo
- Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Winai Wananukul
- Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.,Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Nieminen P, Mustonen AM. Toxic Potential of Traditionally Consumed Mushroom Species-A Controversial Continuum with Many Unanswered Questions. Toxins (Basel) 2020; 12:E639. [PMID: 33023182 PMCID: PMC7599650 DOI: 10.3390/toxins12100639] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 02/06/2023] Open
Abstract
Mushroom poisonings remain a significant cause of emergency medicine. While there are well-known species, such as Amanita phalloides, causing life-threatening poisonings, there is also accumulating evidence of poisonings related to species that have been considered edible and are traditionally consumed. In particular, the Tricholoma equestre group was reported to cause myotoxicity. In addition, particular wild mushrooms that are traditionally consumed especially in Asia and Eastern Europe have been subject to suspicion due to possible mutagenicity. Hitherto, the causative agents of these effects often remain to be determined, and toxicity studies have yielded contradictory results. Due to this, there is no consensus about the safety of these species. The issue is further complicated by difficulties in species identification and other possible sources of toxicity, such as microbiological contamination during storage, leading to sometimes opposite conclusions about the edibility of a species. This review focuses on existing data about these types of mushroom poisonings, including the still sparse knowledge about the causative chemical agents. In addition, the aim is to initiate a meta-discussion about the issue and to give some suggestions about how to approach the situation from the viewpoint of the collector, the researcher, and the practicing physician.
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Affiliation(s)
- Petteri Nieminen
- Institute of Biomedicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland;
| | - Anne-Mari Mustonen
- Institute of Biomedicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland;
- Department of Environmental and Biological Sciences, Faculty of Science and Forestry, University of Eastern Finland, P.O. Box 111, FI-80101 Joensuu, Finland
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11
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Aleckovic-Halilovic M, Pjanic M, Mesic E, Storrar J, Woywodt A. From quail to earthquakes and human conflict: a historical perspective of rhabdomyolysis. Clin Kidney J 2020; 14:1088-1096. [PMID: 33841854 DOI: 10.1093/ckj/sfaa075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/13/2020] [Indexed: 12/19/2022] Open
Abstract
Rhabdomyolysis is a common cause of acute kidney injury, featuring muscle pain, weakness and dark urine and concurrent laboratory evidence of elevated muscle enzymes and myoglobinuria. Rhabdomyolysis is often seen in elderly and frail patients following prolonged immobilization, for example after a fall, but a variety of other causes are also well-described. What is unknown to most physicians dealing with such patients is the fascinating history of rhabdomyolysis. Cases of probable rhabdomyolysis have been reported since biblical times and during antiquity, often in the context of poisoning. Equally interesting is the link between rhabdomyolysis and armed conflict during the 20th century. Salient discoveries regarding the pathophysiology, diagnosis and treatment were made during the two world wars and in their aftermath. 'Haff disease', a form of rhabdomyolysis first described in 1920, has fascinated scientists and physicians alike, but the marine toxin causing it remains enigmatic even today. As a specialty, we have also learned a lot about the disease from 20th-century earthquakes, and networks of international help and cooperation have emerged. Finally, rhabdomyolysis has been described as a sequel to torture and similar forms of violence. Clinicians should be aware that rhabdomyolysis and the development of renal medicine are deeply intertwined with human history.
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Affiliation(s)
- Mirna Aleckovic-Halilovic
- Department of Nephrology, Dialysis and Transplantation, University Hospital Tuzla, Tuzla, Bosnia and Herzegovina
| | - Mirha Pjanic
- Department of Nephrology, Dialysis and Transplantation, University Hospital Tuzla, Tuzla, Bosnia and Herzegovina
| | - Enisa Mesic
- Department of Nephrology, Dialysis and Transplantation, University Hospital Tuzla, Tuzla, Bosnia and Herzegovina
| | - Joshua Storrar
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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12
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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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13
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Yin X, Yang AA, Gao JM. Mushroom Toxins: Chemistry and Toxicology. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2019; 67:5053-5071. [PMID: 30986058 DOI: 10.1021/acs.jafc.9b00414] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Mushroom consumption is a global tradition that is still gaining popularity. However, foraging for wild mushrooms and accidental ingestion of toxic mushrooms can result in serious illness and even death. The early diagnosis and treatment of mushroom poisoning are quite difficult, as the symptoms are similar to those caused by common diseases. Chemically, mushroom poisoning is related to very powerful toxins, suggesting that the isolation and identification of toxins have great research value, especially in determining the lethal components of toxic mushrooms. In contrast, most of these toxins have remarkable physiological properties that could promote advances in chemistry, biochemistry, physiology, and pharmacology. Although more than 100 toxins have been elucidated, there are a number of lethal mushrooms that have not been fully investigated. This review provides information on the chemistry (including chemical structures, total synthesis, and biosynthesis) and the toxicology of these toxins, hoping to inspire further research in this area.
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Affiliation(s)
- Xia Yin
- Shaanxi Key Laboratory of Natural Products & Chemistry Biology, College of Chemistry & Pharmacy , Northwest A & F University , Yangling 712100 , People's Republic of China
| | - An-An Yang
- Department of Pathology , The 969th Hospital of PLA , Hohhot , Inner Mongolia 010000 , People's Republic of China
| | - Jin-Ming Gao
- Shaanxi Key Laboratory of Natural Products & Chemistry Biology, College of Chemistry & Pharmacy , Northwest A & F University , Yangling 712100 , People's Republic of China
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White J, Weinstein SA, De Haro L, Bédry R, Schaper A, Rumack BH, Zilker T. Mushroom poisoning: A proposed new clinical classification. Toxicon 2019; 157:53-65. [DOI: 10.1016/j.toxicon.2018.11.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 10/30/2018] [Accepted: 11/07/2018] [Indexed: 01/19/2023]
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15
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陆 湛, 陈 艳, 黄 波, 彭 升, 王 倩, 刘 丹, 王 华. [Mixed amanita phalloides poisoning with rhabdomyolysis: analysis of 4 cases]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:635-638. [PMID: 29891465 PMCID: PMC6743900 DOI: 10.3969/j.issn.1673-4254.2018.05.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Indexed: 06/08/2023]
Abstract
We report the clinical characteristics, treatments and outcomes of 4 rare cases of mixed amanita fuliginea and amanita rimosa poisoning with rhabdomyolysis, and review the research progress in the intoxication mechanism and treatment. The latent time of amanita poisoning, defined as the period from the ingestion of poisonous mushroom to the onset of gastrointestinal symptoms, was about 8 days, and the severity of poisoning was associated with the amount of mushroom ingested. All the 4 patients developed multiple organ dysfunctions within 3 to 4 days after mushroom ingestion, predominantly in the liver, kidney and central nervous system accompanied with acute gastrointestinal injury and rhabdomyolysis. The treatment measures included persistent hemofiltration and intermittent hemoperfusion once daily for 5-7 days, and plasma exchange was administered in 2 cases for 1 or 2 times. High-dose vitamin C, glucose and corticosteroid were also given to the patients. After the treatments, two patients were cured and the other two died due to an excess intake of poisonous mushroom and lack of early preemptive therapies. Early emetic, gastric lavage, catharsis, fluid infusion and diuresis are critical to interrupt the enterohepatic circulation of amanita phalloides toxins and prevent the development of multiple organ dysfunction. Enhanced hemofiltration and sequential plasma therapy might effectively eliminate toxin from the blood to protect against further organ damages.
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Affiliation(s)
- 湛 陆
- 南方医科大学珠江医院重症医学科,广东 广州 510282Intensive Care Unit, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
- 钦州市第一人民医院重症医学科,广西 钦州 535000Intensive Care Unit, First Municipal Hospital of Qinzhou, Qinzhou 535000, China
| | - 艳波 陈
- 南方医科大学珠江医院重症医学科,广东 广州 510282Intensive Care Unit, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
- 广东药科大学第一附属医院内二科,广东 广州 510080First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, China
| | - 波 黄
- 南方医科大学珠江医院重症医学科,广东 广州 510282Intensive Care Unit, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 升 彭
- 南方医科大学珠江医院重症医学科,广东 广州 510282Intensive Care Unit, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 倩文 王
- 南方医科大学珠江医院重症医学科,广东 广州 510282Intensive Care Unit, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 丹蕾 刘
- 南方医科大学珠江医院重症医学科,广东 广州 510282Intensive Care Unit, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 华 王
- 南方医科大学珠江医院重症医学科,广东 广州 510282Intensive Care Unit, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
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Mustonen AM, Määttänen M, Kärjä V, Puukka K, Aho J, Saarela S, Nieminen P. Myo- and cardiotoxic effects of the wild winter mushroom ( Flammulina velutipes) on mice. Exp Biol Med (Maywood) 2018; 243:639-644. [PMID: 29495884 DOI: 10.1177/1535370218762340] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rhabdomyolysis (destruction of striated muscle) is a novel form of mushroom poisoning in Europe and Asia indicated by increased circulating creatine kinase levels. Particular wild fungi have also been reported to induce elevated creatine kinase activities in mice. Flammulina velutipes (enokitake or winter mushroom) is one of the most actively cultivated mushroom species globally. As it is marketed as a medicinal mushroom and functional food, it is important to examine whether it could induce potentially harmful health effects similar to some previously studied edible fungi. The present study examined the effects of F. velutipes consumption on the plasma clinical chemistry, hematology, and organ histology of laboratory mice. Wild F. velutipes were dried, pulverized, mixed with a regular laboratory rodent diet, and fed to the animals at 0, 3, 6, or 9 g/kg body mass/day for five days ( n = 6/group). F. velutipes consumption caused increased activities of plasma creatine kinase and the MB-fraction of creatine kinase at 6-9 g/kg/d, indicating potentially deleterious effects on both skeletal and cardiac muscle. The plasma total and high-density lipoprotein cholesterol concentrations (at 9 g/kg/d) and white blood cell and lymphocyte counts (at 6-9 g/kg/d) decreased. Although the cholesterol-lowering properties of F. velutipes can be beneficial, the previously unexamined, potentially hazardous side effects of mushroom consumption (myo- and cardiotoxicity) should be thoroughly investigated before recommending this mushroom species as a health-promoting food item. Impact statement This work is important to the field of functional foods, as it provides novel information about the potential myo- and cardiotoxic properties of an edible mushroom, Flammulina velutipes. The results are useful and of importance because F. velutipes is an actively cultivated mushroom and marketed as a health-promoting food item. The findings contribute to the understanding of the complexity of the balance between the beneficial and potentially harmful effects of mushroom consumption.
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Affiliation(s)
- Anne-Mari Mustonen
- 1 Institute of Biomedicine/Anatomy, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio FI-70211, Finland.,2 Department of Environmental and Biological Sciences, Faculty of Science and Forestry, University of Eastern Finland, Joensuu FI-80101, Finland
| | - Maija Määttänen
- 3 Department of Food and Environmental Sciences, Faculty of Agriculture and Forestry, University of Helsinki, Helsinki FI-00014, Finland
| | - Vesa Kärjä
- 4 Department of Pathology, Kuopio University Hospital, Kuopio FI-70211, Finland
| | - Katri Puukka
- 5 NordLab Oulu, Oulu University Hospital, Oulu FI-90029, Finland.,6 Department of Clinical Chemistry, Faculty of Medicine, University of Oulu, Oulu FI-90014, Finland
| | - Jari Aho
- 7 Municipal Veterinary Clinic of Joensuu, Joensuu FI-80110, Finland
| | - Seppo Saarela
- 8 Department of Ecology and Genetics, Faculty of Science, University of Oulu, Oulu FI-90014, Finland
| | - Petteri Nieminen
- 1 Institute of Biomedicine/Anatomy, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio FI-70211, Finland.,2 Department of Environmental and Biological Sciences, Faculty of Science and Forestry, University of Eastern Finland, Joensuu FI-80101, Finland
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Cervellin G, Comelli I, Rastelli G, Sanchis-Gomar F, Negri F, De Luca C, Lippi G. Epidemiology and clinics of mushroom poisoning in Northern Italy: A 21-year retrospective analysis. Hum Exp Toxicol 2017; 37:697-703. [DOI: 10.1177/0960327117730882] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Limited information exists about epidemiology and management of mushroom poisoning. We analyzed and described epidemiology, clinical presentation, and clinical course of mushroom-poisoned patients admitted to emergency departments (EDs) of the Province of Parma, Italy. Methods: Data from the database of mycological service were matched with clinical information retrieved from hospitals’ database, from January 1, 1996 to December 31, 2016. Results: Mycologist consultation was obtained in 379/443 identified mushroom poisonings. A remarkable seasonality was found, with significant peak in autumn. Thanks to the collaboration, the implicated species could be identified in 397 cases (89.6%); 108 cases (24.4%) were due to edible mushrooms, Boletus edulis being the most represented (63 cases). Overall, 408 (92%) cases presented with gastrointestinal toxicity. Twenty cases of amatoxin poisoning were recorded (11 Amanita phalloides and 9 Lepiota brunneoincarnata). One liver transplantation was needed. We observed 13 cases of cholinergic toxicity and 2 cases of hallucinogenic toxicity. Finally, 46 cases were due to “mixed” toxicities, and a total of 69 needed hospitalization. Conclusions: Early identification and management of potentially life-threatening cases is challenging in the ED, so that a mycologist service on call is highly advisable, especially during periods characterized by the highest incidence of poisoning.
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Affiliation(s)
- G Cervellin
- Emergency Department, University Hospital of Parma, Parma, Italy
| | - I Comelli
- Emergency Department, University Hospital of Parma, Parma, Italy
| | - G Rastelli
- Emergency Department, Hospital of Fidenza, Fidenza, Parma, Italy
| | - F Sanchis-Gomar
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - F Negri
- Mycological Consultation Service, Local Health Agency of Parma, Parma, Italy
| | - C De Luca
- Mycological Consultation Service, Local Health Agency of Parma, Parma, Italy
| | - G Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Cervellin G, Comelli I, Benatti M, Sanchis-Gomar F, Bassi A, Lippi G. Non-traumatic rhabdomyolysis: Background, laboratory features, and acute clinical management. Clin Biochem 2017; 50:656-662. [PMID: 28235546 DOI: 10.1016/j.clinbiochem.2017.02.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 12/11/2022]
Abstract
Rhabdomyolysis is a relatively rare condition, but its clinical consequences are frequently dramatic in terms of both morbidity and mortality. Although no consensus has been reached so far about the precise definition of this condition, the term rhabdomyolysis describes a rapid breakdown of striated, or skeletal, muscle. It is hence characterized by the rupture and necrosis of muscle fibers, resulting in release of cell degradation products and intracellular elements within the bloodstream and extracellular space. Notably, the percentage of patients with rhabdomyolysis who develop acute kidney injury, the most dramatic consequence, varies from 13% to over 50% according to both the cause and the clinical and organizational setting where they are diagnosed. Despite direct muscle injury (i.e., traumatic rhabdomyolysis) remains the most common cause, additional causes, frequently overlapping, include hypoxic, physical, chemical or biological factors. The conventional triad of symptoms includes muscle pain, weakness and dark urine. The laboratory diagnosis is essentially based on the measurement of biomarkers of muscle injury, being creatine kinase (CK) the biochemical "gold standard" for diagnosis, and myoglobin the "gold standard" for prognostication, especially in patients with non-traumatic rhabdomyolysis. The essential clinical management in the emergency department is based on a targeted intervention to manage the underlying cause, combined with infusion of fluids and eventually sodium bicarbonate. We will present and discuss in this article the pathophysiological and clinical features of non-traumatic rhabdomyolysis, focusing specifically on Emergency Department (ED) management.
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Affiliation(s)
| | - Ivan Comelli
- Emergency Department, Academic Hospital of Parma, Parma, Italy
| | - Mario Benatti
- Emergency Department, Academic Hospital of Parma, Parma, Italy
| | - Fabian Sanchis-Gomar
- NYU Langone Medical Center, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, USA; Department of Physiology, Faculty of Medicine, University of Valencia and Fundación Investigación Hospital Clínico Universitario de Valencia, Instituto de Investigación INCLIVA, Valencia, Spain
| | - Antonella Bassi
- Laboratory of Clinical Chemistry and Hematology, University Hospital of Verona, Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Chemistry, University of Verona, Verona, Italy
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