A guide to mycetisms: A toxicological and preventive overview

Fungi are often considered a delicacy and are primarily cultivated and harvested, although numerous species are responsible for intoxication due to toxin content. Foodborne diseases are a significant public health concern, causing approximately 420 000 deaths and 600 million morbidities yearly, of which mushroom poisoning is one of the leading causes. Epidemiological data on non-cultivated mushroom poisoning in individual countries are often unrepresentative, as intoxication rarely requires emergency intervention. On the other hand, the lack of specialist knowledge among medical personnel about the toxicological manifestations of mushroom consumption may result in ineffective therapeutic interventions. This work aims to provide an easy-to-consult and wide-ranging tool useful for better understanding the variability of mushroom intoxications, the associated symptoms, and the main treatments for the most severe cases, given the absence of a complete species mapping tool toxic. Moreover, we establish an effective collection network that describes the incidence of mushroom poisonings by reporting the species and associated toxicological manifestations for each case. In conclusion, we highlight the need to establish appropriate primary prevention interventions, such as training the affected population and increasing consultancy relationships between mycological experts and specialised healthcare personnel.

Mushroom poisoning outbreaks in Guizhou Province, China: a prediction study using SARIMA and Prophet models

Mushroom poisoning is a public health concern worldwide that not only harms the physical and mental health of those who are poisoned but also increases the medical and financial burden on families and society. The present study aimed to describe and analyze the current situations and factors influencing mushroom poisoning outbreaks in Guizhou province, Southwest China, between January 2012 and June 2022, and to predict the future trends of its occurrence. Our study provides a basis for the rational formulation of prevention and control and medical resource allocation policies for mushroom poisoning. The epidemiological characteristics and factors influencing mushroom poisoning incidence were analyzed using descriptive epidemiological methods and the chi-squared test, respectively. Then, future occurrence trends were predicted using the SARIMA and Prophet models. In total, 1577 mushroom poisoning incidents were recorded in Guizhou Province, with 7347 exposures, 5497 cases, 3654 hospitalizations, and 93 fatalities. The mortality rate was 4.45% in 1 ~ 6 years higher than other age groups. There were notable geographic and seasonal characteristics, with the number of occurrences much higher in rural areas (1198) than in cities (379), and poisoning cases were more common during the rainy season (June to September). The mortality rate of household poisoning cases was 1.86%, with the most deaths occurring in households. Statistically significant differences were observed in the incidence across various cities, periods, and poisoning locations (P < 0.05). Both models had advantages and disadvantages for prediction. Nevertheless, the SARIMA model had better overall prediction results than the Prophet model (R > 0.9, the residual plot of the prediction results was randomly distributed, and RMSESARIMA < RMSEProphet). However, the prediction result plot of the Prophet model was more explanatory than the SARIMA model and could visualize overall and seasonal trends. Both models predicted that the prevalence of mushroom poisoning would continue to increase in the future; however, the number of fatalities is generally declining. Seasonal patterns indicated that a high number of deaths from gooseberry mushroom poisoning occurred in October. The epidemiological trends of mushroom poisoning remain severe, and health education on related knowledge must be strengthened in rural areas, with June to October as the key prevention and control phase. Further, medical treatment of mushroom poisoning cases with clinical symptoms should pay attention to inquiries to check whether the mushroom is similar in appearance to the Amanita, particularly in October.

A ten-year retrospective California Poison Control System experience with possible amatoxin mushroom calls

INTRODUCTION

Mushrooms containing amatoxin are found worldwide and represent a challenging poisoning for the clinician and consulting poison center. This study evaluates the experience of a large poison system with possible amatoxin-containing mushroom ingestion calls.

METHODS

A 10-year retrospective review of the California Poison Control System database was performed for amatoxin mushroom ingestion calls resulting in hospitalization. Cases found were abstracted and data statistically analyzed for association with a composite endpoint of death, liver transplant, and/or the need for dialysis.

RESULTS

Amatoxin-containing mushroom calls are infrequent with the vast majority (98.4 percent) coming from Northern California during the rainier first and fourth quarters (October through March) of the year. Elevated initial aminotransferase activities and international normalized ratios were predictive of the composite negative outcome. The mortality plus liver transplant and hemodialysis composite rate was 8.2 percent, consistent with current literature.

CONCLUSION

The California Poison Control System has relatively few amatoxin-containing mushroom ingestion calls that result in hospitalization but those that are reported mostly occur in Northern California. Treatment bias towards the sickest patients may explain the association of intravenous fluid use or treatment with acetylcysteine or silibinin with meeting the composite outcome. The initial presence of elevated hepatic aminotransferase activity and international normalized ratios are poor prognostic indicators and are likely reflective of late presentation, an advanced toxic phase of amatoxin poisoning, and/or delays in time to obtain poison center consultation.

A network system for the prevention and treatment of mushroom poisoning in Chuxiong Autonomous Prefecture, Yunnan Province, China: implementation and assessment

BACKGROUND

Mushroom poisoning is a major public health issue in China. The integration of medical resources from different institutes of different levels is crucial in reducing the harm of mushroom poisoning. However, few studies have provided comprehensive implementation procedures and postimplementation effectiveness evaluations. To reduce the harm caused by mushroom poisoning, a network system for the prevention and treatment of mushroom poisoning (NSPTMP) was established in Chuxiong, Yunnan Province, a high-risk area for mushroom poisoning.

METHODS

The NSPTMP consists of three types of institutions, namely, centers for disease prevention, hospitals, and health administration departments, with each kind of institution comprising prefecture, county/city, town, and village levels. After three years of implementation, the network was evaluated by comparing the indices before and after network implementation using data from the "Foodborne Disease Outbreak Surveillance System" and 17 hospitals in Chuxiong. The indices included the fatalities caused by mushroom poisoning, the composition ratios of different types of mushrooms for both outpatients and inpatients and the hospitalization rates.

RESULTS

Compared to the average fatality rate of mushroom poisoning from 2015 to 2017, the average fatality rate from 2018 to 2020 significantly decreased from 0.57 to 0.06% (P < 0.001). Regarding the poisonous genus containing lethal mushrooms, the outpatient and inpatient composition ratios significantly decreased for Amanita (9.36-2.91% and 57.23-17.68%, respectively) and Russula (15.27-8.41%) (P < 0.05). Regarding poisonous mushrooms that caused mild symptoms, the outpatient and inpatient composition ratios significantly increased for Scleroderma (5.13-13.90% and 2.89-18.90%, respectively) and Boletaceae (19.08-31.71%) (P < 0.05), and the hospitalization rates significantly increased for Scleroderma (6.33-18.02%) and Boletaceae (5.65-12.71%) (P < 0.05).

CONCLUSIONS

These findings suggest that the NSPTMP effectively reduced the harm caused by mushroom poisoning. In addition to the integration of medical resources, the development of poisonous mushroom identification, hierarchical treatment systems in hospitals, public education, and professional training also played important roles in improving the system's effectiveness. The establishment and evaluation of the NSPTMP in Chuxiong Prefecture can provide valuable insights and serve as a model for other regions facing similar challenges in managing mushroom poisoning.

Alternatives for mushroom poisoning timely care in Mexico and Central America

BACKGROUND

In countries where the consumption of mushrooms is common, hundreds of mushroom poisonings occur every year, which represents a public health problem. In Mexico, mushroom poisoning is classified as a non-bacterial gastrointestinal poisoning, which prevents timely care.

OBJECTIVE

To create a free-access platform that synthesizes and standardizes the information on mycetism cases and offers tools for diagnosis and timely treatment.

MATERIAL AND METHODS

In locations where cases of mycetism have occurred, information was obtained on the fungi involved, the poisonings that occurred, care protocols, and sample processing.

RESULTS

Records were generated that synthesize and describe the types of mycetism with the highest probability of occurrence in Mexico. Therein, the biological characteristics of fungi, the symptoms they cause and their treatment are described. A protocol proposal for patient care and for the processing of biological samples is presented. Finally, a form is included to collect information on cases of poisoning.

CONCLUSIONS

Systematized and analyzed information on mycetism allows to simplify its diagnosis, attention and treatment. The protocols for clinical care and sample processing are the basis for generating strategies that prevent deaths due to mycetism.

[An investigation of a food poisoning incident caused by Amanita fuliginea]

Mistakenly picking and eating poisonous mushrooms can cause acute poisoning. In August 2020, Qingdao Hospital of Traditional Chinese Medicine handled a poisonous mushroom poisoning incident, conducted epidemiological investigation on all poisoned patients, collected suspicious food, clinical manifestations, clinical test results and treatment conditions, and identified the mushrooms as Amanita fuliginea poisoning after morphological identification. In this incident, 6 people ate grey goose paste, of which 4 were sick with a incubation period of 6~12 h. The clinical manifestations were gastrointestinal symptoms such as nausea, vomiting and diarrhea, liver and kidney damage. After symptomatic support treatment, hemoperfusion or continuous hemofiltration treatment, the patients were cured and discharged. It is suggested to strengthen the popular science education on poisonous mushroom poisoning and improve the ability of identification and clinical treatment of poisonous mushrooms in grass-roots medical institutions.

Epidemiology and Economic Burden of an Outbreak of Cyclopeptide-Containing Mushroom Poisoning in the West of Iran

Little evidence is available on the epidemiological and economical dimensions of certain foodborne diseases such as wild mushroom poisoning. This study aimed to investigate the epidemiology and estimate the costs of poisoning with cyclopeptide-containing mushrooms in Kermanshah province in 2018. In this study, poisoning was investigated in different subgroups. The cost of illness method with a bottom-up approach was used to estimate the poisoning costs. Both direct and indirect costs of the poisoning were included in the analysis. The perspective of the study was society. Required data were obtained from the medical records of Imam Khomeini hospital and completed through a line survey with the patients. Two hundred eighty-three patients were poisoned in Kermanshah due to poisoning with cyclopeptide-containing mushrooms. Of 283 patients, 143 (50.53%) were men and 59.01% of patients were rural residents. About 43% of admissions were out-patient cases and ~40% of patients were hospitalized within 1–3 days. Also, eight patients were pronounced dead in the area. The total cost of poisoning with cyclopeptide-containing mushrooms in Kermanshah province was $ 1,259,349.26. Of that, $ 69,281.65 was related to direct medical costs and $ 10,727.23 was direct non-medical costs. The indirect costs of death were estimated to be $ 1,125,829.7. The current study revealed that there is a significant financial burden due to cyclopeptide-containing mushrooms on patients, the health system, and society as a whole. Further studies are recommended to clarify the epidemiological and economic burden of foodborne illnesses related to wild mushroom poisonings. Sharing the outputs with health authorities, and informing the general public are warranted to reduce the burden of such diseases.

Nephrotoxic Mushroom Poisoning: Global Epidemiology, Clinical Manifestations, and Management

Because mushroom poisonings are increasing worldwide after ingestions of known, newly described, and formerly considered edible species, the objectives of this review are to describe the global epidemiology of nephrotoxic mushroom poisonings, to identify nephrotoxic mushrooms, to present a toxidromic approach to earlier diagnoses of nephrotoxic mushroom poisonings based on the onset of acute renal failure, and to compare the outcomes of renal replacement management strategies. Internet search engines were queried with the keywords to identify scientific articles on nephrotoxic mushroom poisonings and their management during the period of 1957 to the present. Although hepatotoxic, amatoxin-containing mushrooms cause most mushroom poisonings and fatalities, nephrotoxic mushrooms, most commonly Cortinarius species, can cause acute renal insufficiency and failure. Several new species of nephrotoxic mushrooms have been identified, including Amanita proxima and Tricholoma equestre in Europe and Amanita smithiana in the United States and Canada. In addition, the edible, hallucinogenic mushroom Psilocybe cubensis has been noted recently via mass spectrometry as a rare cause of acute renal insufficiency. Renal replacement therapies including hemodialysis are often indicated in the management of nephrotoxic mushroom poisonings, with renal transplantation reserved for extracorporeal treatment failures.

Three Cases of Food Poisoning Due to Paralepistopsis acromelalga Diagnosed from an Outbreak of Erythromelalgia

A married couple of a 62-year-old woman and a 64-year-old man as well as their neighbor, an 84-year-old woman, visited the hospital complaining of a burning sensation on their hands and feet that had presented on the same day. They had consumed mushrooms that had been picked on a mountain five days before the onset of the symptoms. The symptoms were attributed to Paralepistopsis acromelalga. In conclusion, asking about the dietary history is considered essential when diagnosing the cause of erythromelalgia, which has multiple causative diseases, including food poisoning due to P. acromelalga.

Health Care Utilization and Outcomes Associated with Accidental Poisonous Mushroom Ingestions - United States, 2016-2018

Accidental consumption of poisonous mushrooms can result in serious illness and death (1). Reports of severe poisonings from consumption of foraged mushrooms for food or hallucinogenic purposes increased during 1999-2016 (2), and approximately 7,500 poisonous mushroom ingestions were reported annually to poison control centers across the United States (1). To estimate the frequency of emergency department (ED) visits, hospitalizations, and severe adverse outcomes associated with accidental poisonous mushroom ingestion in the United States, CDC analyzed 2016 data from the Healthcare Cost and Utilization Project's* Nationwide Emergency Department Sample (HCUP-NEDS) and National Inpatient Sample (HCUP-NIS) databases as well as 2016-2018 data from three IBM MarketScan sources: Commercial Claims and Encounters (CCAE), Medicare Supplemental and Coordination of Benefits (Medicare), and Multi-State Medicaid databases. During 2016, 1,328 (standard error [SE] = 100) ED visits and 100 (SE = 22) hospitalizations (HCUP data) were associated with accidental poisonous mushroom ingestion. Among 556 patients with a diagnosis of accidental poisonous mushroom ingestion, 48 (8.6%) patients experienced a serious adverse outcome during 2016-2018 (MarketScan data). Serious adverse outcomes were more common among Medicaid-insured patients than among patients with commercial insurance or Medicare (11.5% versus 6.7%, p = 0.049). Because most mushroom poisonings are preventable, wild mushrooms should not be consumed unless they are identified by an expert; increased public health messaging about the potential dangers of mushroom poisoning is needed.

[How poisonous is the Dutch wildlife?]

Recent publications on fatal cases of mushroom poisoning and wasp's stings in the Netherlands raised the question how poisonous the Dutch wildlife is. In this article I focus on plants, berries, mushrooms and animals. The annual reports of the National Poison Control Center provide the number of consultations related to mushroom poisoning, toxic plants and animals. The majority of consultations concerns contact with toxic plants in gardens and indoors. In three-quarter of the cases the patient is a child (0-12 years). Serious mushroom poisoning occurs mainly in adults who mistook a poisonous mushroom for an edible one. Although snake bites are reported in the Netherlands, most of these are due to exotic snakes kept in indoor terraria. Fatal reactions to wasp's stings are due to anaphylactic reactions. All in all, poisoning is rare and the Dutch countryside can be considered a safe place.

[Emergence of amatoxin poisoning in the Netherlands]

CASE DESCRIPTION

A 34-year-old woman from Thai origin developed acute liver failure after ingestion of a soup which contained the death cap (Amanita phalloides).

BACKGROUND

In patients with poisoning due to amatoxin-containing mushrooms, gastro-intestinal complaints usually develop several hours after ingestion, followed by acute hepatic failure which occasionally leads to death. The incidence of reported mushroom poisonings in the Netherlands has increased in 2019, which is possibly associated with migration of asylum seekers who regularly pick and eat mushrooms.

CONCLUSION

In the Netherlands mushroom intoxication is rare. Therefore, there is a lack of knowledge among health care personnel and foragers. The present case report highlights the importance of awareness of the poisonous death cap to prevent intoxications and optimize treatment decisions.

The Yellow Knight Fights Back: Toxicological, Epidemiological, and Survey Studies Defend Edibility of Tricholoma equestre

Rhabdomyolysis, a condition associated with the consumption of Yellow Knight mushrooms (Tricholoma equestre), was first reported in 2001. In response, some countries began to consider the mushroom as poisonous, whereas in others it is still consumed. In the present study, a nationwide survey of Polish mushroom foragers (n = 1545) was conducted to estimate the frequency of T. equestre consumption. The epidemiological database on mushroom poisonings in Poland was analyzed from the year 2008. Hematological and biochemical parameters were followed for a week in 10 volunteers consuming 300 g of molecularly identified T. equestre. More than half the foragers had consumed T. equestre at least once in their lifetime and a quarter had consumed it consecutively. The frequency of adverse events was low and no rhabdomyolysis was reported. The toxicological database indicated that mushrooms from the Tricholoma genus caused poisonings less frequently than mushrooms with well-established edibility and not a single case of rhabdomyolysis has been reported within the last decade. The volunteers consuming T. equestre revealed no hematological or biochemical alterations and no adverse effects were observed. The findings of this study support the view that T. equestre is edible if consumed in rational amounts by healthy subjects.

Mushroom poisoning: a retrospective study concerning 11-years of admissions in a Swiss Emergency Department

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.

Foodborne infections and intoxications in Poland in 2015

AIM

The purpose of the study is to assess the epidemiological situation of food poisonings and infections in Poland in 2015

MATERIALS AND METHODS

The evaluation was based on the analysis of information sent to Department of Epidemiology NIPH-NIH through ROE (Pol. Rejestr Ognisk Epidemicznych)- (an electronic system created for uploading, transfer and analysis of data acquired during the outbreak investigations). Additional sources for the analysis were NIZP-PZH annual bulletins (Czarkowski MP et al. “Infectious diseases and poisonings in Poland”, 2007-2015. Warsaw, NIPH-NIH and GIS)

RESULTS

In 2015 a total number of 560 foodborne infections and intoxications outbreaks were reported in which 21 962 persons were exposed and 7 037 (including 1 896 children up to 14 years of age) got sick. Hospitalization was required for 1 905 of patients. The most frequent etiological agent was Salmonella sp. – 34.3%, and 21.4 % of cases). Viruses were responsible for 23.9% of outbreaks and 29.7 % of cases (And among them rotaviruses– 13% of outbreaks and 7.1% of cases and noroviruses– 10.5% of outbreaks and 26.9% of cases). In 25.2% of outbreaks no etiological agent was found. Just as in 2014 private household was the most frequent place of an outbreak (235 outbreaks), and after that– hospital (148 outbreaks). In 2014 the most frequent vehicle were cakes and desserts (25.6% of all outbreaks with known etiological agent). In 2015 the most frequent vehicle of infection were eggs and egg products) (19% of outbreaks of known vehicle). In 57.3% of outbreaks no vehicle was found or proved. Moreover in 2015 a total number of 4 outbreaks in which more than 100 cases were reported

CONCLUSIONS

The increase in the number of foodborne outbreaks of Salmonella Enteritidis etiology along with the fact of eggs and egg products being the most frequent vehicle indicates an alarming situation and the necessity of microbiological surveillance enchantment in relation to those products

Human and experimental toxicology of orellanine

Orellanine is a nephrotoxic toxin produced by some mushroom species of the Cortinarius genus, typically found in Europe and North America. The nephrotoxicity of Cortinarius orellanus is well known and was first recognized in the 1950s when this mushroom was identified as the cause of a mass poisoning in Poland. Typically, onset of symptoms is delayed for 1-2 weeks after ingestion. Some patients suffer mild gastrointestinal discomfort in the latency period before developing signs of renal impairment due to severe interstitial nephritis, acute focal tubular damage, and interstitial fibrosis. There is no specific antidote to orellanine poisoning. The mainstay of treatment is the prevention of secondary complications of kidney failure, adequate dialysis and, in the case of incomplete recovery, management of chronic renal insufficiency. : In this work, we aim to review about Cortinarius species, including epidemiological studies, chemical structure, toxicokinetics, toxic doses, mechanisms of toxicity, diagnosis, prognosis, and treatment options.

A retrospective study of mushroom poisoning in Iran

The objective of this study was to describe the pattern of mushroom poisoning in adults admitted to the Loghman Hakim Hospital Poison Center from 1992 to 2002. All patients ≥ 12 years of age were included in the study. The frequency of mushroom poisoning with respect to age, sex, season, reason, place of residence, latent phase, clinical and laboratory findings, treatment, and outcome of patients was investigated. Of the 72 421 poisoning cases admitted to Loghman-Hakim Hospital Poison Center from 1992 to 2002, only 37 were poisoned by consumption of toxic mushrooms. As some of the patients' files were incomplete, only 25 files were included in the study. Of this number, 68% were male. The patients' age ranged between 12 and 65 years, with a mean of 31 years of age. All cases were accidental and mostly from Tehran (36%) and the northern provinces (rainy woodlands) of Iran (32%). Autumn was the most common season for poisoning with a frequency of 80%. The latent phase of poisonings was between 0.5 and 12 hours. The most frequently reported symptoms were vomiting (84%), nausea (60%), abdominal pain (60%) and diarrhea (40%). Jaundice was observed in 44% of cases, with a 50% rate of hepatic encephalopathy. A total of 66% of patients were discharged and the duration range of hospitalization was 1-12 days.

In conclusion, people should be more informed of the dangers posed by wild mushrooms. Training of physicians and nurses in the accurate diagnosis and management of patients poisoned with poisonous mushrooms would improve the rate of survival.

A botulism outbreak from roasted canned mushrooms

Food-borne botulism is a rare disease that results from ingestion of the toxins produced by Clostridium botulinum. The most common cause of the disease is the consumption of home-canned foods prepared under inappropriate conditions, especially in rural environments. In this report, a food-borne botulism outbreak potentially caused by roasted home-canned mushrooms is evaluated and the major reasons for delayed diagnosis are emphasized. The clinical features, symptoms and prognosis of the five botulism patients involved in this outbreak are presented. The clinical progressions, treatments, durations of mechanical ventilation, intensive care unit stays and hospital stays of the three patients admitted to Akdeniz University Hospital are reported.

Foodborne infections and intoxications in Poland in 2013

AIM

The purpose of the study is to assess the epidemiological situation of food poisonings and infections in Poland in 2013.

MATERIALS AND METHODS

The evaluation was based on the analysis of information from reports of epidemiological investigations in outbreaks of food poisonings and infections, submitted by the sanitary-epidemiological stations to the Department of Epidemiology, NIZP-PZH annual bulletins (Czarkowski MP et al. "Infectious diseases and poisonings in Poland", 2006-2013. Warsaw, NIPH-NIH and GIS).

RESULTS

In 2013 a further decrease in the number of infections and intoxications with bacterial etiology and an increase in the infections of viral etiology was observed. Furthermore 2013 is another year with low number of cases of trichinellosis (9 cases in total). In 2013 a total number of 491 foodborne infections and intoxications outbreaks were reported in which there were 29,179 persons exposed and 5,664 (including 2 193 children up to 14 years of age) persons ill. Hospitalization was required for 1,445 persons. The most frequent etiological agent in those outbreaks was Salmonella spp.--which was responsible for 36,3% of outbreaks and 21,5% of cases. Viruses were responsible for 29,7 of outbreaks and 45,7 cases, in 19,3% of outbreaks no etiological agent was established. Like in 2012 the most frequent vehicle were dishes made from eggs and milk combined with eggs (9,4% of outbreaks). In 65% of outbreaks reported no vehicle could be found. Moreover in 2013 a total number of 3 outbreaks in which more than 100 cases were reported.

CONCLUSIONS

The increase in the number of foodborne outbreaks of viral etiology shows the need of adjustment some aspects of epidemiological investigations especially such features as: laboratory conformation of etiological agent of ill persons as well as persons involved in the food processing and meals preparing and the aspect of food samples testing.

[Management of poisoning with Amanita phalloides]

Death cap (Amanita phalloides) is commonly found and is one of the five most toxic fungi in Denmark. Toxicity is due to amatoxin, and poisoning is a serious medical condition, causing organ failure with potential fatal outcome. Acknowledgement and clarification of exposure, symptomatic and focused treatment is of primary importance. No data from randomised, controlled trials on management exists, and there is not international consensus on treatment regime. We present amatoxin-case contacts to the Danish Poison Centre from 2006-2012 and summarize current knowledge and Danish recommendations in amatoxin poisoning management.

Foodborne infections and intoxications in Poland in 2012

AIM

The purpose of the study is to assess the epidemiological situation of foodborne infections and intoxications in Poland in 2012.

MATERIALS AND METHODS

The evaluation was based on analysis of information from reports of epidemiological investigations in foodborne outbreaks, submitted by the sanitary-epidemiological stations to the Department of Epidemiology, NIZP-PZH annual bulletins (Czarkowski MP et al. "Infectious diseases and poisonings in Poland", 2006-2012. Warsaw, NIPH-NIH and CSI).

RESULTS

In Poland in 2012 there was observed decrease in the number of infections intoxications both of bacterial and viral origin. It was recorded only one case of trichinellosis. There were reported 491 outbreaks of foodborne poisonings or infections included 5 774 people, among them 718 children 1-14 years old. Out of them 1 364 people were hospitalized. Unlike last year, the predominant etiological agent in those outbreaks were zoonotic Salmonella serotypes which caused 38.1% outbreaks and 26.7% outbreak cases. The viruses have caused 27.1% of outbreaks and 36.2% of cases. In 23.8% of outbreaks etiological agent has not been established. Most often the settings of an outbreak was a private household - 236 outbreaks and a hospital (84 outbreaks). As in previous years, the most common vehicle of infection were foods prepared with milk and eggs -11.8% of outbreaks and egg dishes - 9.0%. In 57.6% of oubreaks vehicle of infection has not been established. Among outbreaks reported in 2012, there were 4 which involved more than 100 people. In 163 outbreaks of food items had been tested and in 33% of them the results were positive.

CONCLUSIONS

The increasing negative results of bacteriological examinations of food items, suggested necessity to start testing food contamination with viruses.

Clinical Profile and Outcome of Patients Presenting with Mushroom Poisoning in a Tertiary Care Center of Eastern Nepal

Introduction: Accidental mushroom poisoning is constantly seen and regularly reported from all over world. Exact magnitude of problem and its clinical profile in Nepal is not well known. This study was done to evaluate clinical profile and treatment outcome of patients presenting with mushroom poisoning in the department of internal medicine, BPKIHS, Dharan. Methods: It is a prospective observational study conducted in department of internal medicine, BPKIHS, Dharan from 1st January 2008 to 31st December 2009. Informed consent was taken. All the patients were subjected to necessary laboratory investigation. They were followed up at 1 week and 1 month after discharge. Results: All together 60 patients were analyzed. Majority of subjects 56 (93.3%) were from rural areas. Vomiting and diarrhea were the two most common presentations seen in 56 (93.3%) subjects. The latent period for the symptoms were > 6 hours in 4 (6.7%) and < 6 hours in 56 (93.3%) subjects. Fulminant hepatic failure was seen in 6 (10%) subjects and among them 4 (66.7%) expired. After admission 3 (5%) subjects developed GI bleeding. Average duration of hospital stay was 4.6 days. In follow up recovery was complete in all subjects who survived the acute phase of poisoning. Conclusions: Especially in patients coming during rainy season mushroom poisoning should be considered in the differential diagnosis of acute gastroenteritis. Mortality is high in subjects with FHF whereas recovery is complete in subjects who survived the acute phase. Keywords: fulminant hepatic failure; gastroenteritis; mushroom poisoning; wild mushrooms.

[Mushroom poisoning]

Mushroom poisoning is a regular complaint for consultation in emergency facilities. These situations are usually benign and symptomatic treatment is sufficient. However, severe damage can occur, potentially life-threatening. We review the various syndromes associated with the toxins involved, their management and the major signs that are suggestive of serious injury and requiring hospitalization.

[Mushroom consumption and toxicity, state of the art]

Mushroom consumption is widespread throughout the world and mushroom foraging is often seen as a recreational activity. However, mushroom hunters, especially if inexperienced, may not fully perceive the risks associated with ingesting potentially toxic mushroom species. It is fundamental that mushrooms must be professionally inspected and their quality and safety approved before being ingested. This article analyzes the main scientific documents and current regulations regarding this topic.

[Recent trends of mushroom poisoning in Japan]

The incidence of mushroom poisoning was studied statistically from 2001 to 2010 in Japan. The total incident of mushroom poisoning was 569 cases, which involved 1,920 patients and 10 deaths. The average incident was 56.9 cases per year, involving 192 patients and 1 death. On regional differences, the mushroom poisoning was more frequent in the northeastern part of Japan. The rate of total incidents for each type of poisoning, which were classified according to symptoms caused, 54.6% in the type of gastro-intestinal disorder, 11.6% in the type of neurological symptoms, and 2.4% in the type of intracellular disorder (violent vomiting, diarrhea and dehydration and hepato-nephrosis, or rhabdomyolysis, or erroneous perception, etc.), respectively. Two species of poisonous mushrooms with gastro-intestinal disorder, Lampteromyces japonicus and Rhodophyllus rhodopolius caused the majority (52%) of all poisonings in Japan.

[An outbreak of gastroenteritis caused by poisonous Boletus mushroom in Sichuan, China, 2012]

OBJECTIVE

To identify the source of infection and risk factors and to provide control measures regarding an outbreak of gastroenteritis involving 30 villagers. Who attended the same wedding party held on March 5(th), 2012, a survey was carried out.

METHODS

Case was defined as having onset of vomiting, nausea, stomachache or diarrhea among the attendees of a wedding party. We randomly selected and interviewed 140 from 470 attendees on their symptoms and food exposures at the wedding. We compared food-specific attack rates (AR) for gastroenteritis in a retrospective cohort study. The leftover foods were tested for Salmonella, Shigella, and Staphylococcus aureus. The leftover Boletus mushrooms were examined and species determined by the Kunming Institute of Botany, Chinese Academy of Sciences.

RESULTS

Of the 140 attendees 61% (85) developed gastroenteritis. Case-attendees had vomiting (94%), nausea (89%), stomachache (53%), and diarrhea (51%). The AR among attendees who ate Boletus mushroom was 69% (81/118), compared to 18% (4/22) of those who did not (RR = 3.8, 95%CI: 1.5 - 9.2). When comparing the ARs between the attendees on consumption of other foods, data did not show statistically significant differences. Among the 7 species of Boletus identified from the leftover mushrooms, 3 (B. venenatus, B. sinicus and B. magnificus) were toxic. Store keepers bought dried or fresh mushrooms from local villagers who had picked up them from the mountains. Salmonella, Shigella, and Staphylococcus aureus tests on those leftover food showed negative results.

CONCLUSION

Poisonous Boletus mushroom contributed to this outbreak. We recommended that education should be targeted on mushroom-pickers regarding how to recognize the poisonous mushrooms. Regulations and laws should also be developed to facilitate the necessary process.

Mushroom poisoning: a study on circumstances of exposure and patterns of toxicity

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.

Clusters of sudden unexplained death associated with the mushroom, Trogia venenata, in rural Yunnan Province, China

Introduction

Since the late 1970's, time-space clusters of sudden unexplained death (SUD) in northwest Yunnan, China have alarmed the public and health authorities. From 2006–2009, we initiated enhanced surveillance for SUD to identify a cause, and we warned villagers to avoid eating unfamiliar mushrooms.

Methods

We established surveillance for SUD, defined as follows: sudden onset of serious, unexplained physical impairment followed by death in <24 hours. A mild case was onset of any illness in a member of the family or close socially related group of a SUD victim within 1 week of a SUD. We interviewed witnesses of SUD and mild case-persons to identify exposures to potentially toxic substances. We tested blood from mild cases, villagers, and for standard biochemical, enzyme, and electrolyte markers of disease.

Results

We identified 33 SUD, a 73% decline from 2002–2005, distributed among 21 villages of 11 counties. We found a previously undescribed mushroom, Trogia venenata, was eaten by 5 of 7 families with SUD clusters compared to 0 of 31 other control-families from the same villages. In T. venenata–exposed persons SUD was characterized by sudden loss of consciousness during normal activities. This mushroom grew nearby 75% of 61 villages that had time-space SUD clusters from 1975 to 2009 compared to 17% of 18 villages with only single SUD (p<0.001, Fisher's exact test).

Discussion

Epidemiologic data has implicated T. venenata as a probable cause of clusters of SUD in northwestern Yunnan Province. Warnings to villagers about eating this mushroom should continue.

[Foodborne infections and intoxications in Poland in 2010]

AIM

The purpose of this paper was to describe the epidemiology of foodborne outbreaks in Poland in 2010.

MATERIAL AND METHODS

The evaluation of the epidemiological situation was based on data from outbreak investigation forms, reported by Sanitary and Epidemiological Stations to the Department of Epidemiology, NIPH-NIH.

RESULTS

In 2010 a notable increase in the number of cases reported with a bacterial infection was observed. This increase however did not exceeded the median number of cases reported in 2004-2008. In 2010 392 foodborne infections and food poisoning involving 6994 cases (outbreaks involving 4 person or more) and 145 foodborne outbreaks (where 2-3 persons became ill were reported. S. Enteritidis was the most frequently etiological agent in outbreaks associated with bacterial infection (32.9% of outbreaks 22.4% cases). Viruses caused 26% of outbreaks affected 30% of cases. In 38.3% outbreaks the etiological agent could not be established. The main vehicle of foodborne outbreaks were meals prepared from (> 3) raw meats (4.6% of outbreaks, 10.9% cases) and meals prepared using milk and eggs (9.9% of outbreaks 5.7% cases). The most frequent places of contamination included farms who produced goods for human consumption (11.5% of outbreaks, 5.0% of cases). Private residences (113 outbreaks with 745 cases) and hospitals were the most common place where food poisoning outbreaks occurred. In 2010 there were 6 outbreaks where more than 100 people were affected in these settings.

CONCLUSIONS

Like in previous years, in 2010 the etiological agents, vehicle and sources of infection were not identified in most foodborne outbreaks. In order to decrease the number of outbreaks with undetermined etiological agent, the spectrum of routine laboratory tests of samples taken in outbreaks should be broaden.

[Mushroom poisoning in Portugal]

The renewed interest in mycology has been reflected in growing use of wild mushrooms in culinary, driven by its nutritional, organoleptic and commercial value. However, the international scientific literature describes several syndromes of poisoning by mushrooms. We live, therefore, a paradigm conducive to an increase of mycetism, whose diagnosis requires a high level of suspicion and knowledge of clinical profiles. In Portugal, the real dimension of this problem is unknown. Although some mycetisms, such as the hepatotoxic syndrome, have high morbidity and mortality, their relative incidences are unknown. Add up to the shortage of international scientific literature, often outdated and inappropriate to clinical practice. In this context, this article provides an updated epidemiological and clinical perspective emphasizing a narrative and descriptive information on the forms of presentation, differential diagnosis and therapeutic approach, with the ultimate goal of the elaboration of a national diagram-oriented approach to decision-making diagnosis. We analyzed all the clinical records of patients admitted into ten hospitals between 1990 and 2008, notified with the code 988.1 of GDH (acute poisoning by mushrooms). There were registered demographic data, way of presentation, time between ingestion and onset of symptoms, the annual distribution, clinical profile, clinical and analytical treatment performed and complications. We identified 93 cases of acute poisoning by mushrooms, with equal gender distribution and inclusion of individuals of all age groups (from 1 to 85 years), but with greater representation from 21 to 50 years. There was a bimodal seasonal pattern, with a higher peak between September and December and a second in the spring. The hepatotoxic profile presentation corresponded to 63.4% and 31.7% of the cases to gastroenteritis syndrome. The mortality in cases of hepatotoxicity was 11.8%. The developmental profile of the rate of prothrombin time (PT), aspartate aminotransferase (AST) and bilirubin, was an important setting for diagnosis and prognosis. TGO increases early, always within 48 hours, having an essential role in the diagnosis of hepatotoxicity. Despite the late elevation of bilirubin, the cases of death revealed that there was an earlier increase, reaching higher values, which seems to have a prognostic value, to be evaluated with further studies. Finally, we propose a diagram of diagnostic performance, considerating the generalized lack of mycological diagnosis in Portugal, which emphasizes the need for a careful history, focused on quantifying the latency period.

Foodborne outbreaks surveillance in the Piedmont Region, Italy (2002-2009)

BACKGROUND

this article summarises the results of eight years (2002-2009) of investigations on food borne disease outbreaks carried out the Regional Agency for Public Health in Piedmont, which is an Italian Region (4,432,571 citizens, 2008).

METHODS

the investigations were conducted as cohort studies supported by laboratory analysis of: food and patients. The data were reported by general practitioners and hospital physicians, and were collected, evaluated and recorded in 22 Hospitals.

RESULTS

it recorded 803 outbreaks of food borne disease, of which 177 mushroom outbreaks with 318 ill people and 499 outbreaks for all the others agents with 3,381 ill people. The maximum prevalence was 15.7/100,000 (2004). The most important causes for numbers of ill people have been (2002-2009): salmonellosis (34%, 1,250/3,699), mushroom poisoning (9%, 318/3,699), Escherichia coli (8%, 228/3,699), Staphyilococcus (6%, 209/3,699), virus (5%, 198/3,699), Clostridium perfringens (4%, 154/3,699), Bacillus cereus (2.1%, 76/3,699), scombrotoxin (1.8%, 65/3,699). 303 out of 304 mushrooms outbreaks occurred from consumers that picking mushrooms themselves to eat in private homes and for all others agents: 57% of 499 the outbreaks occurred in private homes, 27% in restaurants, 6% in canteens, but 39% of 3,381 ill people had eaten in restaurants and other public food facilities, 32% in private homes and 24% in canteens. After mushrooms the eggs (75 outbreaks) were the most important food recognized.

CONCLUSION

the theoretical maximum prevalence which can be hypothesized with this data in Piedmont (2002-2009) is 141/100,000 (sum of the maximum prevalence recorded at least in one Piedmont Hospital district).

Mushroom poisoning: retrospective analysis of 294 cases

OBJECTIVE

The objective of this study was to present special clinical and laboratory features of 294 cases of mushroom poisoning.

MATERIALS AND METHODS

In this retrospective study, 294 patients admitted to the Pediatric and Adult Emergency, Internal Medicine and ICU Departments of Cumhuriyet University Hospital were investigated.

RESULTS

Of 294 patients between the ages of 3 and 72 (28.97 +/- 19.32), 173 were female, 121 were male and 90 were under the age of 16 years. One hundred seventy-three patients (58.8%) had consumed the mushrooms in the early summer. The onset of mushroom toxicity symptoms was divided into early (within 6 h after ingestion) and delayed (6 h to 20 d). Two hundred eighty-eight patients (97.9%) and six (2.1%) patients had early and delayed toxicity symptoms, respectively. The onset of symptoms was within two hours for 101 patients (34.3%). The most common first-noticed symptoms were in the gastrointestinal system. The patients were discharged within one to ten days. Three patients suffering from poisoning caused by wild mushrooms died from fulminant hepatic failure.

CONCLUSION

Education of the public about the consumption of mushrooms and education of health personnel working in health centers regarding early treatment and transfer to hospitals with appropriate facilities are important for decreasing the mortality.

[Foodborne infections and intoxications in Poland in 2008]

A total of 12 217 bacterial foodborne infections and intoxications were registered in 2008 (incidence 32.1/100 000 population). Unlike bacterial infections, the incidence of viral foodborne infections increased in the recent years (2008 - 85.4 vs. 2007 - 57.1; 2006 - 54.21; 2005 - 32.8, and median 2002-2006 - 27.2). In 2008 were notify of 480 foodborne infections and intoxications involving 5788 cases (only outbreaks involving 4 person or more) and 138 foodborne (involving 2-3 persons). S. Enteritidis were the most frequency etiological agent in outbreaks (94.2% of outbreaks 89.3% cases in outbreaks). The main vehicle of foodborne outbreaks in 2008 were food prepared eggs (19.6% of outbreaks, 12.3% cases). Private homes were the most prevalent among the places of food contamination (13.2% of outbreaks). The tree epidemics with 100 or more cases each, were registered (one caused by Norovirus and two by Bacillus cereus) involved 564 cases.

[Increase of poisoning by tropical mushrooms in Japan in recent years]

A tropical poisonous mushroom, Chlorophyllum molybdites, invaded into Japan in recent years, and distributed in south-eastern and central part of Japan including 27 Prefectures in 2009; Gunma, Tochigi, Saitama, Ibaraki, Tokyo (including Bonin Islands), Chiba, Shizuoka, Ishikawa, Aichi, Mie, Shiga, Kyoto, Nara, Osaka, Wakayama, Hyogo, Tottori, Okayama, Hiroshima, Yamaguchi, Kagawa, Tokushima, Kochi, Ohita, Kumamoto, Kagoshima and Okinawa. Poisoning by this fungus has increased recently (Table 2). Topics on distribution and poisoning by Russula subnigricans and Podostroma cornu-damae briefly discussed.

Clinical profile and outcome of children presenting with poisoning or intoxication: a hospital based study

Poisoning is a common preventable cause of morbidity and mortality in children. Most of the poisoning in children less than 5 years of age is accidental. Objective of the study was to study the clinical profile and outcome of childhood poisoning and intoxication. This was a retrospective study done in patients who were admitted in pediatric wards and pediatric intensive care unit (PICU) of BP Koirala Institute of Health Sciences with history of ingestion of poison or intoxication or envenomation firom January 2005 to June 2008. The data collected were analyzed with SPSS 12.0 software. There were 122 children enrolled in study. Male: female ratio was 1.4:1. The mean age of presentation was 5.8 years. Among 122 patients, 43.4% received pre-referral treatment in the form of gastric lavage, atropine etc. Organophosphorus poisoning was the commonest poisoning seen in 55 (45.1%) patients followed by hydrocarbon 12 (9.8%), mushroom 10 (8.2%) and organochlorine 10 (8.2%) poisoning. During treatment, 50.0% received antidotes. 55.7% received antibiotics, gastric lavage and anticonvulsants were required in 43.4% and 13.9% respectively. Overall survival was 87.4%. The time interval between intoxication and presentation to hospital, mean Glasgow Coma Scale (GCS) and presence of coma (GCS <8) were significantly different between survivors and expired cases. In conclusion, organophosphorus is the commonest agent involved in childhood poisoning. Overall, the outcome is good with 87.4% survival in our hospital. The time gap between the poisoning and presentation to hospital and presence of coma predict mortality.

[Poisoning in general practitioner's practice]

Every year the Belgian Poison Center deals with more than 50.000 calls. When a medical evaluation is needed, the patients are often advised to contact their general practitioner. This article gives the general practitioner some clues to face common or severe poisoning situations like benzodiazepines, antidepressants, analgesics (paracetamol, ibuprofen, methadone...), nose drops, bleaches, petroleum distillates, mushrooms or carbon monoxide exposure.

[Foodborne infections and intoxications in Poland in 2007]

A total of 15,249 bacterial foodborne infections and intoxications were registered in 2007 (incidence 40/100,000 population). Unlike bacterial infections, the incidence of viral foodborne infections increased in the recent years (2007--57.1 vs. 2006--54.21, 2005--32.8, 2004--27.2, 2003--21.1 and median 1998-2002--10.0). In 2007 were notify of 399 foodborne infections and intoxications involving 6513 cases (only outbreaks involving 4 person or more) and 148 foodborne (involving 2-3 persons). S. Enteritidis were the most frequency etiological agent in outbreaks (38.8% of outbreaks 27% cases in outbreaks). The main vehicle of foodborne outbreaks in 2007 were food prepared meals from various (>3) raw materials of animal sources (15.3% outbreaks, 17.8% cases) and milk and eggs (17.5% outbreaks, 13.3% cases). Private homes were the most prevalent among the places of food contamination (22.1% of outbreaks). The four epidemics with 100 or more cases each, were registered (one caused by Norovirus and three by unknown agent) involved 576 cases.

[Foodborne infections and intoxications in Poland in 2006]

A total of 17 157 bacterial foodborne infections and intoxications were registered in 2006 (incidence 45/100 000 population). Unlike bacterial infections, the incidence of viral foodborne infections increased in the recent years (2006 - 54.21 vs. 2005 - 32.8, 2004 - 27.2, 2003 - 21.1 and median 1998-2002 - 10.0). The parasitic foodborne infections did not change much during the recent years. There were 11 deaths related to foodborne infections or intoxications registered in 2006, of which the following etiologic agents were established: Salmonella Enteritidis (4), other bacteria (4), other virus (1) and E. multilocularis infestation (2). In 2006 were notified of 385 foodborne infections and intoxications involving 6839 cases (only outbreaks involving 4 person or more) and 170 foodborne (involving 2-3 persons). S. Enteritidis were/was the most frequency etiological agent in outbreaks ((51.2% of outbreaks, 39.8% cases in outbreaks). The main vehicle of foodborne outbreaks in 2006 were food prepared from milk and eggs (26.0% of outbreaks, 16.1% cases in outbreaks) and meals various (> 3) raw materials of animal sources (22.5% cases in outbreaks). Private homes prevailed among places the places of food contamination (17.4% of outbreaks). In 2006 the seven epidemics with 100 or more cases each, were registered involved 953 cases.

Mushroom poisoning

In the research we included a total of 207 subjects with the dismissal diagnosis of "mycetismus", who were treated at the Department of Infectious Diseases, General Hospital Osijek, during the 1983-1992 period. 32 of them were children. There were 44.93% of men, 39.61% of women and 15.45% of children. The latent time > 6 hours was determined in 51 (25%) and < 6 hours in 75% of subjects. In 156 of patients with the latent time > 6 hours, "false" poisoning occured, while 51 patients experienced real mushroom toxins poisoning. At the admission to the hospital, in patients with the latent time > 6 hours, a pathological PT (protrombine time) was established only in women, leukocytosis in both women and children, increased concentration of GGT (gamma-glutamin-transferase) in men, increased AST (aspartate-aminotransferase) and ALT (alanin-aminotransferase) only in women, and increased urea in both women and children. After 24 hours, control measuring established high values of AST and ALT extended PT uremia and exalted amount of ammonia in blood in 11 of patients (2 men, 7 women and 2 children). They had severe liver and kidney damage, the most probably caused by Amanita phalloides toxins. The latent time lasted 9 to 13 hours. Of the 11 above mentioned patients, 2 women, aged 74 and 43, and one girl, aged 6, died. No pathological laboratory parameters were established in 40 of subjects with the latent time of 6 and more hours, and the disease manifested through vomiting and diarrhea that lasted for several days. These subjects most probably suffered from mushroom toxins poisoning. Mushroom toxins irritate the mucuous membrane of the gastrointestinal tract, and there are many such poisonous mushrooms. There were no mortalities in this group of subjects.

Poisoning from wild mushrooms in Eastern Anatolia region: analyses of 5 years

The objective of this study was to describe the demographic and clinical features of patients who were admitted to the emergency department (ED) due to wild mushroom poisoning and to point the importance of mushroom poisonings in our area. This study was performed by examining the files of wild mushroom poisoning patients who were admitted to the ED of Firat University, Faculty of Medicine, between January 2000 and June 2004, retrospectively. Patients>or=16 years of age were included in the study. The frequency of wild mushroom poisoning, age and sex of the patients, season, place of the residence, laboratory findings, treatment and outcome of the patients were investigated. During the study period, 64 patients with wild mushroom poisoning were admitted to the ED. From 64 overall patients, 25 (39.1%) were males. The most common complaints during the admission were nausea, vomiting and abdominal discomfort. The duration of hospitalization was two (range 1-4 days) days. No death was observed. Severity of mushroom poisoning depends on the type of mushroom eaten, the time lag between the poisoning and admission to the hospital, and the rapid and correct treatment given to the patient either in the ambulance or at health centre.

Mushroom poisoning

OBJECTIVE

We aimed to review characteristics of mushrooms and mushroom poisoning and compare clinical picture, laboratory data, treatment modalities and prognostic factors in children with amanita intoxication and non-amanita mushroom poisoning.

METHODS

We analyzed 39 pediatric patients through 1994-2004, retrospectively from the patient files and evaluated the patients in two groups as patients with amanita intoxication and patients with non-amanita mushroom poisoning. All of the cases were admitted to the hospital in autumn. Twenty three (59%) of the patients were female and 16 (41%) were male. Mean age of the patients was 8.05 +/- 2.10 years.

RESULTS

Amanita phalloides toxin was detected in the serum in 8 patients. Eleven (28%) of the cases were strongly suggestive of amanita poisoning but alpha amanitin level could not be studied. The average time of appearance of symptoms after mushroom consumption, duration of symptoms, hospital stay, serum AST, ALT, PT and creatinine levels were significantly higher in patients with amanita poisoning (p<0.01). Conventional therapy, antidote therapy together with hemoperfusion were carried out in 16 (41%) of the patients. Four of the patients in whose blood amatoxin was detected (50%) and 3 of the patients highly suggestive of amanita poisoning (30%), totally 7 patients died of hepatic coma. The average time of admission to hospital, mean AST, ALT, creatinine and PT values at 3rd day were significantly higher in patients who died of hepatic coma. Prognosis was better in case of early admittance to hospital in patients with amanita poisoning.

CONCLUSION

Early diagnosis and treatment in mushroom poisoning can be life saving. Public awareness is very important in prevention of intoxication as well as encouraging early admission to hospitals.