“You must grow like a tree, not like a mushroom.” -Janet Erskine Stuart

 

Amanita genus mushrooms cause a deadly toxidrome. Mortality is cited as 10-30%. The mushrooms can be identified by dots or scales on the cap. Cooking the mushrooms prior to ingestion does not significantly decrease toxicity. Amatoxin is the name given collectively to the related toxins found in amanita mushrooms. They inhibit RNA polymerase II.

 

A typical ingestion course is divided into four stages. The first stage is a latent period, occurring 6 to 24 hours after ingestion. It is marked by the amatoxin killing GI epithelium, hepatocytes, and nephrocytes. The patient might experience no symptoms during this period. In the second stage, which is about 24 hours long, the patient will typically experience abdominal pain, vomiting, and bloody diarrhea. The third stage is again about 24 hours. During this period, the patient appears improved and recovered. If hospitalized, the patient might be discharged during this phase. Finally, the fourth stage is a relapse, during which the patient experiences renal and/or hepatic failure. Due to destruction of clotting factors, the patient may bleed to death.

 

Treatment options are limited. Activated charcoal is likely to be ineffective as GI symptoms are delayed and patients are likely to present to the Emergency Department too late. IV fluid resuscitation can be helpful for urinary excretion of the toxin. Penicillin used to be considered effective, but no longer is. IV Silibinin (found in milk thistle) may be beneficial in severe cases. Extracorporeal albumin dialysis (ECAD) has been found to be effective. Liver transplantation should also be considered.

 

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References

Faybik P, Hetz H, Baker A et al. Extracorporeal albumin dialysis in patients with Amanita phalloides poisoning. Liver International. 2003;23:28-33. doi:10.1034/j.1478-3231.23.s.3.8.x.

Gupta N, Nusbaum J. Ep 11: Cholinergic Toxidrome, SVC Syndrome, Metabolic Acidosis, ROSC, Acrocyanosis, Mushroom Poisoning…And More. Roshcast. 2017. Available at: https://www.roshreview.com/blog/ep-11-cholinergic-toxidrome-svc-syndrome-metabolic-acidosis-rosc-acrocyanosis-mushroom-poisoning/. Accessed January 17, 2017.

Mushroom Poisoning Syndromes – North American Mycological Association. Namycoorg. 2017. Available at: http://www.namyco.org/mushroom_poisoning_syndromes.php. Accessed January 17, 2017.

Nickson C. Mushroom Toxicity. LITFL: Life in the Fast Lane Medical Blog. 2017. Available at: http://lifeinthefastlane.com/ccc/mushroom-toxicity/. Accessed January 17, 2017.

Main image courtesy of www.amanitashop.com.

Second image courtesy of nintendo.wikia.com.