MUSHROOMSMUSHROOMS

Cyclopeptide Containing Cyclopeptide Containing

MushroomsMushrooms

http://www.inf.unitn.it./~mflorian/http://www.inf.unitn.it./~mflorian/mycology/fungi/amanphal.htmlmycology/fungi/amanphal.html

� 95% of mushroom fatalities are due to 95% of mushroom fatalities are due to thesethese

� Include A. verna (death angel), A. virosa Include A. verna (death angel), A. virosa (destroying angel), A. phalloides (death (destroying angel), A. phalloides (death cap)cap)

� Also, Galerina autumnalis, G. marginata, Also, Galerina autumnalis, G. marginata, G. Venenata, and Lepiota helveolaG. Venenata, and Lepiota helveola

SymptomsSymptoms

� Usually not before 6-12 hoursUsually not before 6-12 hours

� Include profuse, watery diarrhea, and Include profuse, watery diarrhea, and gastroenteritis at 12-24 hours; transient gastroenteritis at 12-24 hours; transient improvementimprovement

� 1-6 days later; hepatic, renal and at 1-6 days later; hepatic, renal and at times pancreatic toxicity and deathtimes pancreatic toxicity and death

� Toxin is heat-stable, insoluble in water Toxin is heat-stable, insoluble in water and loses activity very slowly over yearsand loses activity very slowly over years

� Mortality related to age and doseMortality related to age and dose(0.1 mg/kg is lethal)(0.1 mg/kg is lethal)

� Children are more susceptibleChildren are more susceptible

� Toxicity of alpha-aminitin is through Toxicity of alpha-aminitin is through interference with RNA polymerase II, interference with RNA polymerase II, prevents the transcription of DNAprevents the transcription of DNA

� Phalotoxins are rapid-acting and Phalotoxins are rapid-acting and interrupt actin polymerization, impair interrupt actin polymerization, impair cell membrane function, has limited cell membrane function, has limited absorption.absorption.

TherapyTherapy

� Continuous gastrointestinal charcoal Continuous gastrointestinal charcoal lavage to decontaminate (theoretically, lavage to decontaminate (theoretically, up to five days)up to five days)

� Watch for altered mental status due Watch for altered mental status due to hypoglycemiato hypoglycemia

� Supportive therapySupportive therapy

AntidotesAntidotes

� Penicillin displaces amatoxin from plasma Penicillin displaces amatoxin from plasma protein-binding sitesprotein-binding sites

� May inhibit penetration of amatoxin May inhibit penetration of amatoxin into hepatocytesinto hepatocytes

� Doses of 300,000 to 1,000,000 units benzyl Doses of 300,000 to 1,000,000 units benzyl penicillin dailypenicillin daily

� N-acetylcysteine may be helpful as N-acetylcysteine may be helpful as in any patient with liver injuryin any patient with liver injury

Other AntidotesOther Antidotes

� Thioctic acid (alpha-lipoic acid)Thioctic acid (alpha-lipoic acid)

� Silibinin (extract of silymarin from Silibinin (extract of silymarin from Silybum marianum)Silybum marianum)

� Cimetidine may be hepatoprotective.Cimetidine may be hepatoprotective.

� Consider liver transplantation earlyConsider liver transplantation early(Prior to grade III hepatic encephalopathy)(Prior to grade III hepatic encephalopathy)

Monomethylhydrazine -Monomethylhydrazine -

Containing Mushrooms Containing Mushrooms

http://www.wisc.edu/botany/fungi/apr97http://www.wisc.edu/botany/fungi/apr97

� Associated with mortality of 40%Associated with mortality of 40%

� Include G. californica, G. brunnea, Include G. californica, G. brunnea, G. esculentaG. esculenta

� Toxicity is due to gyromitrin which is Toxicity is due to gyromitrin which is metabolized to monomethylhydrazinemetabolized to monomethylhydrazine

� This metabolite reacts with pyridoxine This metabolite reacts with pyridoxine resulting in inhibition of pyridoxal resulting in inhibition of pyridoxal phosphate-related enzymatic reactionsphosphate-related enzymatic reactions

SymptomsSymptoms

� Headache, nausea, vomiting, seizures, Headache, nausea, vomiting, seizures, and hepatorenal failureand hepatorenal failure

� Symptoms occur 6-10 hours after Symptoms occur 6-10 hours after ingestioningestion

� Toxin may be eliminated with cooking Toxin may be eliminated with cooking but inhalation of cooking fumes may but inhalation of cooking fumes may cause poisoningcause poisoning

TherapyTherapy

� Pyridoxine, in dose of 25 mg/kgPyridoxine, in dose of 25 mg/kg

Glutamate Glutamate Glutamic Acid Glutamic Acid GABA GABAPyridoxal 5' Pyridoxal 5' phosphatephosphate

Muscarine-Containing Muscarine-Containing

MushroomsMushrooms

http://www.inf.unitn.it./~mflorian/http://www.inf.unitn.it./~mflorian/mycology/fungi/clitphaemycology/fungi/clitphae

� No lethalityNo lethality

� Includes Clitocybe dealbata (the Includes Clitocybe dealbata (the sweater), C. Illudens (omphalotus sweater), C. Illudens (omphalotus olearius) and Inocybe laceraolearius) and Inocybe lacera

� Small amounts of muscarine are Small amounts of muscarine are in Amanitia muscariain Amanitia muscaria

� Symptoms: SLUDGE within 0.5-2 hoursSymptoms: SLUDGE within 0.5-2 hours

� Therapy: AtropineTherapy: Atropine

Coprine-Containing MushroomsCoprine-Containing Mushrooms

� Rarely fatalRarely fatal

� Coprinus atramentarius (inky caps)Coprinus atramentarius (inky caps)

� Coprine has a disulfiramlike effectCoprine has a disulfiramlike effect(Blocks acetaldehyde dehydrogenase)(Blocks acetaldehyde dehydrogenase)

� Requires ingestion of alcohol 48-72 Requires ingestion of alcohol 48-72 hours after mushroomhours after mushroom

� Symptoms: Flushing, headache, Symptoms: Flushing, headache, hypotension, histamine induced hypotension, histamine induced vasodilationvasodilation

� Therapy: Supportive, anti H1 and Therapy: Supportive, anti H1 and anti H2, prostaglandin inhibitorsanti H2, prostaglandin inhibitors

Ibotenic Acid- and Muscimol-Ibotenic Acid- and Muscimol-

Containing MushroomsContaining Mushrooms

http://www.inf.unitn.it./~mflorian/http://www.inf.unitn.it./~mflorian/mycology/fungi/amanpantmycology/fungi/amanpant

� Not lethalNot lethal

� Amanita gemmata, A. muscaria and Amanita gemmata, A. muscaria and A. pantherinaA. pantherina

� Symptoms: Within 0.5-2 hours, somnolence, Symptoms: Within 0.5-2 hours, somnolence, hallucinations and delirium, in hallucinations and delirium, in adultsadults

� Also, myoclonus, seizures and other Also, myoclonus, seizures and other neurologic effects in childrenneurologic effects in children

� Action is due to stimulation Action is due to stimulation of GABA receptorsof GABA receptors

� Therapy: BenzodiazepineTherapy: Benzodiazepine

Psilocybin-Containing Psilocybin-Containing

MushroomsMushrooms

http://www.halcyon.com/http://www.halcyon.com/mycomed/gallery1mycomed/gallery1

� Rare mortalityRare mortality

� Symptoms: In 0.5-1 hour, CNS effects: ataxia, Symptoms: In 0.5-1 hour, CNS effects: ataxia, hyperkinesis, hallucinations, and seizureshyperkinesis, hallucinations, and seizures

� Psilocybe cubensis, P. caerulescens, Psilocybe cubensis, P. caerulescens, Conocybe cyanopus, Panaeolus foenisecii, Conocybe cyanopus, Panaeolus foenisecii, Gymnopilus spectabilis, Psathyrella foeniseciiGymnopilus spectabilis, Psathyrella foenisecii

Gastrointestinal ToxinsGastrointestinal Toxins

http://www.inf.unitn.it./~mflorian/http://www.inf.unitn.it./~mflorian/mycology/fungi/boleventmycology/fungi/bolevent

� Death is rareDeath is rare

� ““Little brown mushrooms”Little brown mushrooms”

� Boletes, Lactarius, Rhodophyllus, Boletes, Lactarius, Rhodophyllus, Tricholoma, Chlorophyllum Tricholoma, Chlorophyllum molybidites, C. esculentummolybidites, C. esculentum

SymptomsSymptoms

� Variable but usually in 0.5-3 hoursVariable but usually in 0.5-3 hours

� Nausea, vomiting diarrhea and Nausea, vomiting diarrhea and epigastric distressepigastric distress

� Supportive therapySupportive therapy

� Resolution of symptoms in 6-24 hoursResolution of symptoms in 6-24 hours

Orelline-and Orellanine-Orelline-and Orellanine-

Containing MushroomsContaining Mushrooms

http://www.inf.unitn.it./~mflorian/http://www.inf.unitn.it./~mflorian/mycology/fungi/cortelegmycology/fungi/corteleg

� May be lethalMay be lethal

� Symptoms: In 24-36 hours, headache, Symptoms: In 24-36 hours, headache, chills, anorexia, nausea, gastritischills, anorexia, nausea, gastritis

� Hepatotoxicity, and oliguric renal failure Hepatotoxicity, and oliguric renal failure may developmay develop

� Therapy: SupportiveTherapy: Supportive

Ralph's RulesRalph's Rules

� If uncertain of the identity If uncertain of the identity

of a species, don't try itof a species, don't try it

Try to Identify New SpeciesTry to Identify New Species

� Draw no conclusions until definitive Draw no conclusions until definitive spore print, cross section of gill, stem spore print, cross section of gill, stem and bruise color.and bruise color.

� Be able to state with confidence what Be able to state with confidence what distinguishes specimen from 3-5 look distinguishes specimen from 3-5 look alikesalikes

� Confidence of limits of variability Confidence of limits of variability of speciesof species

� Photos confirm identityPhotos confirm identity

� Odor, bruising, brittleness, habit,Odor, bruising, brittleness, habit,...support identification...support identification

� Avoid LBM's, amanita, cortinariusAvoid LBM's, amanita, cortinarius

� Use recent texts and monographsUse recent texts and monographs

� Must be worth eatingMust be worth eating

� Eat slowly: first taste the species. Eat slowly: first taste the species. Second taste is more than 24 hours Second taste is more than 24 hours later.later.

� Wait another 24 hours before trying Wait another 24 hours before trying a full-sized servinga full-sized serving

� Do not over-indulgeDo not over-indulge

� Gather only one species at a timeGather only one species at a time

� Do not eat more than one species Do not eat more than one species at a timeat a time

� Do not eat any species rawDo not eat any species raw