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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