A case of liver failure caused by fatal amanita poisoning was successfully treated by open cholecystostomy drainage / 中华危重病急救医学

The fatality rate of liver failure caused by fatal amanita poisoning is high, and there are no effective antidote drugs in China. On July 30, 2020, the department of infectious diseases and liver diseases of the First People's Hospital of Yunnan Province admitted a 67-year-old female patient with liver failure caused by fatal amanita poisoning. The patient went to the emergency department for treatment due to abdominal pain, vomiting and diarrhea after eating 350-400 g of amanita mushroom for 2 days, accompanied by fatigue for 1 day. There was no abnormality in physical examination. Laboratory indexes: alanine aminotransferase (ALT) 4 798 U/L, aspartate aminotransferase (AST) 10 030 U/L, activated partial thromboplastin time (APTT) 57.5 s, prothrombin time (PT) 72.1 s, international normalized ratio (INR) 8.66, prothrombinactivity (PA) 10%. Based on the patient's medical history, clinical manifestations and laboratory data, the diagnosis was amanita peptide mushroom poisoning and acute liver failure. According to the mechanism of amanita toxin poisoning as enterohepatic circulation, endoscopic retrograde cholangiopancreatography and ultrasound-guided gallbladder puncture and drainage for drainage of bile to discharge toxins were performed to interrupt the enterohepatic circulation of toxins. However, both methods failed, so open cholecystostomy was performed. Because the patient's coagulation function was very poor, artificial hepatic plasma exchange was given to improve coagulation function before open cholecystostomy, and eventually bile was drained successfully. After a total of 19 days of comprehensive medical treatment, the patient was cured and discharged from the hospital, and no sequelae was found after 1 year of follow-up. For such patients, early identification of the disease is required, and blocking the enterohepatic circulation of toxins as soon as possible according to the characteristics and toxicological mechanism of toxins may be the key treatment for rescuing patients with liver failure poisoned by amanita toxin, and it is necessary to combine comprehensive treatments such as active fluid replacement and blood purification to further improve the survival rate.

Analysis of clinical characteristics and blood purification effect of mushroom poisoning in children in Hunan Province / 中国小儿急救医学

Objective:To analyze the epidemiological characteristics, clinical characteristics and blood purification effect of mushroom poisoning in children.Methods:A retrospective study was conducted on 51 children with acute mushroom poisoning admitted to Hunan Children′s Hospital from 2002 to 2020.The epidemiological and clinical characteristics were analyzed, and the prognosis of children with different incubation periods was analyzed and compared.Among them, 36 critically ill children were treated with blood purification.Results:The age distribution was 66(43, 115)months.Mushroom poisoning had obvious seasonal and spatial aggregation.The first symptom was mainly manifested by digestive tract, which was manifested as vomiting, abdominal pain and diarrhea, accounting for 94.1% patients(48/51). The gastrointestinal tract type accounted for 45.1%(23/51) of the clinical types and the multi-organ damage type accounted for 51.0% patients(26/51). The length of hospital stay was 6(3, 11)days.Among them, early onset accounted for 45.1% patients(23/51), late onset accounted for 54.9% patients(28/51). Early onset hospitalization was shorter, about 4(2, 7)days, and fewer organs 1(0, 3) were damaged.The length of hospital stay of late onset was 8(3, 12)days, and the number of damaged organs was 4(2, 4). There was a statistically significant difference( P<0.05). Late onset patients had more severe organ function damage, including liver function, coagulation function, renal function, myocardial enzyme, and there was no significant difference in the final outcome between two groups.In 36 children who were given blood purification treatment, alanine aminotransferase, aspartate aminotransferase, prothrombin time, international normalized ratio, blood urea nitrogen, and lactate dehydrogenase were significantly improved, with statistically significant differences( P<0.05). Conclusion:Mushroom poisoning has obvious seasonal and geographical distribution characteristics; the first manifestation is mainly gastrointestinal symptoms; the clinical types are more common in gastrointestinal and multiple organ damage types.Children with early onset have shorter hospital stays and fewer complications than later onset.Blood purification treatment can significantly improve liver function, kidney function and blood coagulation function in children with toadstool poisoning.

Analysis of plant and poisonous mushroom poisoning events among people aged 0-19 in Guizhou Province from 2015 to 2019 / 中国学校卫生

Objective@#To analyze the epidemiological characteristics of plant and mushroom poisoning events among people aged 0-19 in Guizhou Province from 2015 to 2019, so as to provide the basis for prevention and control of food poisoning events among children and adolescents.@*Methods@#Data of people aged 0 to 19 involved in plant and mushroom poisoning incidents reported by the foodborne disease outbreak surveillance system in Guizhou Province from 2015 to 2019 were collected, verified, sorted and statistically analyzed.@*Results@#From 2015 to 2019, there were 590 cases of plant and mushroom poisoning among people aged 0 to 19 in Guizhou Province, 1 441 people were poisoned and 5 died. In May and September, family and collective dining halls were the places with the highest incidence of plant and poisonous mushroom poisoning incidents, accounting for 90.68% (535/590) of the total incidents. Poisonous mushrooms and masanberry accounted for 71.69% (423/590) of the food poisoning causes, and 5 people died of poisoning were caused by poisonous mushrooms.@*Conclusion@#In the cases of plant and mushroom poisoning among people aged 0-19 years in Guizhou Province,preschool primary and middle school students in rural areas are most vulnerable population of poisoning, so it is necessary to strengthen the publicity and education on the prevention and control of toxic plant and mushroom poisoning among children and teenagers in rural areas, so as to reduce the occurrence of relevant poisoning incidents.

Clinical analysis of 48 patients with acute mushroom poisoning / 中华危重病急救医学

Objective To analyze the clinical manifestation and therapeutic method in patients with acute mushroom poisoning. Methods A retrospective study was conducted. The clinical data of 48 patients with acute mushroom poisoning admitted to Department of Poisoning Treatment of the 307th Hospital of PLA from January 2016 to May 2017 were analyzed. The clinical data including gender, age, clinical symptoms, onset season, initial symptoms, incubation time, the length of hospital stay, treatment, and prognosis. In addition to the conventional treatment, the patients with severe liver damage were treated with continuous blood purification (CBP). The changes in routine blood test, biochemical parameters, blood ammonia and coagulation function before and 1, 3 and 7 days after CBP were observed. Results There were 29 of male (60.4%) and 19 of female (39.6%) in 48 patients with acute mushroom poisoning, with an average age of (48.10±13.14) years. There were 9 patients suffering from gastroenteritis type, 26 suffering from liver damage type, 8 suffering from neuro-psychosis type, 2 suffering from hemolytic type, and 3 suffering from renal damage type. All of the poisoned patients had evident seasonal characteristic, mainly concentrated in the autumn, especially in August, according for 66.7% (32/48). The initial symptoms of poisoning patients were mainly manifested as nausea and vomiting (50.0%). In five kinds of poisoned patients, the incubation time [(1.44±1.15) hours] and the length of hospital stay [(3.50±2.33) days] of neuro-psychosis type was the shortest, and the incubation time of liver-damaged type [(10.63±3.50) hours] and the length of hospital stay of renal damage type [(20.67±0.58) days] was the longest. Patients received symptomatic treatment according to different types, among whom 12 patients with severe liver damage received additional treatment for CBP. After the treatment, alanine aminotransferase (ALT), aspartate aminotransferase (AST), MB isoenzyme of creatine kinase (CK-MB), lactate dehydrogenase (LDH), and prothrombin activity (PTA) were significantly improved as compared with those before CBP treatment, with significant differences between 7 days after CBP and before CBP [ALT (U/L): 213.08±127.30 vs. 2 766.83±1 909.66, AST (U/L): 50.00 (41.00, 85.00) vs. 2 142.00 (1 225.00, 3 126.00), CK-MB (U/L): 24.09±8.87 vs. 44.75±22.09, LDH (μmol·s-1·L-1):3.70±1.46 vs. 13.03±12.77, PTA: (79.08±24.29)% vs. (35.25±19.85)%, all P < 0.01]. Among 48 patients, 47 were cured and discharged, and 1 patient with liver failure died due to aggravation of liver dysfunction, abnormal coagulation and bleeding, and massive hemorrhage of gastrointestinal tract. Conclusions Acute mushroom poisoning patients demonstrated obvious seasonal characteristics, mostly liver-damaged type, and its initial symptoms were mainly presented as nausea, vomiting and other gastrointestinal manifestations. Early clarification of diagnosis, timely treatment, as well as providence with CBP treatment in severe patients should be carried out as soon as possible. In such a way the curative effect can be enhanced, the mortality can be reduced, and the prognosis of the patients could be improved.

Mushroom poisoning in children / 中国小儿急救医学

Because of the extreme similarity in external form between some poisonous mushroom and wild large edible fungi,mushroom poisoning often occurs because of eating the poisonous mushroom by mistake every year in home and abroad.The known poisonous mushroom toxins include cyclopeptide toxin, muscarine,isooxazole derivatives and so on. According to the onset time, it is divided into early-onset, late-onset, and slow-onset style poisoning. According to the different clinical manifestations and the main organ damage, the types of toadstool poisoning were divided into gastrointestinal type, neuropsychiatric type,hemolytic toxin type and multiple organ damage type.The main treatment includes removing the toxic substances,supporting treatment of the disease,and applying the effective antidote,adrenal corticosteroids and blood purification.Avoiding eating poisonous mushrooms is an effective preventive measure.

Serum paraoxonase, arylesterase, and glutathione-s-transferase activities and oxidative stress levels in patients with mushroom poisoning

OBJECTIVES: Consumption of toxic species of mushrooms may have detrimental effects and increase oxidative stress. Paraoxonase, arylesterase and glutathione-S-transferase are antioxidants that resist oxidative stress. In this study, we analyzed the changes in these enzymes during intoxication due to mushrooms. METHODS: The study enrolled 49 adult patients with a diagnosis of mushroom poisoning according to clinical findings and 49 healthy volunteers as the control group. The patients with mild clinical findings were hospitalized due to the possibility that the patient had also eaten the mushrooms and due to clinical findings in the late period, which could be fatal. Paraoxonase, arylesterase, and glutathione-S-transferase concentrations, as well as total antioxidant and oxidant status, were determined in the 49 patients and 49 healthy volunteers by taking blood samples in the emergency department. RESULTS: While paraoxonase, arylesterase, and total antioxidant status were significantly decreased in the patient group (p<0.05), glutathione-S-transferase, total oxidant status and the oxidative stress index were significantly higher (p<0.05). There was a positive correlation between the hospitalization time and the oxidative stress index (r=0.752, p<0.001), whereas a negative correlation was found with glutathione-S-transferase (r=-0.420, p=0.003). CONCLUSION: We observed a significant decrease in paraoxonase and arylesterase and an increase in glutathione-S-transferase and oxidative stress indexes in patients with mushroom poisoning, indicating that these patients had an oxidative status. In particular, a low total antioxidant status and high oxidative stress index may gain importance in terms of the assessment of hospitalization duration.

Mushroom poisoning complicated with multiple organ disfunction syndrome:A case report and literature review / 吉林大学学报(医学版)

Objective:To report one case of mushroom poisoning complicated with multiple organ disfunction syndrome treated by sequential blood purification,and to explore the treatment method and principle of mushroom poisoning complicated with multiple organ disfunction syndrome.Methods:Hemoperfusion was performed in the patient,once every other day,combined with sequential blood purification of hemoperfusion and hemodialysis, and supplemented by hormone therapy and anti-infection.Results:The patient was out of danger,and the vital signs were stable;liver function,kidney function and blood routine were recovered.Conclusion:Early application of hemoperfusion combined with sequential blood purification can effectively treat the mushroom poisoning complicated with multiple organ disfunction syndrome and thrombotic microangiopathy,and improve the prognosis.

Investigation of a wild mushroom poisoning incident / 中国食品卫生杂志

Objective To investigate a poisoning caused by wild mushrooms and to identify the toxin in these mushrooms.Methods Epidemiological investigation,blood test and mushroom toxin were analyzed.Results This incident was taken place in one family,and all family members were dead.Multiple organ damage was observed in all patients;amatoxins and virotoxins were detected in both mushrooms and the soup,but were not detected in blood samples because of dialysis.Conclusion The incident was caused by wild mushrooms and public education shoud be strenthened to urge people to avoid eating wild mushrooms and go to the hospital immediately if poisoning takes place.

Hepatotoxicidad por Amanita lilloi, reporte de primeros casos / Amanita lilloi hepatotoxicity, first cases report

Se presentan dos casos clínicos de intoxicación por A. lilloi, hongos silvestres, que fueron recolectados por quienes los consumieron. Ambas pacientes desarrollaron sintomatología digestiva y evolucionaron a la falla hepática. La consulta tardía retrasó el diagnóstico y el tratamiento, pero igualmente la evolución de ambas pacientes fue favorable.

Two clinical cases of poisoning A. lilloi, wild mushrooms, which were collected by those who consumed themdebe, are presented. Both patients developed gastrointestinal symptoms and progressed to liver failure. The late consultation delayed diagnosis and treatment, but nevertheless the evolution of both patients was favorable.

Experimental study on acute hepatotoxicity in beagles induced by Amanita exitialis / 中华急诊医学杂志

Objective To establish acute hepatotoxic model induced by Amanita exitialis and to study the characteristics of acute toxic liver failure induced by mushrooms containing peptide toxins,in hope for providing some help to experimental research on poisoning induced by mushrooms containing peptide toxins.Methods UPLC-MS/MS (Ultra performance liquid chromatography-tandem mass spectrometry) method was used to detect peptide toxins in Amanita exitialis.To establish acute toxic liver hepatic failure model,the beagles were fed with 60 mg/kg of lyophilized powder of Amanita exitialis fungus which encapsulated in starch capsules.Toxic sighs were observed,coagulation function,hepatic and renal function,liver histopathological morphology,peptide toxin concentration in plasma and urine were detected during the experiment.Results Total peptide toxins in Amanita exitialis was (3 482.6 ± 124.94) mg/ kg.All the beagles had toxic signs including vomiting and diarrhea in 12-48 h after ingestion.On 24 h after ingestion,the beagles' ALT,AST,TBIL,ALP,PT and APTT levels increased obviously.On 36 h after ingestion,the beagles' ALT,AST,PT and APTT values reached their peaks (ALT:283.2 ± 112.9 Kallmann unit;AST:223.9 ±93.8 Kallmann units;PT:132.9 ± 152.6 s;APTT:131.4 ± 153.9 s).On 48 h after ingestion,the beagles' TBIL and ALP levels reached their peaks (TBIL:23.3 ± 14.6 mol/L;ALP:274.5 ± 115.5 U/L).The beagles' TBIL,TP and APTT returned to normal 1 week after ingestion,their ALT,AST and ALP levels returned to normal 3 weeks after ingestion.Three dogs died during 24-72 h after ingestion.Liver histopathological morphology study showed hemorrhagic necrosis of hepatocytes.Peptide toxins can be detected in plasma within 24 h after ingestion.Peptide toxins can be detected in urine within 96 h after ingestion.Conclusion Amanita peptide toxins can cause hemorrhagic necrosis of liver cells and lead to acute liver failure.This model is consistent with clinical pathophysiological process of acute toxic liver failure induced by mushrooms containing peptide toxins,and it can be applied to the study of diagnosis and treatment of poisoning induced by mushrooms containing peptide toxins.

A Case of Mushroom Poisoning with Russula subnigricans: Development of Rhabdomyolysis, Acute Kidney Injury, Cardiogenic Shock, and Death

Mushroom exposures are increasing worldwide. The incidence and fatality of mushroom poisoning are reported to be increasing. Several new syndromes in mushroom poisoning have been described. Rhabdomyolytic mushroom poisoning is one of new syndromes. Russula subnigricans mushroom can cause delayed-onset rhabdomyolysis with acute kidney injury in the severely poisoned patient. There are few reports on the toxicity of R. subnigricans. This report represents the first record of R. subnigricans poisoning with rhabdomyolysis in Korea, describing a 51-year-old man who suffered from rhabdomyolysis, acute kidney injury, severe hypocalcemia, respiratory failure, ventricular tachycardia, cardiogenic shock, and death. Mushroom poisoning should be considered in the evaluation of rhabdomyolysis of unknown cause. Furthermore, R. subnigricans should be considered in the mushroom poisoning with rhabdomyolysis.

Severe but reversible acute kidney injury resulting from Amanita punctata poisoning

Mushroom-related poisoning can cause acute kidney injury. Here we report a case of acute kidney injury after ingestion of Amanita punctata, which is considered an edible mushroom. Gastrointestinal symptoms occurred within 24 hours from the mushroom intake and were followed by an asymptomatic period, acute kidney injury, and elevation of liver and pancreatic enzymes. Kidney function recovered with supportive care. Nephrotoxic mushroom poisoning should be considered as a cause of acute kidney injury.

Characteristics and treatment methods of 17 cases toxic hepatitis type mushroom poisoning patient / 中国基层医药

Objective To analyze the clinical feature of 17 cases children toxic hepatitis type of mushroom poisoning ,investigate toxic hepatitis type mushroom poisoning treatment .Methods 17 children with mushroom poi-soning toxic hepatitis were chosen as the objects of study ,who were retrospectively analyzed .Results 17 cases of tox-ic hepatitis type of mushroom poisoning in children were dealed with drug treatment ,cured 12 cases,5 deaths,the cure rate of 70.6%;all patients,red blood cells,white blood cells and hemoglobin were normal ,7 cases of blood in the stool,6 cases of hematuria .All patients transaminase liver function tests and jaundice index were significantly in-creased,electrocardiogram showed sinus bradycardia 8 cases, sinus tachycardia 2 cases,1 case of renal damage. Conclusion Toxic hepatitis type mushroom poisoning mortality ,the elimination of toxins is where the key to have a certain effect of plasma exchange therapy ,liver transplantation is the most effective means of treatment ,especially gas-trointestinal bleeding with liver damage ,should be carried out as soon as possible based treatment plasmapheresis .

Hongos tóxicos en la Ciudad de Buenos Aires y alrededores / Toxic fungi in Buenos Aires City and surroundings

En la Facultad de Ciencias Exactas y Naturales de la Universidad de Buenos Aires (FCEN-UBA) funciona el Servicio de Identificación de Hongos Tóxicos. Lo integran los investigadores del Programa de Plantas Medicinales y Programa de Hongos que Intervienen en la Degradación Biológica (PROPLAME-PRHIDEB, CONICET) y colabora con servicios médicos, estatales y privados, identificando los materiales remitidos en casos de intoxicaciones con hongos, permitiendo, en muchos casos, realizar el tratamiento adecuado. El presente trabajo da a conocer los casos atendidos por el servicio desde 1985 hasta 2012 inclusive, además de una tabla para reconocer las especies tóxicas más comunes de la región. Según esta información, el 47% de las consultas que se recibieron correspondieron a pacientes menores de 18 años de edad que ingirieron materiales fúngicos de forma accidental (o al menos se sospechaba que lo hubieran hecho). El 53% restante correspondió a adultos que afirmaron ser capaces de distinguir hongos comestibles de tóxicos. Se determinó que Chlorophyllum molybdites fue la principal especie causante de intoxicaciones, la cual es comúnmente confundida con el hongo comestible Macrolepiota procera. En segundo lugar Amanita phalloides, un hongo altamente tóxico, que se caracteriza por presentar inicio de síntomas en forma tardía (latencia de 6-10 horas), evolucionando a falla hepática con el consiguiente requerimiento de trasplante o la muerte, si no se realiza el tratamiento adecuado en forma oportuna.

In Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires there is a service called Servicio de Identificación de Hongos Tóxicos, directed by researchers of the Program of Medicinal Plants and Fungi Involved in Biological Degradation (PROPLAME-PRHIDEB, CONICET) that assist hospitals and other health establishments, identifying the different samples of fungi and providing information about their toxicity, so that patients can receive the correct treatment. The objective of the present study was to analyze all the cases received from 1985 to 2012. This analysis permitted the confection of a table identifying the most common toxic species. The information gathered revealed that 47% of the patients were under 18 years of age and had eaten basidiomes; the remaining 53% were adults who insisted that they were able to distinguish edible from toxic mushrooms. Chlorophyllum molybdites turned out to be the main cause of fungal intoxication in Buenos Aires, which is commonly confused with Macrolepiota procera, an edible mushroom. In the second place Amanita phalloides was registered, an agaric known to cause severe symptoms after a long period of latency (6-10 hours), and which can lead to hepatic failure even requiring a transplant to prevent severe internal injuries or even death, is not early and correctly treated.

Mushroom Poisoning by Podostroma cornu-damae: A Case Report and Review of the Literature

Podostroma cornu-damae is a rare species of fungus belonging to the Hyocreaceae family. Its fruit body is highly toxic, as it contains trichothecene mycotoxins. Unfortunately, it highly resembles Ganoderma lucidum and Cordyceps, well-known health foods; this can lead to poisoning. We experienced such a case of a 42-year old man who received mushroom poisoning by injesting Podostroma cornu-damae. The patient was presented with severe pancytopenia and infection. The patient recovered without any complications after conservative care, antibiotics therapy, and granulocyte colony stimulating factor administration. The most common complications of podostroma cornu-damae intoxication were reported pancytopenia, infection, disseminated intravascular coagulation, acute renal failure, etc. It is important to provide enough fluid therapy, use of antibiotics to infection and granulocyte colony stimulating factor administration.

An Elderly Man with Fatal Respiratory Failure after Eating a Poisonous Mushroom Podostroma cornu-damae / 결핵및호흡기질환

A 73-year-old, previously healthy man presented with nausea, vomiting, diarrhea, dry mouth and febrile sensation 3 hours after eating boiled wild mushrooms. After admission, he showed progressive severe respiratory distress, pancytopenia, azotemia, hypotension, hypoxemia and consolidation of the entire left lung on chest radiography. With a preliminary diagnosis of necrotizing pneumonia, he underwent left pneumonectomy in order to remove all necrotic lung tissue. Lung histology showed extensive hemorrhagic necrosis, massive inflammatory cell infiltration, prominent proliferation of young fibroblasts and the formation of an early-stage hyaline membrane along the alveolar wall. Despite aggressive treatment, including mechanical ventilation, continuous renal replacement therapy and administration of granulocyte colony stimulating factor and broad spectrum antibiotics, he died on hospitalization day 13. Subsequently, the mushroom was identified as Podostroma cornu-damae. This is the first case of a histological evidence of lung involvement by Podostroma cornu-damae poisoning in Korea.

An outbreak of gastroenteritis caused by poisonous Boletus mushroom in Sichuan, China, 2012 / 中华流行病学杂志

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 5th,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.

Clinical and Biochemical Profile of Acute Liver Failure with Hepatic Encephalopathy in Children from Eastern Nepal.

Introduction: Hepatic encephalopathy is a potentially reversible neurophyschiatric abnormality in the setting of liver failure. Acute liver failure (ALF) is a potentially life-threatening disorder in children. Objectives: The present study evaluated the clinical profile, outcome and factors influencing the outcome of children presenting with acute liver failure and hepatic encephalopathy presenting to a referral hospital of Eastern Nepal. Methodology: Thirty children (17 males and 13 females) were admitted with this diagnosis during two year period.Prospective study. Results: The most common cause of acute liver failure was mushroom poisoning seen in 30% of cases. Only 37% (11 out of 30) children survived, most of them in early stages (Stage I and II) of encephalopathy. Bleeding manifestations were significantly more common (P=0.002) in deaths as compared to survivors. Conclusion: As liver failure is associated with high mortality rates especially in absence of facilities for liver transplantation, efforts should be directed in favor of implementing preventive measures such as vaccination and community education to prevent toxin ingestion.

A Case of Acute Renal Failure Complicated by the Poisoning of Amanita virgineoides / 대한신장학회지

Mushroom poisonings are potentially fatal. Most fatalities are due to the amatoxin that causes fulminant hepatic failure and acute renal failure. We report a patient who developed acute renal failure after ingesting Amanita virgineoides, which required renal replacement therapy, despite recovery of liver injury. A kidney biopsy showed acute tubular necrosis. The patient was recovered with the supportive care and temporary hemodialysis.

Patogênese das lesões associadas à intoxicação por Ramaria flavo-brunnescens em bovinos / Pathogenesis of lesions associated with poisoning by Ramaria flavo-brunnescens in cattle

O estudo da patogênese da intoxicação pelo cogumelo Ramaria flavo-brunnescens em bovinos foi realizado através da avaliação retrospectiva de tecidos selecionados de nove casos espontâneos e quatro casos experimentais. Para a investigação da patogênese das lesões observadas na língua, esôfago, casco e cauda, foram avaliadas as alterações histopatológicas e aspectos histoquímicos e histoquímico-ultra-estruturais das lesões. As técnicas histoquímicas utilizadas foram o Tricrômico de Masson e a oxidação seletiva da ceratina (OSC). O estudo histoquímico-ultra-estrutural foi realizado através da técnica de Swift sob microscopia eletrônica de transmissão. Os pelos da vassoura da cauda foram examinados sob microscopia de luz polarizada. Todas as alterações observadas nas estruturas ceratinizadas estudadas, mas especialmente nas que sofrem ceratinização dura, revelaram defeitos na ceratinização. Aliando ao estudo morfológico os resultados obtidos através da técnica da OSC e da microscopia eletrônica/técnica de Swift pode-se associar os defeitos na ceratinização a uma redução na quantidade de aminoácidos sulfurados (cistina), principalmente nas estruturas que sofrem ceratinização dura, sendo este provavelmente o principal mecanismo patogenético na intoxicação por R. flavo brunnescens em bovinos.

The pathogenesis of the lesions of Ramaria flavo-brunnescens poisoning in cattle was studied throughout the retrospective evaluation of selected tissues from nine spontaneous and four experimental cases of the disease. The pathogenesis of lesions observed in the tongue, esophagus, hoof, and tail was investigated analyzing microscopic lesions, histochemical and histochemical-ultrastructural changes. Histochemical techniques utilized were Masson's Trichrome and Selective Oxidation of Keratin (SOK). The histochemical-ultrastructural study was acomplished throughout the Swift method under transmission electron microscopy. Hair shafts of the tip of the tail were analyzed under polarized light. Lesions of varying degrees of severity were observed. All changes observed in the keratinized structures studied, mostly in the hard keratin, showed defective keratinization. The morphologic study and the results obtained with SOK and Swift techniques showed that the defective keratinization results of low amounts of sulphur containing amino acids (cystine) in hard keratin structures. This is probably the main pathogenetic mechanism of the lesions observed in R. flavo brunnescens poisoning in cattle.