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 percent) 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 percent) and six (2.1 percent) patients had early and delayed toxicity symptoms, respectively. The onset of symptoms was within two hours for 101 patients (34.3 percent). 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.

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.

Acute mushroom poisoning : a report of 41 cases.

A retrospective analysis of all mushroom poisoning cases admitted in Tansen Mission Hospital in the period of two months of the year 2005 was done. Forty-one cases were admitted during that period, among which only 34 case records could be found for analysis. Female (58.82%) outnumbered the male and 15 (44.11%) of the cases were from pediatric age group. The poisoning was secondary to consumption of different species of Amanita variety including the most poisonous Amanita phalloides. The commonest symptoms at the time of presentation in both adults and children was gastrointestinal (diarrhea, vomiting and abdominal pain). There were 12 mortalities and they died at the median interval of 3.5 days after admission. The main cause of death was acute liver failure and acute renal failure. Relative risk of having a bad outcome was found to be higher when the mushroom was consumed with alcohol when compared with non-alcoholics. High mortality was probably due to late presentation and only the conservative management in all the cases. Increased community and medical awareness is needed to reduce the frequency, morbidity and mortality of mushroom poisoning.

Intoxicação por Ramaria flavo-brunnescens (Clavariaceae) em bovinos / Poisoning by Ramaria flavo-brunnescens (Clavariaceae) in cattle

Dois surtos de intoxicação pelo cogumelo Ramaria flavo-brunnescens são relatados em bovinos de duas fazendas localizadas nos municípios de Santa Maria e São Gabriel, no Rio Grande do Sul, no período de abril-maio de 2005. De um total de 180 bovinos de sobreano que tiveram acesso a bosques de eucaliptos, 19 adoeceram e 10 morreram. A evolução clínica foi de 8-15 dias e os sinais clínicos incluíam depressão, perda de peso, desidratação, salivação excessiva, afrouxamento e perda dos pêlos longos da cauda, alisamento da superfície dorsal da língua com ocasional ulceração, afrouxamento do estojo córneo dos chifres, fezes em forma de cíbalos e recobertas por película de muco, hipópion, hifema e opacidade da córnea. Dois novilhos tinham leucocitose devido a leve desvio regenerativo à esquerda. Os achados de necropsia confirmaram as observações clínicas e adicionalmente incluíam esofagite fibrinonecrótica, principalmente no terço distal do esôfago. Alterações histopatológicas na pele da cauda incluíam hiperqueratose ortoqueratótica, folículos pilosos com contornos irregulares, espessamento da camada de queratina tricolemal e formação ocasional de tampões de queratina; degeneração e necrose da bainha radicular externa também era observada. Nos cascos havia hemorragia, fibrina e infiltrado neutrofílico nas lâminas dérmicas, hiperplasia do topo das lâminas epidérmicas com queratinização irregular e retenção dos núcleos; várias lâminas epidérmicas estavam encurtadas e fundidas. Na mucosa da língua o epitélio de revestimento estava adelgaçado, com atrofia e perda das papilas filiformes, áreas multifocais de disqueratose e espongiose das células da camada basal. Em algumas porções havia perda do epitélio e a superfície da língua era formada por tecido de granulação e infiltrado inflamatório misto. A mucosa esofágica de seis novilhos apresentava vários graus de necrose epitelial e inflamação. A perda do epitélio de revestimento revelava uma área subjacente de tecido ...

Two oubreaks of poisoning by the mushroom Ramaria flavo-brunnescens are reported in cattle from two farms located in the municipalities of Santa Maria and São Gabriel, state of Rio Grande do Sul, during April-May 2005. Out of a total of 180 yearling calves that had access to a pasture with eucalyptus woods, 19 were affected and 10 died. The clinical courses were 8-15 days and clinical signs included depression, weight loss, dehydration, drooling, loosening and loss of the long hairs of the tip of the tail, smoothening of the dorsal surface of the tongue with occasional ulceration, loosening of the corneal encasement of horns, hard and ball-shaped feces covered with a film of mucous, hypopion, hyphema and corneal opacity. Two calves had leucocytosis due to mild regenerative left shift. Nine calves were necropsied. Necropsy findings confirmed the clinical observation and additionaly included fibrinonecrotic esophagitis, mainly in the distal third of the esophageal mucosa. Histopathological changes in the skin of the tail included orthokeratotic hyperkeratosis; hair folicles with irregular contours, thickening of the tricolemmal keratin layer with occasional formation of keratin plugs, and degeneration and necrosis of the outer root sheath. At the laminar region of the hooves, there was hyperplasia of the top of epidermal laminae with irregular keratinization and retention of nuclei; several epidermal laminae were shortened and fused. There was hemorrhage, fibrin and neutrophilic infiltrate in the dermal laminae. In the mucosa of the tongue there was thinning of the covering epithelium, atrophy and loss of filiform papillae, multifocal areas of dyskeratosis, and spongiosis of the basal cell layer. In some parts the epithelium was lost and the surface consisted of granulation tissue and mixed inflammatory cell infiltrate. The esophageal mucosae of six calves had varying degree of epithelial necrosis and inflammation. The loss of the covering epithelium revealed ...

Emergency room cases of mushroom poisoning

To describe the pattern of mushroom poisoning in adults. We investigated patients presenting at the Emergency Room, Medical School Hospital, Cumhuriyet University, Turkey between 1999 and 2003 with complaints of mushroom poisoning. They were kept under observation in the emergency unit and Anesthesia Department intensive care unit. We evaluated the demographical features of the patients, laboratory data, vital signs, and applied treatment and results. Seventy-eight patients aged between 19-72 [40.27 +/- 16.09] were studied, 52 were females [67%], and 26 were males [33%]. It was established that 90% [70] of the patients had picked wild mushrooms, and 67.9% [53] had done so in springtime. Methods of cooking were as follows: 30 patients [38.4%] grilled the mushrooms, 28 patients [35.8%] stir fried, and 20 patients [25.6%] consumed mushrooms uncooked. Onset of symptoms was mostly [43.5%] within the first hour of consumption. The most common [42.3%] symptoms were gastrointestinal complaints. Upon examining laboratory results, 17.9% revealed variations in hematological parameters, impairment in renal functions in 6 patients [7.6%], hematuria in 10 patients [12.8%] and 15.3% had primarily elevated liver enzymes. Seventy-four patients [97%] completely recovered and were discharged. However, 2 patients [2.8%] who consumed raw mushrooms died due to acute hepatic failure. There was a 20-year-old patient at week 31 of her first pregnancy who had consumed uncooked wild mushrooms. She developed gastrointestinal symptoms and mild loss of consciousness within the first half hour. She received quadruple therapy and completely recovered. The results of the study indicated that the public, as well as the cultivators, were rather unconcerned and uneducated regarding this issue. Efforts aimed at overcoming this problem will decrease the number of mushroom poisoning cases, will help to save on treatment costs, and more importantly, reduce patient mortality