Intoxicación con Amanita phalloides: serie de tres casos / Amanita phalloides poisoning: series of three cases

Se presenta una serie de tres casos de pacientes adultos con intoxicación por Amanita phalloides, ocurridos entre los años 2010 y 2011. Dos pacientes eran de sexo masculino, de 40 y 75 años de edad, y la mujer de 65 años. En todos los casos se asoció el cuadro clínico a la práctica de recolección casera de hongos para preparación de alimentos (actividad sostenida durante más de 10 años en todos los casos). La recolección se realizó en zonas de robles en un caso, y en zonas de castaños en los otros dos casos. En los tres casos la consulta se realizó entre las 16 y 36 h de la ingesta. Los tres pacientes desarrollaron diarrea, hepatopatía y falla hepática sin encefalopatía. A todos se les realizó tratamiento con carbón activado seriado, aspirado duodenal y penicilina endovenosa. El trasplante hepático fue necesario en uno de los casos. No hubo secuelas hepáticas en ninguno de los pacientes. Conclusiones: la práctica de recolección de hongos silvestres para consumo humano es un hábito riesgoso si se realiza por personas inexpertas en el reconocimiento de las especies tóxicas. Si bien la intoxicación por A. phalloides es un cuadro poco frecuente, su alta morbimortalidad hace indispensable el reconocimiento temprano y abordaje oportuno por parte de los médicos.

We present a series of three cases of Amanita phalloides poisoning in adult patients admitted during the period 2010 - 2011. Two patients were males of 40 and 75 years old, and the third was a woman of 65 years old. In all cases, the poisoning was associated with the home practice of collecting wild mushroom for cooking (activity traditionally carried out for more than 10 years in all cases). Mushroom collection was carried out in areas of oak trees for one case, and in areas of chestnuts trees in the two other cases. In all three cases the admission took place between 16 and 36 hours from intake. All three patients developed diarrhea, liver disease and liver failure without encephalopathy. All patients received treatment with activated charcoal (serial administration), duodenal aspiration and intravenous penicillin. Liver transplantation was necessary in one case. There were no hepatic sequelae in any patients. Conclusions: The practice of collecting wild mushrooms for human consumption is a risky habit if performed by people untrained in recognition of toxic species. While poisoning with A. phalloides is uncommon, its high mortality makes indispensable its early recognition and treatment by physicians.

Mushroom poisoning in children: clinical presentation and outcome

A variable clinical picture characterizes mushroom poisoning. The Amatoxin, the main toxic component of these fungi, are responsible for gastrointestinal symptoms as well as hepatic and renal failure. As acute gastroenteritis is extremely common in our set up, so every patient presenting with these symptoms is treated as gastroenteritis of viral aetiology. The authors present the clinical picture of the phalloid syndrome, its treatment and immediate outcome. All children age less than 16 years admitted in Saidu Hospital Swat from January to December 2006 with mushroom poisoning were included in the study. Patients with doubtful history or with associated illness were not included. The diagnosis was based on the clinical picture of the patient, history and the laboratory data. In addition to maintenance of fluid and electrolyte balance and treating sepsis, oral Silymarin and intravenous penicillin was started. Liver function tests, renal functions tests, serum electrolytes and coagulation profile was done in all the patients. The severity of poisoning was graded according to hepatic transaminase elevations and prolongation of prothrombin time. Of the 18 patients, fifteen were above five years of age. Female were twice in number. Fifteen patients developed hepatic failure and three patients developed renal failure. Thirteen patients expired. To start timely management, Mushroom poisoning should be considered in the differential diagnosis in patients presenting with food poisoning particularly coming in groups. Delay in diagnosis is associated with high mortality