Atypical poisonings with botanicals raise suspicion of malicious activity.

Heightened toxicovigilance since the terrorist actions of 9/11 has raised concerns for malicious use of highly toxic botanicals, as the 3 cases reported illustrate.

Digital imaging: a promising tool for mushroom identification.

Mushroom poisoning is a diagnostic and treatment dilemma for health care professionals. Decisions regarding treatment following ingestions are usually made without a firm identification of the fungus and tend to be more aggressive than necessary. The identification of mushrooms is beyond the scope of health care professionals, and a mycologist is essential to make an accurate identification. Telemedicine and digital imaging is an emerging technology that can assist in mushroom identification and facilitate patient care. The efficacy of using digital images sent over the Internet was tested in a pilot project. This article describes three cases in which digital images and verbal descriptions assisted in mushroom identification. When the actual specimen was sent to a mycologist, a definitive identification was obtained and compared with the presumptive identification. Digital images alone do not permit definitive identification; however, they often contain sufficient information to help the clinician rule out the possibility of a severely toxic species. Data accumulated to date indicate that digital imaging can be an important tool in the diagnosis and treatment of mushroom ingestion, and possibly other biologicals such as plants, insects, and reptiles.