MUSHROOMS

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MUSHROOMS
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Cyclopeptide Containing Mushrooms
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http//www.inf.unitn.it./mflorian/mycology/fungi
/amanphal.html
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• 95 of mushroom fatalities are due to these
• Include A. verna (death angel), A. virosa
  (destroying angel), A. phalloides (death cap)
• Also, Galerina autumnalis, G. marginata, G.
  Venenata, and Lepiota helveola

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Symptoms

• Usually not before 6-12 hours
• Include profuse, watery diarrhea, and
  gastroenteritis at 12-24 hours transient
  improvement
• 1-6 days later hepatic, renal and at times
  pancreatic toxicity and death

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• Toxin is heat-stable, insoluble in water and
  loses activity very slowly over years
• Mortality related to age and dose(0.1 mg/kg is
  lethal)
• Children are more susceptible

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• Toxicity of alpha-aminitin is through
  interference with RNA polymerase II, prevents the
  transcription of DNA
• Phalotoxins are rapid-acting and interrupt actin
  polymerization, impair cell membrane function,
  has limited absorption.

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Therapy

• Continuous gastrointestinal charcoal lavage to
  decontaminate (theoretically, up to five days)
• Watch for altered mental status due to
  hypoglycemia
• Supportive therapy

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Antidotes

• Penicillin displaces amatoxin from plasma
  protein-binding sites
• May inhibit penetration of amatoxin into
  hepatocytes
• Doses of 300,000 to 1,000,000 units benzyl
  penicillin daily
• N-acetylcysteine may be helpful as in any
  patient with liver injury

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Other Antidotes

• Thioctic acid (alpha-lipoic acid)
• Silibinin (extract of silymarin from Silybum
  marianum)
• Cimetidine may be hepatoprotective.
• Consider liver transplantation early(Prior to
  grade III hepatic encephalopathy)

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Monomethylhydrazine -Containing Mushrooms
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• http//www.wisc.edu/botany/fungi/apr97

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• Associated with mortality of 40
• Include G. californica, G. brunnea, G. esculenta

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• Toxicity is due to gyromitrin which is
  metabolized to monomethylhydrazine
• This metabolite reacts with pyridoxine resulting
  in inhibition of pyridoxal phosphate-related
  enzymatic reactions

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Symptoms

• Headache, nausea, vomiting, seizures, and
  hepatorenal failure
• Symptoms occur 6-10 hours after ingestion
• Toxin may be eliminated with cooking but
  inhalation of cooking fumes may cause poisoning

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Therapy

• Pyridoxine, in dose of 25 mg/kg

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• Glutamate ? Glutamic Acid ??? GABA

Pyridoxal 5' phosphate
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Muscarine-Containing Mushrooms
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• http//www.inf.unitn.it./mflorian/mycology/fungi
  /clitphae

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• No lethality
• Includes Clitocybe dealbata (the sweater), C.
  Illudens (omphalotus olearius) and Inocybe lacera
• Small amounts of muscarine are in Amanitia
  muscaria

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• Symptoms SLUDGE within 0.5-2 hours
• Therapy Atropine

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Coprine-Containing Mushrooms
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(No Transcript)
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• Rarely fatal
• Coprinus atramentarius (inky caps)
• Coprine has a disulfiramlike effect(Blocks
  acetaldehyde dehydrogenase)
• Requires ingestion of alcohol 48-72 hours after
  mushroom

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• Symptoms Flushing, headache, hypotension,
  histamine induced vasodilation
• Therapy Supportive, anti H1 and anti H2,
  prostaglandin inhibitors

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Ibotenic Acid- and Muscimol-Containing Mushrooms
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• http//www.inf.unitn.it./mflorian/mycology/fungi
  /amanpant

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• Not lethal
• Amanita gemmata, A. muscaria and A. pantherina
• Symptoms Within 0.5-2 hours, somnolence,
  hallucinations and delirium, in
  adults
• Also, myoclonus, seizures and other neurologic
  effects in children

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• Action is due to stimulation of GABA receptors
• Therapy Benzodiazepine

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Psilocybin-Containing Mushrooms
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• http//www.halcyon.com/mycomed/gallery1

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• Rare mortality
• Symptoms In 0.5-1 hour, CNS effects ataxia,
  hyperkinesis, hallucinations, and seizures
• Psilocybe cubensis, P. caerulescens, Conocybe
  cyanopus, Panaeolus foenisecii, Gymnopilus
  spectabilis, Psathyrella foenisecii

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Gastrointestinal Toxins
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• http//www.inf.unitn.it./mflorian/mycology/fungi
  /bolevent

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• Death is rare
• Little brown mushrooms
• Boletes, Lactarius, Rhodophyllus, Tricholoma,
  Chlorophyllum molybidites, C. esculentum

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Symptoms

• Variable but usually in 0.5-3 hours
• Nausea, vomiting diarrhea and epigastric
  distress
• Supportive therapy
• Resolution of symptoms in 6-24 hours

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Orelline-and Orellanine-Containing Mushrooms
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• http//www.inf.unitn.it./mflorian/mycology/fungi
  /corteleg

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• May be lethal
• Symptoms In 24-36 hours, headache, chills,
  anorexia, nausea, gastritis
• Hepatotoxicity, and oliguric renal failure may
  develop
• Therapy Supportive

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Ralph's Rules

• If uncertain of the identity of a species, don't
  try it

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Try to Identify New Species

• Draw no conclusions until definitive spore
  print, cross section of gill, stem and bruise
  color.
• Be able to state with confidence what
  distinguishes specimen from 3-5 look alikes

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• Confidence of limits of variability of species
• Photos confirm identity
• Odor, bruising, brittleness, habit,...support
  identification

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• Avoid LBM's, amanita, cortinarius
• Use recent texts and monographs
• Must be worth eating

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• Eat slowly first taste the species. Second
  taste is more than 24 hours later.
• Wait another 24 hours before trying a full-sized
  serving
• Do not over-indulge

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• Gather only one species at a time
• Do not eat more than one species at a time
• Do not eat any species raw