MUSHROOMS

1
MUSHROOMS
5000 SPECIES (2)
2
Cyclopeptide Toxin

• Amanita phalloides (death cap)
• A. verna
• A.virosa
• Galerina marginata

3

• 1-Amatoxins
• ?-amanitin
• ß-amanitin
• 2-Phallotoxin
• Phalloidin

4

• Amatoxin
• high oral absorb, entrohepatic circulation, renal
  reabsorption
• Phallotoxin
• very low oral absorption (no oral toxicity)
• Both heat stable

5
Amatoxin

• Inhibit RNA polymerase
• Interfere DNA Transcription Protein
  Synthesis Necrosis

6
Amatoxin target

• Liver
• KIDNEY
• PANCREAS
• INTESTINE

7
phallotoxin

• Bind to actin
• Disrupt cell membrane liver
• protein synthesis

8
Clinical

• 1-- GI effect (6-24h)
• Abdominal pain
• nausea
• vomiting
• Diarrhea
• Fever
• Hypoglycemia
• elecrolyte imbalance

9
CLINICAL

• 2- Temporary clinical remission (24-72h)
• Toxin induce cell injury (misdiagnose)

10
CLINICAL

• 3--Hepatorenal phase (3-6 days)
• Hepatic-renal failure
• Pancreatitis
• Coagulophaty
• Seizure
• Coma

11
Treatment

• Lavage
• Charcoal
• Diuresis
• Electrolyte balance
• Vit K
• FFP
• Glucose

12
Penicillin G

• 300,000-One million IU/Kg (seizure)
• Displace toxin from protein binding
  renal excretion

13
Silymarin

• 140 mg TID
• Inhibit toxin uptake by cells
• NAC thioctic acid hyperbaric(oxygen)
• regenerate
• Hemodialysis- hemopefusion late

14
Gyromitrin toxin (heat labile)

• Gyromitra esculenta gyromitrin GI methyl
  formyl hydrazine GI
• 
  Methyl Hydrazine

15
metabolites toxicity

• Inhibit Pyridoxal Phosphate GABA
• seizure
• liver Nitrosamide Liver Toxicity
• Inhibit histaminase His GI
  effect
• Inhibit Dihydrofolate Reductase Anemia
• Induce oxidative Stress Hemolysis ,
  Methemoglobinemia

16
Clinical (after 6h)

• GI nausea-vomit-abdo pain-diarrhea
• CNS dizziness-headache-seizure-coma
• Liver ALT and AST-coagulopathy-jaundice
• Blood hemolysis-metHb-anemia-
• others hypotension-rhabdomyolysis

17
treatment

• metHb gt 30 ---- methylene blue o2 supp
• Folinic acid 5-15 mg/day for 7 day
• Pyridoxine up to 25 mg/kg diazepam seizure
  
• Vit K fluid (ringer-lactat) alkaline
  urine prevent myoglobin deposition

18
MUSCARINE

• Heat stable
• Low oral absorbtion
• Clitocybe
• Inocybe
• No effect on nicotinic receptor
• No CNS effect

19
CLINICAL (0.5 1h)

• Cholinergic
• salivation
• lacrimation
• Diarrhea
• Bradycardia
• Hypotension
• perspiration

20
Treatment

• Lavage
• Charcoal
• Ipratropium (inhalation)
• Atropine
• Glycopyrolate (0.5 to 1 mg ) IV
• No CNS effect

21

• AMANITA MUSCARIA
• AND
• AMANITA PANTHERINA

22
ISOXAZOLE COMPOUND

• Ibotenic acid NMDA activation excitation
• muscimol GABA agonist depression
• serotonin , dopamine

23
CLINICAL (0.5 TO 2 h)

• Ephoria depression
• Agitation somnolence
• Amnestic to event during intoxication
• GI effect tremor ataxia hallucination-salivat
  ion-perspiration-bradycardia
• no effect on muscarinic receptors

24
Treatment

• Charcoal
• Quiet, dark room
• Diazepam in agitation
• No role for atropine
• Poison exctract by water (discard water)

25
INDOLE ALKALOID

• Psilocybin (heat stable)
• psilocin

body
26

• Psilocybe
• Gymnopilus
• panaeolus

27

• Stimulate (5HT 2 A) receptor
• LSD like effect

28
Clinical ( 0.5-2 h)

• Mydriasis
• Blurred vision
• Hypotension
• Tachycardia
• Euphoria
• Agitation
• Hallucination
• Hyperthermia
• seizure

29
treatment

• Charcoal
• Quiet and dark room
• Diazepam
• Antipsychotic worsen hyperthermia
• Or induce seizure)

30
GI IRRITANT

• CHLOROPHYLLUM MOLYBDITES
• OMPHALOTUS OLEARIUS

31

• Toxin not isolated
• Cooking decrease toxicity

32
Clinical ( 0.5-2 h)

• Nausea
• Vomiting
• Abdominal pain
• Bloody diarrhea
• Bradycardia
• Diaphoresis
• Chills
• dizziness

33

• GI effect muscarinic like effect without
  salivation and lacrimation

34
treatment

• Fluid
• Electrolyte
• Ondansetron
• Charcoal (low effect)

35
NEPHROTOXIC MUSHROOM
AMANITA SMITHIANA
36
TOXIN

• Cortinarius
• Orellanine (heat stable)
• Disruption of actin and inhibit protein
  synthesis
• Cortinarin A , cortinarin B
• A.smithiana
• Aminohexadienoic acid

37
Clinical effect

• 36h post ingestion! Nausea vomiting
  headache polydipsia
• 7-10 day renal failure (tubulin necrosis)
• oliguria - anuria

38
Treatment

• Hemodialysis for a long time is a supportive care
  ( 50-70 improve after several weeks)

39
MUSHROOM WITH DISULFIRAM EFFECT

• COPRINUS ATRAMENTARIOUS
• COPRINE (HEAT STABLE)
• AMINOCYCLOPROPANOL

BODY
40

• INHIBIT
• ALDEHYDE DEHYDROGENASE
• If ethanol ingestion within 48 h after mushroom
• Flushing-vomiting-tachycardia-arrhythmia

41
Treatment

• Hemodialysis ethanol
• 
  acetaldehyde
• Fomepizole inhibit alcohol dehydrogenase
• 
  

42
MUSHROOM INDUCE RHABDOMYOLYSIS

• RUSSULA SUBNIGRICANS
• TRICHOLOMA EQUESTER

43
CLINICAL

• GI effect myalgia (myoglobinuria)
• Treatment
• Fluid, alkaline urine

44
(No Transcript)