9/14/2015
Folkloric edibility test results of 50 selected Algonquin Park mushroom taxa
Species
Agaricus campestris
Amanita citrina
Amanita flavoconia
Amanita fulva
Amanita muscaria
Amanita cf. solaniolens
Amanita virosa
Armillariella mellea
Boletus rubripes
Cantharellula umbonata
Cantharellus cibarius
Clavulina cristata
Collybia dryophila
Cortinarius alboviolaceus
Cortinarius raphanoides
Craterellus cornucopioides
Cystoderma granulosum
Dermocybe semisanguineus
Entoloma lividoalbum
Gymnopilus penetrans
Hydnum repandum
Hygrocybe cantharellus
Hygrophorus
yg p
coccineus
Hygrophorus eburneus
Hygrophorus flavescens
Hygrophorus niveus
Hygrophorus vitellinus
Hypholoma capnoides
Hypomyces lactifluorum
Lactarius camphoratus
Lactarius deliciosus
Lactarius cf. subvernalis
Leccinum insigne
Leccinum holopus
Lepiota clypeolaria
Lycoperdon perlatum
Lycoperdon pyriforme
Marasmius rotula
Pholiota squarrosa
Piptoporus betulinus
Pseudoclitocybe cyathiformis
Ramariopsis kunzei
Rozites caperata
Russula rosacea
Scleroderma citrinum
Suillus americanus
Suillus granulatus
Suillus pictus
Tylopilus felleus
Xerula radicata
HMB436H – Medical & Veterinary Mycology
Lecture 4 – Mushroom poisoning
Dr. James Scott
Dalla Lana School of Public Health
University of Toronto
Groves
1979
Lincoff
1981
McIlvaine
1902
McKnight
1987
Miller
1978
Moser
1983
Phillips
1991
Pilát
1952, 1961
Garlic
Onion
Worms/insects
Cap peel
Bruise
--------------------------█
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█
--------------█
-█
---------█
----█
█
-----------█
-█
---
---------------█
-█
---------------█
-----------█
-█
█
--
-█
-█
-█
█
----█
---█
█
-----█
--█
█
█
-█
-█
--█
█
█
█
█
-█
-█
-█
-█
█
█
█
---------█
-█
█
--█
-----█
█
█
█
---█
█
█
------█
---█
-----█
---
█
-█
---█
-█
█
--------------------█
--█
-----------█
--█
--
Odour
--█
------█
-------------█
----█
----█
-█
█
----█
-█
█
-█
█
█
--
mushrooms
fish, potatoes
stale towels
indistinct
fish
potatoes
wet sawdust, fish
fruit
dried mushrooms
latex rubber
apricots
mushrooms
clean laundry
flour
soil
indistinct
curry, soil
dried grass
fruit, sweet
mushrooms
indistinct
indistinct
indistinct
mildew, soil
mushrooms, spicy, like cooked meat
indistinct
solvent, garlic
indistinct
rotting fish
curry
fruit, sweet
mushrooms
mushrooms, fruit
solvent
garlic
shoe polish
slightly like solvent
fruit, mushrooms
indistinct
mushrooms
fresh fish, mushrooms
slightly like gasoline
indistinct
slightly like solvent
solvent, mushrooms
mushrooms
solvent, mushrooms
solvent
solvent, like car vinyl
indistinct
2
Recent serious local poisonings by an unusual mushroom species
A summary of the scope of treatment by various authors
of 50 selected Algonquin Park mushroom taxa
Arora
1979
Silver
• 28 Oct 2003:
Pomerleau
1980
Percent of total
species treated1
72
68
70
70
60
80
70
92
44
90
Percent of treated f
d
species with edibility status given
58
64
66
68
52
72
40
84
44
78
edible: poisonous
8:2
8:2
8:2
9:1
7:3
7:3
9:1
6:4
8:2
8:2
Percent of species with no edibility status 14
4
16
2
8
8
30
8
0
12
1All percentages calculated out of the total of 50 taxa examined
– Chinese female 67 y/o ate mushrooms 5 days ago picked from a park in North York
– 2 days later developed vomiting and diarrhea
– no vomiting or diarrhea x 2 days
– presented at NYGH as dehydrated, confused, jaundiced , lethargic
– xfr to TGH ICU on 29 Oct 2003
– ↑LFTs…, intubated, seizure
– Died 30 Oct 2003 (~7 d following ingestion)
3
4
…more
…more
• 29 Sept 2006
• 22 Sept 2006
– Polish male and female ~40 y/o from Toronto eat wild mushrooms
– Develops GI symptoms after 1 d
– Female hospitalized
– Transient elevation of LFTs
– Treated supportively & with silymarin (milk thistle) extract
– Both resolved after 8 d
5
– (?Ukrainian) Kitchener grandmother serves wild mushrooms to family
– 4 family members (including grandma) get sick
5 y/o grandson xfered to HSK receives liver transplant
– 5 y/o grandson xfered to HSK, receives liver transplant
– All survive
• 30 Sep 2006
– Chinese female, 57 y/o ate mushrooms picked form a lawn in Scarborough
– Died in hospital 7 days later
6
1
9/14/2015
Lepiota subincarnata
Lepiota subincarnata
Lepiota subincarnata
EF Bossenmaier
Lepiota josserandi
EF Bossenmaier
Lepiota josserandi
2
9/14/2015
Lepiota cristata
Lepiota procera
GL Barron
Cyclopeptide poisonings from mushroom ingestion
• 1998 AAPCC list 9,839 mushroom poisonings of which 40 involved cyclopeptide‐containing species
• Children make up approx one half of the potential cyclopeptide exposures in the US
Group 1: Amatoxin‐type
Group 1: Amatoxin
type
15
Amatoxins
16
Phalloidins
• Family of cyclopeptide toxins
• Potent inhibitors of RNA II polymerase
• Target tissues with high rates of protein synthesis (liver, kidneys, brain, pancreas)
h i (li
kid
b i
)
• Absorbed α‐amanitin excreted into bile
• Recirculated by enterohepatic circulation • Family of cyclopeptide toxins
• Gastroenteritis 6‐12 h post ingestion
• Interrupts actin polymerization‐
d
depolymerization impairing membrane l
i i i
ii
b
function
• Typically resolves with supportive care within 24 hr
17
18
3
9/14/2015
Amatoxins / phallotoxins
Another recent serious local poisoning
• 20 July 2006:
• Amanita phalloides, A. virosa, A. verna, &c.
– 45 y/o male ate mushrooms picked in High Pk
– developed abdominal pain, vomiting and diarrhea within 6 hr, taken to emerg by EMS
– LFTs OK at admission, but increased over 24 hr
– Mushroom ID was Amanita bisporigera/ virosa cpx
– Tx: n‐acetylcysteine, milk thistle & penicillin G
– Resolved without transplantation ~10 d
• Galerina autumnalis, G. marginalis, G. venenata
• Lepiota rubrotincta, L. josserandi, L. helveola, etc. 19
20
Amanita bisporigera
Amanita phalloides
5 cm
Galerina autumnalis
Conocybe filaris
P Kaminski
4
9/14/2015
Amatoxins
Amatoxin content
Species
Amanita phalloides
Amanita virosa
Amanita virosa
Lepiota brunneoincarnata
Lepiota josserandi
Season: Summer to late fall
Onset: (6‐) 12‐24 (‐48) hr pp Sx: 1) GI symptoms lasting 1‐2 d
Amatoxin*
1.4 ‐ 6.8 mg/g
1 9 ‐ 2.6
1.9 ‐
26
1.3
3.5
2) Treacherous remission 12‐24 hr
3) Liver/ kidney failure, death in 4‐7 d
Toxin: α‐Amanitin inhibits RNAII pol
Rx: ‐ treat symptoms, follow LFTs
‐ interrupt enterohepatic circulation
‐ liver transplant has been successful
‐ silymarin / penicillin may reduce reabsorption
* lethal dose for adult approx. 10 mg
26
25
Group 1A: Orellanine
Group 1A: Orellanine
27
28
Cortinarius orellanus group
Orellanine
Season: Late summer to late fall (east coast)
Onset: (36 hr) 3‐14 (‐17) d pp
Sx: 1) Renal insufficiency, interstitial inflammatory
signs, tubular necrosis, GI Sx, (LFTs OK)
2) Eventual multi‐organ involvement
)
l
li
i
l
3) Death in 14‐21 d (15% mortality)
Toxin: ‐ not much is known about it
Group 2: Ibotenic acid / Muscimol
Group 2: Ibotenic acid / Muscimol
Rx: ‐ treat symptoms, renal support, forced diuresis
may amplify nephrotoxicity
‐ renal transplant may be considered
29
30
5
9/14/2015
Amanita muscaria var. muscaria
Amanita muscaria var. muscaria
Amanita caesarea
Amanita amerimuscaria
Ibotenic acid / Muscimol
Season: Summer to late fall
Onset: 30‐120 (180) min pp
Sx: atropine‐like toxicosis (rarely cholinergic), dizziness,
Group 3: Gyromitrin &
monomethylhydrazine (MMH)
th lh d i (MMH)
muscle cramps, mood swings, ±nausea / vomiting,
often with antithetic symptoms alternating rapidly
(**very little muscarine in North American biotypes**)
Toxin: GABA analogues, CNS sympathetic effects
Rx: ‐ GI decontamination, charcoal
‐ conservative symptom treatment
35
36
6
9/14/2015
Gyromitra esculenta
Morchella esculenta group
Gyromitrin &
monomethylhydrazine (MMH)
Season: Early to late spring
Onset: (2‐) 6‐12 hr postprandial
Sx: 1) Mild: GI symptoms, abdominal pain, muscle
cramps, vertigo, headache
2) Severe: convulsions, death (more often chronic)
Toxin: MMH
‐ thermolabile
‐ cumulative (acute vs. chronic intoxication)
Rx: ‐ monitor LFTs, treat symptoms
‐ possible role for pyridoxine (B6)
Morchella elata group
40
Group 4: Muscarine
Group 4: Muscarine
41
Inocybe geophylla
7
9/14/2015
Clitocybe dealbata
Inocybe patouillardii
Muscarine
Season: Summer to late fall
Onset: 30‐120 (180) min pp
Sx: ‐ perspiration, SLUDGE syndrome, pupilar constriction
blurred vision, bradycardia, hypotension
Group 5: Coprine
Group 5: Coprine
Toxin: cholinergic (aka muscarinic) effects
Rx: ‐ atropine is antedotal
45
Coprinus atramentarius
46
Morchella elata group !!
8
9/14/2015
Coprine
Season: Late spring to late fall
Onset: Usually 30 min after EtOH ingestion
– reaction possible up to 6 d after ingestion of mushroom
– may occur in children following cough elixir
Sx: Flushing of upper body, swelling/ tingling of hands, /
metallic taste, tachycardia, tachypnea, headache, nausea/ vomiting
Toxin: Antabuse / disulfiram‐like reaction
Rx: Supportive care
49
51
Panaeolus cinctulus
53
Group 6: Psilocybin‐type
Group 6: Psilocybin
type
50
Psilocybe semilanceolata
Panaeolina foenisecii
54
9
9/14/2015
Gymnopilus spectabilis
Galerina autumnalis
Group 7: Miscellaneous GI irritants
Group 7: Miscellaneous GI irritants
(may include some muscarine)
Armillaria ostoyae
57
58
Armillaria ostoyae
59
Chlorophyllum molybdites
10
9/14/2015
Russula emetica group
Omphalotus illudens
Omphalotus illudens
Boletus satanus
Cantharellus cibarius
Boletus subvelutipes
11
9/14/2015
Miscellaneous
Season: Late spring to late fall
Onset: 30 min to (2‐) 4 hr pp
Sx: ‐ nausea, vomiting, diarrhea, other symptoms
Toxin: various, poorly‐defined
Rx: ‐ treat symptoms, replace fluids
‐ charcoal may be useful in severe poisonings
Boletus calopus
68
A recent case...
Purple reaction when treated with KOH
Hapalopilus nidulans
www.gbif.org
69
70
Summary
Other considerations
• Bioconcentration
– Pb, Cs, Co, Hg, U, Zn
• Bacterial overgrowth
• Food sensitivity
Avg Onset
Symptoms
Likely toxin
< 45 min pp
flushing or face & neck, tingling of arms
Coprine
15‐120 min pp
PSL/ SLUDGE syndrome, constricted pupils
Muscarine
1‐3 hr pp
muscle spasms, hyperactivity/ p
yp
y
lethargy, nausea/ vomiting
Ibotenic acid/ Ibotenic
acid/
Muscimol
misc. GI irritants
nausea, vomiting, diarrhea
– trehalose intolerance
71
(2)6‐12(48) hr pp
bloated feeling, nausea/ vomiting, headache, LFTs
MMH
(6)12‐24(48) hr pp
severe gastroenteritis, remission, LFTs, symptom progression
Amatoxins
3‐14 (17) d pp
severe thirst, frequent urination, renal pain
Orellanine
12