MUSHROOMS

Cyclopeptide Containing Mushrooms

mycology/fungi/amanphal.html

•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

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

•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

•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.

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

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

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)

Monomethylhydrazine - Containing Mushrooms

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

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

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

Therapy •Pyridoxine, in dose of 25 mg/kg

Glutamate  Glutamic Acid  GABA Pyridoxal 5' phosphate

Muscarine-Containing Mushrooms

mycology/fungi/clitphae

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

•Symptoms: SLUDGE within hours •Therapy: Atropine

Coprine-Containing Mushrooms

•Rarely fatal •Coprinus atramentarius (inky caps) •Coprine has a disulfiramlike effect (Blocks acetaldehyde dehydrogenase) •Requires ingestion of alcohol hours after mushroom

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

Ibotenic Acid- and Muscimol- Containing Mushrooms

mycology/fungi/amanpant

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

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

Psilocybin-Containing Mushrooms

mycomed/gallery1

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

Gastrointestinal Toxins

mycology/fungi/bolevent

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

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

Orelline-and Orellanine- Containing Mushrooms

mycology/fungi/corteleg

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

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

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

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

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

•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

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