1. MUSHROOMS

2. Cyclopeptide Containing Mushrooms

3. http://www.inf.unitn.it./~mflorian/ mycology/fungi/amanphal.html

4. •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

5. 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

6. •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

7. •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.

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

9. 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

10. 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)

11. Monomethylhydrazine - Containing Mushrooms

12. http://www.wisc.edu/botany/fungi/apr97

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

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

15. 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

16. Therapy •Pyridoxine, in dose of 25 mg/kg

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

18. Muscarine-Containing Mushrooms

19. http://www.inf.unitn.it./~mflorian/ mycology/fungi/clitphae

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

21. •Symptoms: SLUDGE within 0.5-2 hours •Therapy: Atropine

22. Coprine-Containing Mushrooms

24. •Rarely fatal •Coprinus atramentarius (inky caps) •Coprine has a disulfiramlike effect (Blocks acetaldehyde dehydrogenase) •Requires ingestion of alcohol 48-72 hours after mushroom

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

26. Ibotenic Acid- and Muscimol- Containing Mushrooms

27. http://www.inf.unitn.it./~mflorian/ mycology/fungi/amanpant

28. •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

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

30. Psilocybin-Containing Mushrooms

31. http://www.halcyon.com/ mycomed/gallery1

32. •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

33. Gastrointestinal Toxins

34. http://www.inf.unitn.it./~mflorian/ mycology/fungi/bolevent

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

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

37. Orelline-and Orellanine- Containing Mushrooms

38. http://www.inf.unitn.it./~mflorian/ mycology/fungi/corteleg

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

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

41. 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

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

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

44. •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

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