mushroom poisoning

Introduction

inadvertent ingestion of poisonous mushrooms is a relative common event in Autumn
unfortunately in Australia, ingestion of potentially fatal death cap mushrooms (mainly found under oak trees) do tend to occur each Autumn
the other common accidental ingestion of a “poisonous” mushroom in Victoria is the Yellow Stainer
other fungi known to cause poisonings in Victoria include Ghost Fungus (Omphalotus nidiformis), Chlorophyllum brunneum and species of Earthball (Scleroderma) that have been mistakenly collected as truffles.
most other mushrooms only cause GIT symptoms but there are some specific mushroom syndromes as outlined below

delayed onset gastro symptoms > 6hrs from ingestion is suggestive of potentially lethal hepatotoxic ingestions
Identification is probably most easily done by comparison with photos and descriptions in text-books. At present, there is no reliable, up-to-date systematic key to the identification of Australian fungi.
Amanita sp have WHITE GILLS and are responsible for 95% of fatalities - if it has white gills don't eat it unless you are absolutely sure it is safe (there are some safely edible Amanitas such as A. fulva, and some other species have white gills and may be edible but not worth the risk)! This does not mean if it doesn't have white gills it is safe!

Amanita phalloides (death cap mushroom), A.virosa (European Destroying Angel), A. verna (fool's mushroom), A. bisporigera (eastern NA Destroying Angel), Galerina autumnalis, G. marginata, G. venenata, Lepiota helveola
typically found near oak trees
Amanitins are cyclic octapeptides that stop protein synthesis affecting all organs, but damage to the liver is the most severe and liver failure is primarily responsible for the death - STT3B is the key protein that is required for a-amanitin to have its toxic effect - research is beginning on whether indocyanine green could be an effective antidote as it seems to work on mice if given early after exposure (esp. within 4hrs) ¹⁾
delayed onset gastroenteritis starting 6-24hrs
delayed onset hepatotoxicity which may result in fulminant liver failure and death
Mx principles
- multi-dose charcoal
- iv fluid Rx
- iv silibinin for 5 days
- iv N-acetyle cysteine (Parvolex)
- iv cimetidine
- iv vitamin C
- may need liver transplant

Gyromitra esculenta, G.infula, Sarcosphaera coronaria, Cyathipodia macropus
delayed onset gastroenteritis starting 4-10hrs
delayed onset hepatotoxicity which may result in fulminant liver failure and death
+/- seizures
Mx principles
- seizure Mx
  - Benzodiazepines
  - iv pyridoxine 70 mg/kg IV to max. 5g
- methaemoglobinaemia
  - iv Methylene blue
- supportive care
  - iv fluids

Cortinarius orellanus, C. speciosissinus, Mycena pura, Omphalatus orarius
end stage renal failure may develop 3-20 days after ingestion in ~11%

Amanita muscaria (the Fly Agaric the red ones found in pine or oak forests), A. pantherina, A. gemmata
onset 0.5-2hrs, symptoms usually resolve in 6-24hrs
may cause delirium, hallucinations, coma, and in children, seizures
Rx with benzodiazepines and supportive care

Amanita muscaria (the common Fly Agaric)

Psilocybe cubensis, P. mexicana, Conocybe cyanopus, Gymnopilus aeruginosa, Panaeolousfoenisecil
onset 0.5-2hrs, sysmptoms usually resolve in 12hrs

Clitocybe dealbata, C. illudens, Inocybe fastigiata, Boletus calopus
cholinergic symptoms usually start 0.5-2hrs and usually resolve within 12hrs
Mx
- atropine
- glycopyrrolate
- supportive care
- wheeze: salbutamol + ipratropium

usually onset < 6hrs, mostly within 3hrs of ingestion
Chlorophyllum molybdites, Clitocybe nebularis, Omphalates illudens
Agaricus xanthodermus (Yellow Stainer) common in urban grass areas - bright yellow staining on fresh caps or stem bases when rubbed
supportive care

¹⁾