The effects of CDP-choline treatment in Amanita phalloides mushroom toxicosis.

Amanita phalloides poisoning is known to be the most fatal case among mushroom poisoning cases. Its main mechanism of toxicity is that it leads to cell death by the irreversible binding of its toxins to the DNA-dependent RNA polymerase II enzyme. This study was planned to analyze the effects of the CDP-choline molecule on Amanita phalloides mushroom poisoning cases. The extract of the Amanita phalloides mushroom was taken and intraperitoneally administered to male Wistar Albino rats at a dose of 0.3 g/kg. In the experiment phase, the rats were divided into three groups of CDP-choline treatment according to the doses of 100 mg/kg, 250 mg/kg, and 500 mg/kg, and one control group was administered a 1 ml/kg dose of 0.9% isotonic NaCl solution. The treatments were then administered intraperitoneally at the 2nd hour, and at the 6th hour, the rats were sacrificed. The degree of damage in the liver and kidney tissues of the rats was evaluated histopathologically. It was concluded that CDP-choline reduced or prevented the damage that occurred in the liver significantly and dose-dependently in the toxicosis picture caused by Amanita phalloides, and it showed a tendency to lower or prevent the damage in the kidney, albeit not significantly.

Investigation of Antioxidant Activity, Myco-Chemical Content, and GC-MS Based Molecular Docking Analysis of Bioactive Chemicals from Amanita konajensis (Agaricomycetes), a Tribal Myco-Food from India.

In humans, a wide range of health disorders have been induced due to an imbalanced metabolism and an excess generation of reactive oxygen species (ROS). Different biological properties found in mushrooms seem to be the reason for their customary use as a favourite delicacy. Therefore, exploration of wild edible mushrooms as a source of various biological compounds is gaining much importance today. Amanita konajensis, one of the underutilized macrofungi popularly consumed in Eastern India, demands a systematic study of its medicinal values. The study aims to explore the myco-chemical contents of A. konajensis ethanolic extract (EtAK1) and screen their antioxidant potency through various in vitro assays. GC-MS analysis identified the chemical components of EtAK1. Further, structure-based virtual screening of the identified compounds was analysed for drug-like properties and molecular docking with the human p38 MAPK protein, a potent targeting pathway for human lung cancer. The morpho-molecular features proved the authenticity of the collected mushroom. The screening assays showed that EtAK1 was abundant in flavonoids, followed by phenolics, ß-carotene, and lycopene, and had strong antioxidant activity with EC50 values of 640-710 µg/mL. The GC-MS analyses of EtAK1 identified the occurrence of 19 bioactive compounds in the mushroom. In silico analysis revealed that anthraergostatetraenol p-chlorobenzoate, one of the compounds identified, displayed high binding affinity (ΔG = -10.6 kcal/mol) with human p38 MAPK. The outcome of this study will pave the way for the invention of myco-medicine using A. konajensis, which may lead to a novel drug for human lung cancer.

Psychoactive Isoxazoles, Muscimol, and Isoxazole Derivatives from the Amanita (Agaricomycetes) Species: Review of New Trends in Synthesis, Dosage, and Biological Properties.

Herbal products found in nature can serve as great systems of study for drug design. The Amanita muscaria mushroom is native to many parts of the Northern Hemisphere and has a very distinctive appearance with its red cap and white spotted warts. The mushroom comprises several pharmacologically active alkaloids, including muscazone, muscarine, ibotenic acid, and muscimol, the latter two compounds being potent GABA agonists. Muscimol has served as a backbone in the design of GABA agonists devoid of effects on the GABA-metabolizing enzyme, GABA transaminase, and GABA uptake systems. In this sense, several analogs of muscimol have been synthesized and studied including THIP, THPO, iso-THIP, iso-THAZ and 4-PIOL which all interact with the GABA receptors much differently. The growing pharmacological and toxicological interest based on many conflicting opinions on the use of the neuroprotective role of muscimol analogs against some neurodegenerative diseases, its potent role in the treatment of cerebral ischemia and other socially significant health conditions provided the basis for this review.

A network system for the prevention and treatment of mushroom poisoning in Chuxiong Autonomous Prefecture, Yunnan Province, China: implementation and assessment.

BACKGROUND: Mushroom poisoning is a major public health issue in China. The integration of medical resources from different institutes of different levels is crucial in reducing the harm of mushroom poisoning. However, few studies have provided comprehensive implementation procedures and postimplementation effectiveness evaluations. To reduce the harm caused by mushroom poisoning, a network system for the prevention and treatment of mushroom poisoning (NSPTMP) was established in Chuxiong, Yunnan Province, a high-risk area for mushroom poisoning. METHODS: The NSPTMP consists of three types of institutions, namely, centers for disease prevention, hospitals, and health administration departments, with each kind of institution comprising prefecture, county/city, town, and village levels. After three years of implementation, the network was evaluated by comparing the indices before and after network implementation using data from the "Foodborne Disease Outbreak Surveillance System" and 17 hospitals in Chuxiong. The indices included the fatalities caused by mushroom poisoning, the composition ratios of different types of mushrooms for both outpatients and inpatients and the hospitalization rates. RESULTS: Compared to the average fatality rate of mushroom poisoning from 2015 to 2017, the average fatality rate from 2018 to 2020 significantly decreased from 0.57 to 0.06% (P < 0.001). Regarding the poisonous genus containing lethal mushrooms, the outpatient and inpatient composition ratios significantly decreased for Amanita (9.36-2.91% and 57.23-17.68%, respectively) and Russula (15.27-8.41%) (P < 0.05). Regarding poisonous mushrooms that caused mild symptoms, the outpatient and inpatient composition ratios significantly increased for Scleroderma (5.13-13.90% and 2.89-18.90%, respectively) and Boletaceae (19.08-31.71%) (P < 0.05), and the hospitalization rates significantly increased for Scleroderma (6.33-18.02%) and Boletaceae (5.65-12.71%) (P < 0.05). CONCLUSIONS: These findings suggest that the NSPTMP effectively reduced the harm caused by mushroom poisoning. In addition to the integration of medical resources, the development of poisonous mushroom identification, hierarchical treatment systems in hospitals, public education, and professional training also played important roles in improving the system's effectiveness. The establishment and evaluation of the NSPTMP in Chuxiong Prefecture can provide valuable insights and serve as a model for other regions facing similar challenges in managing mushroom poisoning.

Appraisal of Antioxidant Potential and Natural Bioactive Compound Determination through HPLC from Two Saprotrophic Amanita (Agaricomycetes) Species from Pakistan.

The present study was carried out to investigate and identify bioactive compounds along with antioxidant capacity, total flavonoids and total phenolic contents from two saprophytic Amanita species, i.e., mushrooms A. manicata (Berk. & Broome) Pegler and A. nana Singer. Antioxidant potential was assessed by DPPH (2,2-diphenyl-1-picrylhydrazyl) free radical scavenging and ABTS (2,2'-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid) assay, total phenolics, and flavonoids. Both mushrooms were found to possess antioxidants and wide range of phenolics and bioactive compounds. There was maximum percent inhibition (83.2 ± 0.120%) on DPPH by A. manicata. However, maximum percent inhibition using ABTS was found to be 79.5 ± 0.251% by A. nana. Similarly, A. nana possesses maximum amount of both flavonoids and phenolics i.e., 0.3473 ± 0.0088 mg/100 g of catechin and 0.097 ± 0.0011 mg/100 g of GAE equivalent, respectively. Both mushrooms exhibited a variety of natural compounds such as P-coumaric acid, M-coumaric acid, benzoic acid, ferulic acid etc. Ferulic acid, chlorogenic acid, and cinnamic acid were also detected in A. manicata. A. manicata exhibited best and greater antiradical potential than A. nana due the presence of excessive natural bioactive compounds. From the reported results, it was revealed that both inedible mushrooms could be a potential source of antioxidants and secondary metabolites and might be used for making novel drugs in future by pharmaceutical industries.

Extrapolating Qualitative Mycochemical Profiling and Therapeutic Potential of Two Mycorrhizal Amanita Species (Agaricomycetes) from Pakistan.

The present study was an attempt to evaluate the antimicrobial and anthelmintic potential of two Amanita species, i.e., A. orsonii and A. glarea, along with their qualitative mycochemical screening. Maceration technique was adopted to make crude extracts in non-polar (petroleum ether and chloroform) and polar (ethanol and distilled water) solvents. Qualitative mycochemical screening revealed the presence of a variety of secondary metabolites like terpenoids, flavonoids, tannins, alkaloids, saponins, and cardiac glycosides. Antimicrobial activities were carried out by using agar well diffusing method against four bacterial and one fungal strain. The antibacterial potential ranged between 4.86 ± 0.088 mm and 34.83 ± 0.166 mm with maximum inhibition zone exhibited by petroleum ether extract against Pseudomonas fluorescens and least potential by distilled water macerate of A. orsonii against the Escherichia coli. The antifungal activity ranged between 14.5 ± 0.288 and 24.76 ± 0.145 mm, with the highest potential provided by chloroform extract of A. orsonii and least capability put forward by A. glarea by petroleum ether extract against Fusarium solanii. Antibiotics and antimycotic discs were used as standard and some of the crude extracts showed bigger zone of inhibition as compared to standard. Different concentrations of ethanolic extracts of both mushrooms were subjected to anthelmintic potential against parasite Haemonchus contortus. All the crude extracts were more potent than standard oxfandazole used. Anthelmintic potential ranged between 9.9 ± 0.057 and 54.93 ± 0.033 minutes for death of parasite, while the paralyzed time ranged between 4.86 ± 0.088 and 24.86 ± 0.088 minutes. From the results obtained it was concluded that both mushrooms can be used as potential source of curative antibacterial, antifungal, and anthelmintic agents against several diseases that might be used in pharmaceutical industries for making medicines and to screen out secondary metabolites in future.

Mechanism and treatment of α-amanitin poisoning.

Amanita poisoning has a high mortality rate. The α-amanitin toxin in Amanita is the main lethal toxin. There is no specific detoxification drug for α-amanitin, and the clinical treatment mainly focuses on symptomatic and supportive therapy. The pathogenesis of α-amanitin mainly includes: α-amanitin can inhibit the activity of RNA polymeraseII in the nucleus, including the inhibition of the largest subunit of RNA polymeraseII, RNApb1, bridge helix, and trigger loop. In addition, α-amanitin acts in vivo through the enterohepatic circulation and transport system. α-Amanitin can cause the cell death. The existing mechanisms of cell damage mainly focus on apoptosis, oxidative stress, and autophagy. In addition to the pathogenic mechanism, α-amanitin also has a role in cancer treatment, which is the focus of current research. The mechanism of action of α-amanitin on the body is still being explored.

Results of diagnostics and treatment of amanita phalloides poisoning in Slovakia (2004-2020).

The paper presents results of AI diagnostics and treatment across the period of 2004-2020 pointing to the efficacy of two particular protocols. METHOD: Quantitative determination of amanitins in blood (ATOs) and urine (ATOu) performed by the original ELISA kit, indicated upon mycological history and clinical symptoms of poisoning. ATOu positive cases were recommended our protocol; ATOu negative results excluded amanitin poisoning. RESULTS: out of 2876 fungal poisonings registered in Slovakia during the subjected period, were 698 AI suspected cases. In 557 of them, was AI reliably excluded, in 141 confirmed. Urinary ATOu correlated with the severity of poisoning in the range of 6-47 h after mushroom ingestion, without false negativity. Serum ATOs had no diagnostic value. 129 patients with confirmed AI received full treatment protocol with antidotes of penicillin plus silibinin. In this group died two patients of acute kidney injury in the early stages of poisoning and 127 patients were recovered. Silibinin without penicillin was used in 12 patients. One of them undergone liver transplantation and four patients died of fulminant liver failure, respectively intracranial hemorrhage. Treatment failure in the PNC + silibinin protocol was 1.5 % (2 of 127 patients), silibinin alone being 41.7 % (5 of 12 patients, p = 0.00058). CONCLUSION: Early diagnostics of amanitin intoxication based on mycological and clinical history and subsequent determination of urinary amanitin levels (ATOu) allows early initiation of treatment. The use of treatment protocol with antidotes of PNC and silibinin is of high therapeutic efficacy. The omission of PNC from the treatment protocol significantly worsens patients' prognosis.

[An investigation of a food poisoning incident caused by Amanita fuliginea].

Mistakenly picking and eating poisonous mushrooms can cause acute poisoning. In August 2020, Qingdao Hospital of Traditional Chinese Medicine handled a poisonous mushroom poisoning incident, conducted epidemiological investigation on all poisoned patients, collected suspicious food, clinical manifestations, clinical test results and treatment conditions, and identified the mushrooms as Amanita fuliginea poisoning after morphological identification. In this incident, 6 people ate grey goose paste, of which 4 were sick with a incubation period of 6~12 h. The clinical manifestations were gastrointestinal symptoms such as nausea, vomiting and diarrhea, liver and kidney damage. After symptomatic support treatment, hemoperfusion or continuous hemofiltration treatment, the patients were cured and discharged. It is suggested to strengthen the popular science education on poisonous mushroom poisoning and improve the ability of identification and clinical treatment of poisonous mushrooms in grass-roots medical institutions.

Amanitin intoxication: effects of therapies on clinical outcomes - a review of 40 years of reported cases.

BACKGROUND AND AIMS: Amanita phalloides poisoning causes severe liver damage which may be potentially fatal. Several treatments are available, but their effectiveness has not been systematically evaluated. We performed a systematic review to investigate the effect of the most commonly used therapies: N-acetylcysteine (NAC), benzylpenicillin (PEN), and silibinin (SIL) on patient outcomes. In addition, other factors contributing to patient outcomes are identified. METHODS: We searched MEDLINE and Embase for case series and case reports that described patient outcomes after poisoning with amanitin-containing Amanita mushrooms. We extracted clinical characteristics, treatment details, and outcomes. We used the liver item from the Poisoning Severity Score (PSS) to categorize intoxication severity. RESULTS: We included 131 publications describing a total of 877 unique cases. The overall survival rate of all patients was 84%. Patients receiving only supportive care had a survival rate of 59%. The use of SIL or PEN was associated with a 90% (OR 6.40 [3.14-13.04]) and 89% (OR 5.24 [2.87-9.56]) survival rate, respectively. NAC/SIL combination therapy was associated with 85% survival rate (OR 3.85 [2.04, 7.25]). NAC/PEN/SIL treatment group had a survival rate of 76% (OR 2.11 [1.25, 3.57]). Due to the limited number of cases, the use of NAC alone could not be evaluated. Additional analyses in 'proven cases' (amanitin detected), 'probable cases' (mushroom identified by mycologist), and 'possible cases' (neither amanitin detected nor mushroom identified) showed comparable results, but the results did not reach statistical significance. Transplantation-free survivors had significantly lower peak values of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total serum bilirubin (TSB), and international normalized ratio (INR) compared to liver transplantation survivors and patients with fatal outcomes. Higher peak PSS was associated with increased mortality. CONCLUSION: Based on data available, no statistical differences could be observed for the effects of NAC, PEN or SIL in proven poisonings with amanitin-containing mushrooms. However, monotherapy with SIL or PEN and combination therapy with NAC/SIL appear to be associated with higher survival rates compared to supportive care alone. AST, ALT, TSB, and INR values are possible predictors of potentially fatal outcomes.

Medical error in treatment of Amanita phalloides poisoning in pre-hospital care.

BACKGROUND: Geopolitical and climate changes form the background of the current migration crisis. It has many faces. One of them are the tragic cases of poisoning of refugees due to eating wild forest mushrooms for socioeconomic reasons in the Western and Northern European countries. The most serious food poisonings in Europe, but not only, are caused by lamellar mushrooms, the most dangerous being Amanita phalloides. Its poisonous properties can be attributed to α-amanitin, an RNA polymerase II inhibitor. Unfortunately, as it is characterized by a delayed onset of symptoms, A. phalloides poisoning has a high risk of complications. CASE PRESENTATION: Our article presents a case of A. phalloides poisoning in a 28-year-old man, in which the responding medical emergency unit made errors in diagnosis and treatment. Since the correct diagnosis was made too late, the typical treatment of A. phalloides poisoning was ineffective. The patient suffered a life-threatening liver failure and needed liver transplant from a deceased donor. CONCLUSIONS: Mushroom poisoning is a particularly important problem not only in countries with a mushroom picking tradition, but also-due to the inflow of refugees-in countries where mushroom poisoning was very rare until recently. In such cases it is crucial to quickly implement the correct procedure, as this can prevent the need for liver transplant or even death. This is a particularly important consideration for the first medical professionals to contact the patient, especially in cases where the patient reports mushrooms consumption and presents alarming symptoms of the gastrointestinal tract. Such situations cannot be underestimated and ignored.

Mycochemical Screening and Study of Medicinal Properties of Two Amanita Species (Agaricomycetes) from Pakistan.

Fresh basidiocarps of Amanita cinnamomescens and A. pakistanica were collected from Ayubia-Khanspur, Pakistan, during the 2018 monsoon season. Basidiocarps of A. cinnamomescens and A. pakistanica were evaluated for their mycochemicals, mineral composition, and antioxidant and antimicrobial activities. The percentage yield of extracts ranged from 4.13% to 18.20%. The extracts contained noticeable total phenolic contents (0.043 ± 0.02 to 0.046 ± 0.01 mg/g) and total flavonoid contents (0.090 ± 0.004 to 0.0935 ± 0.003 mg/g) and good radical scavenging ability according to the ABTS assay (79.74% ± 0.03% to 85.34% ± 0.02%) and the DPPH radical assay (35.77% ± 0.01% to 44.77% ± 0.003%). In addition, the tested extracts showed substantial antimicrobial activity, which ranged from 10 ± 0.33 to 32.66 ± 0.33 mm. Both mushrooms were also analyzed for their mineral content (sodium, potassium, calcium, nickel, cobalt, copper, zinc, manganese, chromium, and iron). It was concluded that A. cinnamomescens and A. pakistanica can be used as a potential source for formulation of dietary functional foods and pharmaceuticals with antioxidant and antimicrobial effects. To our knowledge, this is the first report on in vitro biological activities and mycochemical analysis of A. pakistanica and A. cinnamomescens from Pakistan.

Mercury and selenium in developing and mature fruiting bodies of Amanita muscaria.

Both mercury (Hg) and selenium (Se) occur in many mushroom species, but the morphological distribution of these elements during different developmental stages of the fruiting bodies is not known. Although Amanita muscaria can be consumed after suitable processing, they are often ignored by mushroom foragers, leaving an abundance for investigative study. Multiple specimens in each of six developmental stages (button to fully mature) were collected in excellent condition during a single morning from the same forested location and composited. With an average of 30 specimens per composite, and low temporal, spatial, and measurement uncertainty, the data are likely to be representative of the typical concentrations of Hg and Se for each developmental stage. Hg (range 0.58-0.74 mg kg-1 dry weight cap; 0.33 to 0.44 mg kg-1 dw stipe) and Se (range 8.3-11 mg kg-1 dw cap; 2.2 to 4.3 mg kg-1 dw stipe) levels were observed to vary during the developmental stages, and the variability may relate to the demands in growth. In common with some other species, the lower stipe concentrations may be consistent with nutrient/contant transport and support functions. Both Hg and Se levels were lowest during periods of maximum sporocarp growth. Selenium occurs at almost an order of magnitude greater levels than Hg. Due to its role in mitigating the effects of Hg toxicity, this property is of significance to those who consume the species either for nutritional, medicinal, or recreational purposes, although the losses of both these elements during processing are not known.

Breaking the paradigms of residual categories and neglectable importance of non-used resources: the "vital" traditional knowledge of non-edible mushrooms and their substantive cultural significance.

INTRODUCTION: One of the main goals of ethnomycological studies has been understanding the role of wild edible mushrooms (WEM) in diverse cultures. To accomplish such a purpose, the local knowledge of WEM and their cultural importance have been evaluated and compared using qualitative and quantitative methods. However, few studies have documented these aspects in non-edible mushrooms, because they are considered to be in a category of residual cultural importance. To make up for this lack of investigation, this paper analyzes the traditional knowledge of non-edible mushrooms to understand their cultural role and break it down to its components. The analysis of this topic shows how this knowledge represents a good strategy to prevent mushroom intoxications in humans. METHODS: This study was carried out in two communities residing in La Malintzi National Park, Tlaxcala, Mexico. Mushroom species indicated as non-edible were collected during 13 ethnomycological expeditions and seven requests. To get an insight into the local knowledge about these mushrooms, we used ethnographic techniques, 91 free listings and 81 semi-structured interviews. RESULTS: In total, we collected 178 specimens of wild mushrooms recognized as non-edible by locals, which corresponded to 103 species belonging to 45 genera. People who participated in the study had a vast and deep understanding of non-edible mushrooms. For them, the most important species were Amanita muscaria, Neoboletus aff. erythropus, Xerocomellus chrysenteron, and Suillus tomentosus. Two uses were the most mentioned by respondents: as an insecticide and for medicinal purposes. Of note, however, is that A. muscaria was reported as edible years ago. To avoid possible intoxication, all non-edible mushrooms were included in the general category of "poisonous mushrooms." Non-edible species are seen as a cosmogonic counterpart ("twins") of the edible species that they resemble. We obtained 101 specific recognition criteria, useful only when comparing paired species: edible vs non-edible. The most culturally important non-edible groups were differentiated by clear and precise characteristics, which were reflected in the nomenclature and allowed their classification into specific ethnotaxa. CONCLUSIONS: We found that non-used resources can be the object of a deep traditional knowledge and have a vast cultural importance. In the case of wild non-edible mushrooms in particular: the species are named; they are the subject of vast traditional knowledge which is based on their edible/non-edible duality; this knowledge is widespread but has limited consensus, there is little lexical retention; and this knowledge is vital to avoid fatal intoxications. In consequence, both deadly species and species that share similarities with the most important edible mushrooms have a high cultural importance.

Medium Cut-Off Membrane Can Be a New Treatment Tool in Amanita phalloides Poisoning.

Mushroom poisoning is a common health problem that can be seen seasonally and geographically. Most mushroom poisoning requiring treatment worldwide is due to Amanita phalloides. Although liver failure and kidney injury are frequent, poisoning can also lead to more serious clinical situations, such as shock, pancreatitis, encephalopathic coma, cardiac failure, disseminated intravascular coagulation, and multiple organ dysfunction syndrome, and may cause death. In addition, when standard treatment approaches fail, extracorporeal treatment methods are often used. We report 2 cases in which hemodialysis with medium cut-off membrane was performed. We observed an improvement in liver and kidney function in both of our cases. The first case recovered, but the second case proved fatal owing to Acinetobacter sepsis, despite an improvement in renal function. Medium cut-off membrane hemodialysis may be an alternative option in the treatment of Amanita phalloides poisoning.

Intravenous rifampicin use in the management of amanita phalloides toxicity.

Context: Amanita phalloides related toxicity from amatoxins can result in acute liver and multi-organ failure and is responsible for 90% of all mushroom poisoning death. However, more evidence is needed in regards to different management strategies.Case details: We present two cases of amanita mushroom ingestion who were treated with intravenous rifampicin.Discussion: Further study is needed to establish the efficacy and role of rifampicin in amatoxin related mushroom poisoning.

Bioactivity-based analysis and chemical characterization of cytotoxic compounds from a poisonous mushroom, Amanita spissacea, in human lung cancer cells in vitro.

As part of our systematic study on Korean toxic mushrooms, bioactivity-guided fractionation of the MeOH extract of Amanita spissacea (Amanitaceae) fruiting bodies and chemical investigation of its cytotoxic fractions led to the isolation of (9E)-8-oxo-9-octadecenoic acid (1), (10E)-9-oxo-10-octadecenoic acid (2), (9E)-8-oxo-9-octadecenoate methyl ester (3), (9Z)-9-octadecenoate-(2'S)-2',3'-dihydroxypropyl ester (4), (9Z)-9-octadecenoic acid (5), and palmitic acid (6). The structures of the isolates were elucidated by NMR spectroscopic analysis and LC/MS analysis. Among the isolated compounds, compounds 1 and 2 exhibited the most potent cytotoxic activity in all human lung cancer cell lines examined, with IC50 values ranging from 255.7 to 321.0 µM and 250.2 to 322.5 µM, respectively. The cytotoxicity of these compounds was also found to be mediated by apoptosis associated with caspase-3 activation. These findings provide experimental evidence suggesting the potential of A. spissacea as a promising natural source for the discovery of novel anticancer drug candidates.

Amanita phalloides intoxication: mechanism of toxicity, clinical manifestations and therapeutic approaches.

Ingestion of Amanita phalloides is the most common cause of fatal mushroom poisoning. The clinical picture of intoxication varies from mild subclinical manifestation to lethal fulminant course with the development of acute liver failure. Early diagnosis of Amanita phalloides poisoning is crucial for the outcome but i tis difficult because it is often mistaken as gastroenteritis or due to other mushroom poisoning. The diagnosis is based on the history of recent mushroom ingestion followed by gastrointestinal symptoms, typical time course and laboratory markers and is proven with mycological examination or toxicological examination. Specific treatment consists of detoxification procedures, supportive measures, administration of drugs and therapy in the specialized intensive care unit in the case of acute liver failure. In selected patients with acute liver failure urgent liver transplantation is the only life-saving option.