Mushroom Poisoning-A 17 Year Retrospective Study at a Level I University Emergency Department in Switzerland.

The consequences of mushroom poisoning range from mild, mostly gastrointestinal, disturbances to organ failure or even death. This retrospective study describes presentations related to mushroom poisoning at an emergency department in Bern (Switzerland) from January 2001 to October 2017. Gastrointestinal disturbances were reported in 86% of the 51 cases. The National Poisons Information Centre and mycologists were involved in 69% and 61% of the cases, respectively. Identification of the mushroom type/family was possible in 43% of the cases. The most common mushroom family was Boletaceae (n = 21) and the most common mushrooms Xerocomus chrysenteron (n = 7; four being part of a cluster), Clitocybe nebularis, Lepista nuda and Lactarius semisanguifluus (n = 5 each, four being part of a cluster). Poisonous mushrooms included Amanita phalloides (n = 3, all analytically confirmed), Boletus satanas (n = 3), Amanita muscaria (n = 2) and Amanita pantherina (n = 2). There were no fatalities and 80% of the patients were discharged within 24 h. Mushroom poisoning does not appear to be a common reason for emergency consultation and most presentations were of minor severity and related to edible species (e.g., due to incorrect processing). Nevertheless, poisonous mushrooms and severe complications were also recorded. Collaboration with a poison centre and/or mycologists is of great importance, especially in high risk cases.

No clinically relevant effects in children after accidental ingestion of Panaeolina foenisecii (lawn mower's mushroom).

INTRODUCTION: Panaeolina foenisecii is one of the most common and widely distributed lawn mushrooms in Europe and North America, and frequently involved in accidental mushroom ingestion, mainly in children. Nevertheless, there is contradictory information regarding the toxicity profile of P. foenisecii in the literature. Objective of the study was to assess clinical effects with particular attention on psychoactive properties of P. foenisecii in case of accidental oral exposure. METHODS: This observational case series is based on prospectively collected data on mushroom poisoning using a structured data collection form, and it was performed in seven poisons centres in Germany and Switzerland. Inclusion criteria were accidental ingestion of at least one cap of P. foenisecii identified by a mycologist, and a follow up of at least 4 hours. RESULTS: Nineteen cases met all inclusion criteria, and only children were involved with a mean age of 3 years. They ingested 1-2 mushrooms in 14 cases and 3-5 mushrooms in five cases. Three patients received a single dose of activated charcoal. Sixteen out of 19 cases did not develop any symptoms, 2/19 complained of minor abdominal discomfort. One child was temporarily mildly hyperactive, and this was the only patient observed in a hospital for 12 hours. None of the children showed signs of hallucinations. CONCLUSIONS: This multicentre study demonstrates that the typically small amounts of P. foenisecii ingested by children probably do not lead to clinically significant symptoms.

Acute toxicity profile of tolperisone in overdose: Observational poison centre-based study.

INTRODUCTION: Tolperisone is a centrally acting muscle relaxant that acts by blocking voltage-gated sodium and calcium channels. There is a lack of information on the clinical features of tolperisone poisoning in the literature. The aim of this study was to investigate the demographics, circumstances and clinical features of acute overdoses with tolperisone. METHODS: An observational study of acute overdoses of tolperisone, either alone or in combination with one non-steroidal anti-inflammatory drug in a dose range not expected to cause central nervous system effects, in adults and children (< 16 years), reported to our poison centre between 1995 and 2013. RESULTS: 75 cases were included: 51 females (68%) and 24 males (32%); 45 adults (60%) and 30 children (40%). Six adults (13%) and 17 children (57%) remained asymptomatic, and mild symptoms were seen in 25 adults (56%) and 10 children (33%). There were nine adults (20%) with moderate symptoms, and five adults (11%) and three children (10%) with severe symptoms. Signs and symptoms predominantly involved the central nervous system: somnolence, coma, seizures and agitation. Furthermore, some severe cardiovascular and respiratory signs and symptoms were reported. The minimal dose for seizures and severe symptoms in adults was 1500 mg. In 11 cases the latency between the ingestion and the onset of symptoms was known and was reported to be 0.5-1.5 h. CONCLUSIONS: The acute overdose of tolperisone may be life-threatening, with a rapid onset of severe neurological, respiratory and cardiovascular symptoms. With alternative muscle relaxants available, indications for tolperisone should be rigorously evaluated.

Mushroom poisoning: a study on circumstances of exposure and patterns of toxicity.

BACKGROUND: Picking wild mushrooms is a popular pastime in Switzerland. Correct identification of the species is difficult for laypersons. Ingestion of toxic mushrooms may result in serious toxicity, including death. The aim of the study is to analyze and describe the circumstances of exposure to mushrooms, and to define the clinical relevance of mushroom poisoning for humans in Central Europe. MATERIALS AND METHODS: We performed a retrospective case study and analyzed all inquiries concerning human exposures to mushrooms (n = 5638, 1.2% of all inquiries) which were reported to the Swiss Toxicological Information Centre between January 1995 and December 2009. RESULTS: The most frequent reason for contacting the poison center in cases of adult exposure was toxicity resulting from edible species. Pediatric exposure predominantly occurred from mushrooms found around the home. Severe symptoms have not only been observed after ingestion of non-amatoxin-containing toxic mushrooms, i.e. Boletus sp. and Cortinarius sp., but also after meals of edible species. The mortality of confirmed amatoxin poisonings was high (5/32) compared to other reports. CONCLUSIONS: Inquiries regarding mushroom poisoning were a relatively infrequent reason for contacting the poison center. Nevertheless, accidental ingestion of toxic mushrooms can be responsible for severe or fatal poisonings. Although pediatric exposure to mushrooms found around the home has not led to serious toxicity in this study, prevention of exposure is warranted. Inspection of wild mushrooms by a certified mushroom expert or a mycologist seems to be a safe procedure which should be recommended.