Mushroom Poisoning by Macrolepiota neomastoidea.

There are currently over 5,000-known species of mushrooms worldwide. Only 20-25% of mushrooms have been named, and 3% of these are poisonous. More than 95% of mushroom poisoning cases occur due to difficulties associated with the identification of mushroom species. Most of the fatal mushroom poisoning cases recorded to date have been related to the Amanita species. Until now, a case of fatal poisoning caused by Macrolepiota neomastoidea (M. neomastoidea) has not been reported in Asia. A 57-year-old male patient was admitted to the emergency room with nausea, vomiting, diarrhea, and abdominal pain. He reported ingesting wild mushrooms with his mother and sister about 2 days ago. His mother and sister were treated with only supportive care, but he was admitted to the intensive care unit and underwent liver transplantation due to acute liver failure. We are reporting a case of fatal M. neomastoidea intoxication from wild mushrooms, a rare case of mushroom poisoning.

Amanita diemii singer y amanita merxmellueri bresinsky & garrido (agaricales, basidiomycota), las amanitas comestibles de Chile / Amanita diemii singer and amanita merxmuelleri Bresinsky & garrido (agaricales, basiodiomycota), the edible amanitas of Chile

Se presenta una breve revisión del género Amanita Pers. y posteriormente, se describen los caracteres macromorfológicos de las especies nativas comestibles Amanita diemii Singer y Amanita merxmuelleri Bresinsky & Garrido, las cuales se encuentran distribuidas desde la Región del Maule hasta la Región de Magallanes asociadas a especies del género Nothofagus Blume.

A brief review of the genus Amanita Pers. is presented and then the characters macromorphological of edible native species Amanita diemii Singer and Amanita merxmuelleri Bresinsky & Garrido, which are distributed from the Maule Region to the Magallanes Region described associated with Nothofagus Blume species.

[Forensic medical diagnostics of intoxication with certain poisonous mushrooms in the case of the lethal outcome in a hospital].

The present study was undertaken with a view to improving forensic medical diagnostics of intoxication with poisonous mushrooms in the cases of patients' death in a hospital. A total of 15 protocols of forensic medical examination of the corpses of the people who had died from acute poisoning were available for the analysis. The deathly toxins were amanitin and muscarine contained in various combinations in the death cap (Amanita phalloides) and the early false morels (Gyromitra esculenta and G. gigas). The main poisoning season in the former case was May and in the latter case August and September (93.4%). The mortality rate in the case of group intoxication (such cases accounted for 40% of the total) amounted to 28.6%. 40% of the deceased subjects consumed mushrooms together with alcohol. The poisoning caused the development of either phalloidin- or gyromitrin-intoxication syndromes (after consumption of Amanita phalloides and Gyromitra esculenta respectively). It is emphasized that the forensic medical experts must substantiate the diagnosis of poisoning with mushroom toxins based on the results of the chemical-toxicological and/or forensic chemical investigations. The relevant materials taken from the victim or the corpse should be dispatched for analysis not only within the first day but also on days 2-4 after intoxication. The mycological and genetic analysis must include the detection and identification of mushroom microparticles and spores in the smears from the oral cavity, vomiting matter, wash water, gastric and intestinal contents. In addition, the macro- and microscopic morphological signs, clinical data (major syndromes, results of laboratory studies, methods of treatment) should be taken into consideration as well as the time (season) of mushroom gathering, simultaneous poisoning in a group of people, and other pertinent information.

Coma in the course of severe poisoning after consumption of red fly agaric (Amanita muscaria).

Red fly agaric poisoning is rare. It can be consumed for suicidal purposes or its psychedelic effect. The paper describes the case of a young men, who fell into a coma after ingestion of the red toadstools. Quick identification of the poison, early use of gastric lavage and symptomatic treatment resulted in regression of symptoms and lead to the patient's discharge from the hospital on the third day after intoxication. Authors discussing the poisonous alkaloids contained in the red toadtools: ibotenic acid, muscimol, muscasone and muscarine and theirs properties, responsible for the symptoms of intoxication.

Tratamiento precoz con sistema de recirculación con adsorbentes moleculares (MARS) en dos intoxicaciones graves por setas / Early molecular adsorbent recirculating system (MARS) treatment in two severe mushroom poisonings

No disponible

[Toxic fungi in Buenos Aires City and surroundings]. / Hongos tóxicos en la Ciudad de Buenos Aires y alrededores.

In Facultad de Ciencias Exactas y Naturales,Universidad de Buenos Aires there is a service called Servicio de Identificación de Hongos Tóxicos, directed by researchers of the Program of Medicinal Plants and Fungi Involved in Biological Degradation (PROPLAME-PRHIDEB, CONICET) that assist hospitals and other health establishments, identifying the different samples of fungi and providing information about their toxicity, so that patients can receive the correct treatment. The objective of the present study was to analyze all the cases received from 1985 to 2012. This analysis permitted the confection of a table identifying the most common toxic species. The information gathered revealed that 47% of the patients were under 18 years of age and had eaten basidiomes; the remaining 53% were adults who insisted that they were able to distinguish edible from toxic mushrooms. Chlorophyllum molybdites turned out to be the main cause of fungal intoxication in Buenos Aires, which is commonly confused with Macrolepiota procera, an edible mushroom. In the second place Amanita phalloides was registered, an agaric known to cause severe symptoms after a long period of latency (6-10 hours), and which can lead to hepatic failure even requiring a transplant to prevent severe internal injuries or even death, is not early and correctly treated.

Hongos tóxicos en la Ciudad de Buenos Aires y alrededores / Toxic fungi in Buenos Aires City and surroundings

En la Facultad de Ciencias Exactas y Naturales de la Universidad de Buenos Aires (FCEN-UBA) funciona el Servicio de Identificación de Hongos Tóxicos. Lo integran los investigadores del Programa de Plantas Medicinales y Programa de Hongos que Intervienen en la Degradación Biológica (PROPLAME-PRHIDEB, CONICET) y colabora con servicios médicos, estatales y privados, identificando los materiales remitidos en casos de intoxicaciones con hongos, permitiendo, en muchos casos, realizar el tratamiento adecuado. El presente trabajo da a conocer los casos atendidos por el servicio desde 1985 hasta 2012 inclusive, además de una tabla para reconocer las especies tóxicas más comunes de la región. Según esta información, el 47% de las consultas que se recibieron correspondieron a pacientes menores de 18 años de edad que ingirieron materiales fúngicos de forma accidental (o al menos se sospechaba que lo hubieran hecho). El 53% restante correspondió a adultos que afirmaron ser capaces de distinguir hongos comestibles de tóxicos. Se determinó que Chlorophyllum molybdites fue la principal especie causante de intoxicaciones, la cual es comúnmente confundida con el hongo comestible Macrolepiota procera. En segundo lugar Amanita phalloides, un hongo altamente tóxico, que se caracteriza por presentar inicio de síntomas en forma tardía (latencia de 6-10 horas), evolucionando a falla hepática con el consiguiente requerimiento de trasplante o la muerte, si no se realiza el tratamiento adecuado en forma oportuna.

In Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires there is a service called Servicio de Identificación de Hongos Tóxicos, directed by researchers of the Program of Medicinal Plants and Fungi Involved in Biological Degradation (PROPLAME-PRHIDEB, CONICET) that assist hospitals and other health establishments, identifying the different samples of fungi and providing information about their toxicity, so that patients can receive the correct treatment. The objective of the present study was to analyze all the cases received from 1985 to 2012. This analysis permitted the confection of a table identifying the most common toxic species. The information gathered revealed that 47% of the patients were under 18 years of age and had eaten basidiomes; the remaining 53% were adults who insisted that they were able to distinguish edible from toxic mushrooms. Chlorophyllum molybdites turned out to be the main cause of fungal intoxication in Buenos Aires, which is commonly confused with Macrolepiota procera, an edible mushroom. In the second place Amanita phalloides was registered, an agaric known to cause severe symptoms after a long period of latency (6-10 hours), and which can lead to hepatic failure even requiring a transplant to prevent severe internal injuries or even death, is not early and correctly treated.

Hongos tóxicos en la Ciudad de Buenos Aires y alrededores / Toxic fungi in Buenos Aires City and surroundings

En la Facultad de Ciencias Exactas y Naturales de la Universidad de Buenos Aires (FCEN-UBA) funciona el Servicio de Identificación de Hongos Tóxicos. Lo integran los investigadores del Programa de Plantas Medicinales y Programa de Hongos que Intervienen en la Degradación Biológica (PROPLAME-PRHIDEB, CONICET) y colabora con servicios médicos, estatales y privados, identificando los materiales remitidos en casos de intoxicaciones con hongos, permitiendo, en muchos casos, realizar el tratamiento adecuado. El presente trabajo da a conocer los casos atendidos por el servicio desde 1985 hasta 2012 inclusive, además de una tabla para reconocer las especies tóxicas más comunes de la región. Según esta información, el 47% de las consultas que se recibieron correspondieron a pacientes menores de 18 años de edad que ingirieron materiales fúngicos de forma accidental (o al menos se sospechaba que lo hubieran hecho). El 53% restante correspondió a adultos que afirmaron ser capaces de distinguir hongos comestibles de tóxicos. Se determinó que Chlorophyllum molybdites fue la principal especie causante de intoxicaciones, la cual es comúnmente confundida con el hongo comestible Macrolepiota procera. En segundo lugar Amanita phalloides, un hongo altamente tóxico, que se caracteriza por presentar inicio de síntomas en forma tardía (latencia de 6-10 horas), evolucionando a falla hepática con el consiguiente requerimiento de trasplante o la muerte, si no se realiza el tratamiento adecuado en forma oportuna.(AU)

In Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires there is a service called Servicio de Identificación de Hongos Tóxicos, directed by researchers of the Program of Medicinal Plants and Fungi Involved in Biological Degradation (PROPLAME-PRHIDEB, CONICET) that assist hospitals and other health establishments, identifying the different samples of fungi and providing information about their toxicity, so that patients can receive the correct treatment. The objective of the present study was to analyze all the cases received from 1985 to 2012. This analysis permitted the confection of a table identifying the most common toxic species. The information gathered revealed that 47% of the patients were under 18 years of age and had eaten basidiomes; the remaining 53% were adults who insisted that they were able to distinguish edible from toxic mushrooms. Chlorophyllum molybdites turned out to be the main cause of fungal intoxication in Buenos Aires, which is commonly confused with Macrolepiota procera, an edible mushroom. In the second place Amanita phalloides was registered, an agaric known to cause severe symptoms after a long period of latency (6-10 hours), and which can lead to hepatic failure even requiring a transplant to prevent severe internal injuries or even death, is not early and correctly treated.(AU)

Hongos tóxicos en la Ciudad de Buenos Aires y alrededores. / [Toxic fungi in Buenos Aires City and surroundings].

In Facultad de Ciencias Exactas y Naturales,Universidad de Buenos Aires there is a service called Servicio de Identificación de Hongos Tóxicos, directed by researchers of the Program of Medicinal Plants and Fungi Involved in Biological Degradation (PROPLAME-PRHIDEB, CONICET) that assist hospitals and other health establishments, identifying the different samples of fungi and providing information about their toxicity, so that patients can receive the correct treatment. The objective of the present study was to analyze all the cases received from 1985 to 2012. This analysis permitted the confection of a table identifying the most common toxic species. The information gathered revealed that 47

of the patients were under 18 years of age and had eaten basidiomes; the remaining 53

were adults who insisted that they were able to distinguish edible from toxic mushrooms. Chlorophyllum molybdites turned out to be the main cause of fungal intoxication in Buenos Aires, which is commonly confused with Macrolepiota procera, an edible mushroom. In the second place Amanita phalloides was registered, an agaric known to cause severe symptoms after a long period of latency (6-10 hours), and which can lead to hepatic failure even requiring a transplant to prevent severe internal injuries or even death, is not early and correctly treated.

Amatoxin and phallotoxin composition in species of the genus Amanita in Colombia: a taxonomic perspective.

Some species in the genus Amanita have a great variety of toxic secondary metabolites. They are characterized macroscopically by having a white spore print and free gills, and microscopically by the presence of a divergent hymenophoral trama. Some species of Amanita present in Colombia were chemically characterized by analyzing their toxin composition using HPLC. Samples were collected in oak (Quercus humboldtii) and pine (Pinus radiata) forests. Twelve species were recovered, Amanita fuligineodisca, Amanita xylinivolva, Amanita flavoconia, Amanita rubescens, Amanita bisporigera, Amanita muscaria, Amanita humboldtii, Amanita sororcula, Amanita brunneolocularis, Amanita colombiana, Amanita citrina, Amanita porphyria as well as two unreported species. Results showed that most of the analyzed species have α -amanitin in concentrations ranging from 50 ppm to 6000 ppm. Concentrations of α-amanitin in the pileus were significantly greater than in the stipe. Phalloidin and phallacidin were only present in A. bisporigera. Chromatographic profiles are proposed as an additional taxonomic tool since specific peaks with similar retention times were conserved at the species level.

Amatoxin and phallotoxin concentration in amanita bisporigera spores.

Even though amatoxins and phallotoxins have been well characterized in basidiocarps of Amanita species, to our knowledge no report of these toxins in spores of Amanitas has been published. Reversed phase HPLC was used to determine non-zero concentrations of alpha-amanitin (0.30 mg/g), and phallacidin (0.02 mg/g) in spores taken from white Amanita sect. phalloideae species. We did not find significant amounts of phalloidin in Amanita spores. We also report concentrations of these toxins from pileus and stipe tissues that are similar to previously reported values, lending support to the hypothesis that toxin concentrations in spores are much less than in other basidiocarp tissues.

Intoxicaciones agudas por setas / Acute mushrooms poisoning

La recolección y consumo de setas silvestres por sujetos sin conocimientos micológicos, y la ingesta accidental en niños son responsables de un número creciente de intoxicaciones. Es raro que la atención urgente a un intoxicado por hongos se efectúe en base a la confirmación de la especie o al aporte del ejemplar, por lo que resulta crucial conocer los síndromes tóxicos. La mayoría de estos cuadros son leves. La mortalidad se relaciona habitualmente con el desarrollo de necrosis hepática potencialmente mortal tras consumir Amanita phalloides u otras especies que contienen amatoxinas. No existe un tratamiento con evidencia científica y éste se fundamenta en medidas de soporte. A propósito de este caso se analizan las claves para llegar a un diagnóstico sindrómico basándose en el período de latencia y se describen los cuadros más representativos, así como la actitud terapéutica. Además se exponen otros hongos que pueden producir manifestaciones clínicas peculiares y excepcionales (AU)

The collection and consumption of wild mushrooms by individuals with no mycological knowledge and their accidental ingestion by minors are responsible for a growing increase of poisonings. It is not usual for emergency care of a patient affected by mushroom poisoning to be based on recognition of the responsible species of fungus or access to a sample of the mushroom consumed. It is this reason knowledge of toxidromes is crucial. In the majority of cases, the symptoms are weak. Mortality is usually related to the development of potentially fatal liver necrosis after consumption of the fungus Amanita phalloides and others which contain amatoxins. Treatment is based on support measures but no specific treatments exist that are based on scientifically proven studies. In the following article the clues used in diagnosing which make it possible to carry out asyndromic diagnosis based on a period of latency will be analyzed. The mushrooms that are responsible for the most common syndromes, therapeutic options, as well as varieties of toxic fungus which may produce peculiar and exceptional symptoms are also reported (AU)

Amanita phalloides poisoning-induced end-stage renal failure.

Fungi poisoning is quite frequent: in particular, Amanita phalloides has life-threatening toxicity. It is responsible for fulminant hepatitis, and also has renal toxicity. Herein, we report on a patient who developed acute renal failure after ingesting A. phalloides, which required definitive renal replacement therapy, despite rapid liver injury recovery. A kidney biopsy showed massive acute tubular necrosis, mainly in the proximal convoluted tubule, and mild interstitial infiltration by mononuclear cells.

Identification of toxic oligopeptides in Amanita fungi employing capillary electrophoresis-electrospray ionization-mass spectrometry with positive and negative ion detection.

The identification of toxic oligopeptides employing CE-ESI-MS is presented. The analytes studied ama- and phallotoxins are of significant forensic interest because over 90% of the lethal cases of fungus poisoning in man are caused by species of Amanita which contain these toxins. A CE method was developed to separate the toxins alpha-, beta- and gamma-amanitin, phalloidin and phallacidin. Their fragmentation patterns in MS(n) experiments were investigated in the positive and in the negative ion mode, also the influence of the sheath liquid mixture of the used interface on the S/N. Method validation included the determination of the LOD and the repeatability of the migration time and peak area for both detection modes. With the optimized method LODs of 13-79 ng/mL (17-87 nmol/L) were reached. The CE-MS procedure was successfully applied to the identification of ama- and phallotoxins in extracts of air-dried mushroom samples.

Successful treatment of an adult with Amanita phalloides-induced fulminant liver failure with molecular adsorbent recirculating system (MARS).

Despite significant advances in intensive care management of Amanita phalloides-induced fulminant liver failure (FLF), patients with this condition still have a high mortality rate in the absence of orthotopic liver transplantation. Molecular Adsorbent Recirculating System (MARS) is a new, cell-free, extracorporeal liver assistance method utilizing an albumin dialysate for the removal of albumin-bound toxins, and a highly effective depurative therapy in adults with wild mushroom-induced FLF. We report the case of a 39 year old woman with Amanita phalloides-induced FLF, admitted to our intensive care unit (ICU) and treated with MARS. Our patient had severe hepatic dysfunction: hepatic encephalopathy (grade II), ALT = 5022 (2475-10098) IU/L, bilirubin = 7.18 (4.8-10.1) mg/dL, prothrombin time (PT) = 90.4 (29.3-140.4) s. MARS sessions had an immediate impact on liver tests: statistically significant decrease in ammonia, ALT and PT. Hepatic encephalopathy was successfully reduced. The patient survived and the hepatic function completely recovered. MARS appears to be a safe and highly effective depurative therapy in adults with Amanita phalloides-induced FLF.

Cerebral hemodynamic and metabolic changes in patients with fulminant hepatic failure during liver transplantation.

BACKGROUND: Cerebral autoregulation and metabolism may be seriously compromised in patients with fulminant hepatic failure (FHF). The mechanism responsible for the alteration in cerebral blood flow (CBF) has not been yet clearly defined; however, it is known that it does correlate with liver function. Orthotopic liver transplant (OLT) rapidly restores normal liver function, but little is known about the restoration of cerebral metabolism and hemodynamics. To investigate the relationship between liver function and CBF, we evaluated autoregulation and metabolic changes during OLT in six patients comatose due to FHF. METHODS: We evaluated autoregulation based on a linear regression analysis between mean arterial blood pressure and parallel CBF velocity (CBFV) changes using transcranial Doppler ultrasound. Cerebral metabolism rate was estimated by the arterial-jugular venous oxygen content difference (a-jDO2), while the percentile variation in cerebral metabolic rate for oxygen (CMRO2) was estimated using CBFV percentile variation rather than CBF percentile variation (eCMRO2). RESULTS: Prior to transplant autoregulation was impaired in all patients. However it markedly improved at the end of surgery (P <.05). The eCMRO2 improved as well, particularly among subjects who displayed prompt neurological recovery. In all patients the a-jDO2 was low before transplantation increasing to normal values at the end of surgery. CONCLUSIONS: A hallmark of FHF seems to be failure of autoregulation, which is linked to uncoupling between CBF and CMRO2 as attested by an a-jDO2 lower than normal in all patients (luxury perfusion). The recovery of liver function rapidly improves cerebral hemodynamics and metabolic stability. The study of autoregulation and eCMRO2 recovery using Doppler monitoring proffers the possibility to predict early graft function after liver reperfusion. In our patients eCMRO2 seemed to be associated with improved neurological outcomes.

Armanita Muscaria

El objetivo del presente trabajo es el estudaio etnobotánico e histórico de la Amanita muscaria y su utilización através de las diferentes culturas.

Amanita muscaria: chemistry, biology, toxicology, and ethnomycology.

The fly agaric is a remarkable mushroom in many respects; these are its bearing, history, chemical components and the poisoning that it provokes when consumed. The 'pantherina' poisoning syndrome is characterized by central nervous system dysfunction. The main species responsible are Amanita muscaria and A. pantherina (Amanitaceae); however, some other species of the genus have been suspected for similar actions. Ibotenic acid and muscimol are the active components, and probably, some other substances detected in the latter species participate in the psychotropic effects. The use of the mushroom started in ancient times and is connected with mysticism. Current knowledge on the chemistry, toxicology, and biology relating to this mushroom is reviewed, together with distinctive features concerning this unique species.