The characteristics of liver injury induced by Amanita and clinical value of α-amanitin detection.

BACKGROUND: Amanita poisoning as a foodborne disease has raised concerning mortality issues. Reducing the interval between mushroom ingestion and medical intervention could greatly influence the outcomes of Amanita poisoning patients, while treatment is highly dependent on a confirmed diagnosis. To this end, we developed an early detection-guided intervention strategy by optimizing diagnostic process with performing α-amanitin detection, and further explored whether this strategy influenced the progression of Amanita poisoning. METHODS: This study was a retrospective analysis of 25 Amanita poisoning patients. Thirteen patients in the detection group were diagnosed mainly based on α-amanitin detection, and 12 patients were diagnosed essentially on the basis of mushroom consumption history, typical clinical patterns and mushroom identification (conventional group). Amanita poisoning patients received uniform therapy, in which plasmapheresis was executed once confirming the diagnosis of Amanita poisoning. We compared the demographic baseline, clinical and laboratory data, treatment and outcomes between the two groups, and further explored the predictive value of α-amanitin concentration in serum. RESULTS: Liver injury induced by Amanita appeared worst at the fourth day and alanine aminotransferase (ALT) rose higher than aspartate aminotransferase (AST). The mortality rate was 7.7% (1/13) in the detection group and 50.0% (6/12) in the conventional group (P = 0.030), since patients in the detection group arrived hospital much earlier and received plasmapheresis at the early stage of disease. The early detection-guided intervention helped alleviate liver impairment caused by Amanita and decreased the peak AST as well as ALT. However, the predictive value of α-amanitin concentration in serum was still considered limited. CONCLUSIONS: In the management of mushroom poisoning, consideration should be given to the rapid detection of α-amanitin in suspected Amanita poisoning patients and the immediate initiation of medical treatment upon a positive toxin screening result.

Spontaneous rupture of the branches of left subclavian artery: A case report and review of the literatures.

RATIONALE: Spontaneous rupture of the branches of left subclavian artery (LSA) without any obvious risk factors is rare. PATIENT CONCERNS: A 51-year-old female patient without history of trauma and hypertension complained about left chest pain. DIAGNOSES: A chest Computed tomography (CT) scan revealed a large pleural effusion (PE) in the left thorax cavity and hemothorax was confirmed by thoracentesis. INTERVENTIONS: The patient underwent surgery. OUTCOMES: spontaneous rupture of the branches of LSAwas confirmed. LESSONS: The patient recovered well and discharged after timely treatments. The unusual possibility should be paid attention in mind in acute chest pain cases.

Successful treatment of an acute infective endocarditis secondary to fish bone penetrating into left atrium caused by Granulicatella adiacens and Candida albicans: A case report.

RATIONAL: Infective endocarditis caused by a foreign body of the upper digestive tract is rare. We report a rare case of Granulicatella adiacens and Candida albicans coinfection acute endocarditis combined with systematic embolization caused by a fish bone from the esophagus penetrating into the left atrium. PATIENT CONCERN: A 42-year-old woman was admitted to our hospital because of fever, abdominal pain, headache, and right limb weakness. DIAGNOSES: Clinical examination indicated endocarditis and systemic embolisms secondary to a fish bone from the esophagus penetrating into the left atrium. The emergency surgery confirmed the diagnosis. Cultures of blood and vegetation show G adiacens and C albicans. INTERVENTIONS: Antimicrobial therapy lasted 6 weeks after surgery. OUTCOMES: The patient was discharged with excellent condition7 weeks after hospitalization and was well when followed 6 months later. LESSONS: The successful treatment of this patient combines quick diagnosis, timely surgery, and effective antimicrobial regimen. This rare possibility should be kept up in mind in acute infective endocarditis cases.