A guide to mycetisms: A toxicological and preventive overview.

Fungi are often considered a delicacy and are primarily cultivated and harvested, although numerous species are responsible for intoxication due to toxin content. Foodborne diseases are a significant public health concern, causing approximately 420 000 deaths and 600 million morbidities yearly, of which mushroom poisoning is one of the leading causes. Epidemiological data on non-cultivated mushroom poisoning in individual countries are often unrepresentative, as intoxication rarely requires emergency intervention. On the other hand, the lack of specialist knowledge among medical personnel about the toxicological manifestations of mushroom consumption may result in ineffective therapeutic interventions. This work aims to provide an easy-to-consult and wide-ranging tool useful for better understanding the variability of mushroom intoxications, the associated symptoms, and the main treatments for the most severe cases, given the absence of a complete species mapping tool toxic. Moreover, we establish an effective collection network that describes the incidence of mushroom poisonings by reporting the species and associated toxicological manifestations for each case. In conclusion, we highlight the need to establish appropriate primary prevention interventions, such as training the affected population and increasing consultancy relationships between mycological experts and specialised healthcare personnel.

We propose a review of the literature that describes the main syndromes resulting from the consumption of toxic fungal species, reporting symptoms and clinical manifestations, latency times and, where possible, diagnostic tools for recognising the species involved and interventions to be carried out.

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.

Alternatives for mushroom poisoning timely care in Mexico and Central America.

BACKGROUND: In countries where the consumption of mushrooms is common, hundreds of mushroom poisonings occur every year, which represents a public health problem. In Mexico, mushroom poisoning is classified as a non-bacterial gastrointestinal poisoning, which prevents timely care. OBJECTIVE: To create a free-access platform that synthesizes and standardizes the information on mycetism cases and offers tools for diagnosis and timely treatment. MATERIAL AND METHODS: In locations where cases of mycetism have occurred, information was obtained on the fungi involved, the poisonings that occurred, care protocols, and sample processing. RESULTS: Records were generated that synthesize and describe the types of mycetism with the highest probability of occurrence in Mexico. Therein, the biological characteristics of fungi, the symptoms they cause and their treatment are described. A protocol proposal for patient care and for the processing of biological samples is presented. Finally, a form is included to collect information on cases of poisoning. CONCLUSIONS: Systematized and analyzed information on mycetism allows to simplify its diagnosis, attention and treatment. The protocols for clinical care and sample processing are the basis for generating strategies that prevent deaths due to mycetism.

ANTECEDENTES: En países donde el consumo de hongos es frecuente ocurren cientos de casos de micetismos al año, por lo que representan un problema de salud pública. En México, los micetismos son clasificados como una intoxicación gastrointestinal de tipo no bacteriano, lo que impide su atención oportuna. OBJETIVO: Crear una plataforma de libre acceso que sintetice y estandarice la información de los casos de micetismos y ofrezca herramientas para su diagnóstico y tratamiento oportuno. MATERIAL Y MÉTODOS: En localidades donde han ocurrido casos de micetismos se obtuvo información sobre los hongos involucrados, las intoxicaciones ocurridas, protocolos de atención y procesamiento de muestras. RESULTADOS: Se generaron cédulas que sintetizan y describen las intoxicaciones por hongos con mayor probabilidad de ocurrencia en México. En ellas se describen las características biológicas de los hongos, síntomas que provocan y su tratamiento. Se presenta una propuesta de protocolo para la atención del paciente y para el procesamiento de muestras biológicas. Por último, se incluye un formulario para recopilar información sobre los casos de intoxicaciones. CONCLUSIONES: La información sistematizada y analizada sobre los micetismos permite simplificar su diagnóstico, atención y tratamiento. Los protocolos para la atención clínica y el procesamiento de muestras son la base para generar estrategias que eviten decesos por micetismo.

[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.

Health Care Utilization and Outcomes Associated with Accidental Poisonous Mushroom Ingestions - United States, 2016-2018.

Accidental consumption of poisonous mushrooms can result in serious illness and death (1). Reports of severe poisonings from consumption of foraged mushrooms for food or hallucinogenic purposes increased during 1999-2016 (2), and approximately 7,500 poisonous mushroom ingestions were reported annually to poison control centers across the United States (1). To estimate the frequency of emergency department (ED) visits, hospitalizations, and severe adverse outcomes associated with accidental poisonous mushroom ingestion in the United States, CDC analyzed 2016 data from the Healthcare Cost and Utilization Project's* Nationwide Emergency Department Sample (HCUP-NEDS) and National Inpatient Sample (HCUP-NIS) databases as well as 2016-2018 data from three IBM MarketScan sources: Commercial Claims and Encounters (CCAE), Medicare Supplemental and Coordination of Benefits (Medicare), and Multi-State Medicaid databases. During 2016, 1,328 (standard error [SE] = 100) ED visits and 100 (SE = 22) hospitalizations (HCUP data) were associated with accidental poisonous mushroom ingestion. Among 556 patients with a diagnosis of accidental poisonous mushroom ingestion, 48 (8.6%) patients experienced a serious adverse outcome during 2016-2018 (MarketScan data). Serious adverse outcomes were more common among Medicaid-insured patients than among patients with commercial insurance or Medicare (11.5% versus 6.7%, p = 0.049). Because most mushroom poisonings are preventable, wild mushrooms should not be consumed unless they are identified by an expert; increased public health messaging about the potential dangers of mushroom poisoning is needed.

Reviewing the world's edible mushroom species: A new evidence-based classification system.

Wild mushrooms are a vital source of income and nutrition for many poor communities and of value to recreational foragers. Literature relating to the edibility of mushroom species continues to expand, driven by an increasing demand for wild mushrooms, a wider interest in foraging, and the study of traditional foods. Although numerous case reports have been published on edible mushrooms, doubt and confusion persist regarding which species are safe and suitable to consume. Case reports often differ, and the evidence supporting the stated properties of mushrooms can be incomplete or ambiguous. The need for greater clarity on edible species is further underlined by increases in mushroom-related poisonings. We propose a system for categorizing mushroom species and assigning a final edibility status. Using this system, we reviewed 2,786 mushroom species from 99 countries, accessing 9,783 case reports, from over 1,100 sources. We identified 2,189 edible species, of which 2,006 can be consumed safely, and a further 183 species which required some form of pretreatment prior to safe consumption or were associated with allergic reactions by some. We identified 471 species of uncertain edibility because of missing or incomplete evidence of consumption, and 76 unconfirmed species because of unresolved, differing opinions on edibility and toxicity. This is the most comprehensive list of edible mushrooms available to date, demonstrating the huge number of mushrooms species consumed. Our review highlights the need for further information on uncertain and clash species, and the need to present evidence in a clear, unambiguous, and consistent manner.

Nephrotoxic Mushroom Poisoning: Global Epidemiology, Clinical Manifestations, and Management.

Because mushroom poisonings are increasing worldwide after ingestions of known, newly described, and formerly considered edible species, the objectives of this review are to describe the global epidemiology of nephrotoxic mushroom poisonings, to identify nephrotoxic mushrooms, to present a toxidromic approach to earlier diagnoses of nephrotoxic mushroom poisonings based on the onset of acute renal failure, and to compare the outcomes of renal replacement management strategies. Internet search engines were queried with the keywords to identify scientific articles on nephrotoxic mushroom poisonings and their management during the period of 1957 to the present. Although hepatotoxic, amatoxin-containing mushrooms cause most mushroom poisonings and fatalities, nephrotoxic mushrooms, most commonly Cortinarius species, can cause acute renal insufficiency and failure. Several new species of nephrotoxic mushrooms have been identified, including Amanita proxima and Tricholoma equestre in Europe and Amanita smithiana in the United States and Canada. In addition, the edible, hallucinogenic mushroom Psilocybe cubensis has been noted recently via mass spectrometry as a rare cause of acute renal insufficiency. Renal replacement therapies including hemodialysis are often indicated in the management of nephrotoxic mushroom poisonings, with renal transplantation reserved for extracorporeal treatment failures.

Foodborne infections and intoxications in Poland in 2017

AIM: The purpose of this study is to assess the epidemiological situation of food poisonings and infections in Poland in 2017. MATERIALS AND METHODS: The evaluation was based on the analysis of information sent to Department of Epidemiology NIPH-NIH through ROE (pol. Rejestr Ognisk Epidemicznych)- (an electronic system created for uploading, transfer and analysis of data acquired during the outbreak investigations). Additional sources for the analysis were NIPH-NIH annual bulletins (Czarkowski MP et al. "Infectious diseases and poisonings in Poland", 2011-2017. Warsaw, NIPH-NIH and GIS). RESULTS: In 2016 a total number of 926 foodborne infections and intoxications outbreaks were reported in which 27 702 persons were exposed and 7 416. A total number of 2 502 of patients were hospitalized. The most frequent etiological agent of outbreaks was hepatitis A virus (HAV) (27.1%). The most frequent cause of infection for all outbreaks cases was Salmonella sp. ­ 37.2%, especially serotype Enteritidis (32.2%). Among other agents rotaviruses caused 9.3% of outbreaks and noroviruses 14.5%. In 12.2% of outbreaks no etiological agent was found. The most frequent place of an outbreak was private household- 560 outbreaks (60.4%), and after that- hospital- 155 outbreaks (16.7%). In 86.8% of outbreaks no vehicle was found and in remaining the most frequent vehicle were eggs and egg products- 5.6% % of all outbreaks. CONCLUSIONS: Increasing yearly trend of Salmonella Enteritidis outbreaks, and high proportion of eggs and egg products as vehicles in those outbreaks point towards necessity of microbiological surveillance enchantment in relation to abovementioned products. Dynamic increase in HAV outbreaks is a good example of how a pathogen with high epidemic potential could spread in susceptible population.

[Investigation on an incident of groups mushroom poisoning].

Objective: To investigate an incident of mushroom poisoning and related clinical data. Methods: A descriptive analysis was performed to investigate an incident of poisonous mushroom poisoning in Jinan, Shandong Province, China in July 2016. The clinical data of four patients were analyzed and summarized, and the causes of this incident and prevention and control measures were summarized. Results: This incident of acute poisonous mushroom poisoning was caused by Lepiota brunneoincarnata. The patients mainly had digestive system symptoms, including nausea, vomiting, and severe abdominal pain, and later developed liver damage. After comprehensive rescue treatment, one patient died and three survived. The main clinical manifestation of the patient who died was multiple organ failure, especially liver failure. Conclusion: This incident of poisoning was caused by Lepiota brunneoincarnata the residents ate by mistake.

Foodborne infections and intoxications in Poland in 2015

AIM: The purpose of the study is to assess the epidemiological situation of food poisonings and infections in Poland in 2015 MATERIALS AND METHODS: The evaluation was based on the analysis of information sent to Department of Epidemiology NIPH-NIH through ROE (Pol. Rejestr Ognisk Epidemicznych)- (an electronic system created for uploading, transfer and analysis of data acquired during the outbreak investigations). Additional sources for the analysis were NIZP-PZH annual bulletins (Czarkowski MP et al. "Infectious diseases and poisonings in Poland", 2007-2015. Warsaw, NIPH-NIH and GIS) RESULTS: In 2015 a total number of 560 foodborne infections and intoxications outbreaks were reported in which 21 962 persons were exposed and 7 037 (including 1 896 children up to 14 years of age) got sick. Hospitalization was required for 1 905 of patients. The most frequent etiological agent was Salmonella sp. ­ 34.3%, and 21.4 % of cases). Viruses were responsible for 23.9% of outbreaks and 29.7 % of cases (And among them rotaviruses­ 13% of outbreaks and 7.1% of cases and noroviruses­ 10.5% of outbreaks and 26.9% of cases). In 25.2% of outbreaks no etiological agent was found. Just as in 2014 private household was the most frequent place of an outbreak (235 outbreaks), and after that­ hospital (148 outbreaks). In 2014 the most frequent vehicle were cakes and desserts (25.6% of all outbreaks with known etiological agent). In 2015 the most frequent vehicle of infection were eggs and egg products) (19% of outbreaks of known vehicle). In 57.3% of outbreaks no vehicle was found or proved. Moreover in 2015 a total number of 4 outbreaks in which more than 100 cases were reported CONCLUSIONS: The increase in the number of foodborne outbreaks of Salmonella Enteritidis etiology along with the fact of eggs and egg products being the most frequent vehicle indicates an alarming situation and the necessity of microbiological surveillance enchantment in relation to those products

[Analysis of spatiotemporal patterns and influential factors for mushroom poisoning in Hunan Province in 2015].

OBJECTIVE: To understand the spatial distribution of mushroom poisoning in Hunan Province and its influential factors, and to provide the evidence for control of the mushroom poisoning.
 Methods: The surveillance data for mushroom poisoning cases from 122 counties in Hunan Province in 2015 were collected. Based on geographical information system database, spatial autocorrelation analysis and spatial regression analysis (via OpenGeoDa) was conducted.
 Results: The incidence of mushroom poisoning in Hunan Province in 2015 was 2.94/100 000. Global Moran's I values was 0.315 (P<0.05). Local spatial autocorrelation analysis indicated that Ningxiang, Xiangtan, Shaoyang, Lingling, Jiahe, and Linwu districts et al were "positive hotspot" regions. Guzhang, Hecheng, Dingcheng, Yueyang districts et al were "negative hotspot" regions. Spatial regression analysis revealed that the reported incidence of mushroom poisoning was positively correlated with the annual average temperate (Z=2.145, P=0.032), the number of health care institutions per capita (Z=2.352, P=0.019), and the number of students enrollment in secondary schools (Z=4.309, P<0.001). It was negatively associated with the number of school staff and workers of secondary schools (Z=-2.626, P=0.009).
 Conclusion: The spatial distribution of mushroom poisoning cases in Hunan Province in 2015 is highly clustered. Mushroom poisoning cases are more prevalent in the middle and southern regions and less prevalent in the northern areas of the province. The annual average temperate and the number of students enrollment in secondary schools demonstrate a certain positive influence on the distribution of mushroom poisoning in Hunan.

Acute liver injury and acute liver failure from mushroom poisoning in North America.

BACKGROUND & AIMS: Published estimates of survival associated with mushroom (amatoxin)-induced acute liver failure (ALF) and injury (ALI) with and without liver transplant (LT) are highly variable. We aimed to determine the 21-day survival associated with amatoxin-induced ALI (A-ALI) and ALF (A-ALF) and review use of targeted therapies. METHODS: Cohort study of all A-ALI/A-ALF patients enrolled in the US ALFSG registry between 01/1998 and 12/2014. RESULTS: Of the 2224 subjects in the registry, 18 (0.8%) had A-ALF (n = 13) or A-ALI (n = 5). At admission, ALF patients had higher lactate levels (5.2 vs. 2.2 mm, P = 0.06) compared to ALI patients, but INR (2.8 vs. 2.2), bilirubin (87 vs. 26 µm) and MELD scores (28 vs. 24) were similar (P > 0.2 for all). Of the 13 patients with ALF, six survived without LT (46%), five survived with LT (39%) and two died without LT (15%). Of the five patients with ALI, four (80%) recovered and one (20%) survived post-LT. Comparing those who died/received LT (non-spontaneous survivors [NSS]) with spontaneous survivors (SS), N-acetylcysteine was used in nearly all patients (NSS 88% vs. SS 80%); whereas, silibinin (25% vs. 50%), penicillin (50% vs. 25%) and nasobiliary drainage (0 vs. 10%) were used less frequently (P > 0.15 for all therapies). CONCLUSION: Patients with mushroom poisoning with ALI have favourable survival, while around half of those presenting with ALF may eventually require LT. Further study is needed to define optimal management (including the use of targeted therapies) to improve survival, particularly in the absence of LT.

Mushroom poisoning in Hong Kong: a ten-year review.

INTRODUCTION: Mushroom poisoning is a cause of major mortality and morbidity all over the world. Although Hong Kong people consume a lot of mushrooms, there are only a few clinical studies and reviews of local mushroom poisoning. This study aimed to review the clinical characteristics, source, and outcome of mushroom poisoning incidences in Hong Kong. METHODS: This descriptive case series review was conducted by the Hong Kong Poison Information Centre and involved all cases of mushroom poisoning reported to the Centre from 1 July 2005 to 30 June 2015. RESULTS: Overall, 67 cases of mushroom poisoning were reported. Of these, 60 (90%) cases presented with gastrointestinal symptoms of vomiting, diarrhoea, and abdominal pain. Gastrointestinal symptoms were early onset (<6 hours post-ingestion) and not severe in 53 patients and all recovered after symptomatic treatment and a short duration of hospital care. Gastrointestinal symptoms, however, were of late onset (≥6 hours post-ingestion) in seven patients; these were life-threatening cases of amatoxin poisoning. In all cases, the poisonous mushroom had been picked from the wild. Three cases were imported from other countries, and four collected and consumed the amatoxin-containing mushrooms in Hong Kong. Of the seven cases of amatoxin poisoning, six were critically ill, of whom one died and two required liver transplantation. There was one confirmed case of hallucinogenic mushroom poisoning caused by Tylopilus nigerrimus after consumption of a commercial mushroom product. A number of poisoning incidences involved the consumption of wild-harvested dried porcini purchased in the market. CONCLUSION: Most cases of mushroom poisoning in Hong Kong presented with gastrointestinal symptoms and followed a benign course. Life-threatening cases of amatoxin poisoning are occasionally seen. Doctors should consider this diagnosis in patients who present with gastrointestinal symptoms that begin 6 hours or more after mushroom consumption.

Foodborne infections and intoxications in Poland in 2013.

AIM: The purpose of the study is to assess the epidemiological situation of food poisonings and infections in Poland in 2013. MATERIALS AND METHODS: The evaluation was based on the analysis of information from reports of epidemiological investigations in outbreaks of food poisonings and infections, submitted by the sanitary-epidemiological stations to the Department of Epidemiology, NIZP-PZH annual bulletins (Czarkowski MP et al. "Infectious diseases and poisonings in Poland", 2006-2013. Warsaw, NIPH-NIH and GIS). RESULTS: In 2013 a further decrease in the number of infections and intoxications with bacterial etiology and an increase in the infections of viral etiology was observed. Furthermore 2013 is another year with low number of cases of trichinellosis (9 cases in total). In 2013 a total number of 491 foodborne infections and intoxications outbreaks were reported in which there were 29,179 persons exposed and 5,664 (including 2 193 children up to 14 years of age) persons ill. Hospitalization was required for 1,445 persons. The most frequent etiological agent in those outbreaks was Salmonella spp.--which was responsible for 36,3% of outbreaks and 21,5% of cases. Viruses were responsible for 29,7 of outbreaks and 45,7 cases, in 19,3% of outbreaks no etiological agent was established. Like in 2012 the most frequent vehicle were dishes made from eggs and milk combined with eggs (9,4% of outbreaks). In 65% of outbreaks reported no vehicle could be found. Moreover in 2013 a total number of 3 outbreaks in which more than 100 cases were reported. CONCLUSIONS: The increase in the number of foodborne outbreaks of viral etiology shows the need of adjustment some aspects of epidemiological investigations especially such features as: laboratory conformation of etiological agent of ill persons as well as persons involved in the food processing and meals preparing and the aspect of food samples testing.

Foodborne infections and intoxications in Poland in 2012.

AIM: The purpose of the study is to assess the epidemiological situation of foodborne infections and intoxications in Poland in 2012. MATERIALS AND METHODS: The evaluation was based on analysis of information from reports of epidemiological investigations in foodborne outbreaks, submitted by the sanitary-epidemiological stations to the Department of Epidemiology, NIZP-PZH annual bulletins (Czarkowski MP et al. "Infectious diseases and poisonings in Poland", 2006-2012. Warsaw, NIPH-NIH and CSI). RESULTS: In Poland in 2012 there was observed decrease in the number of infections intoxications both of bacterial and viral origin. It was recorded only one case of trichinellosis. There were reported 491 outbreaks of foodborne poisonings or infections included 5 774 people, among them 718 children 1-14 years old. Out of them 1 364 people were hospitalized. Unlike last year, the predominant etiological agent in those outbreaks were zoonotic Salmonella serotypes which caused 38.1% outbreaks and 26.7% outbreak cases. The viruses have caused 27.1% of outbreaks and 36.2% of cases. In 23.8% of outbreaks etiological agent has not been established. Most often the settings of an outbreak was a private household - 236 outbreaks and a hospital (84 outbreaks). As in previous years, the most common vehicle of infection were foods prepared with milk and eggs -11.8% of outbreaks and egg dishes - 9.0%. In 57.6% of oubreaks vehicle of infection has not been established. Among outbreaks reported in 2012, there were 4 which involved more than 100 people. In 163 outbreaks of food items had been tested and in 33% of them the results were positive. CONCLUSIONS: The increasing negative results of bacteriological examinations of food items, suggested necessity to start testing food contamination with viruses.

Severe morel mushroom poisonings in France - a nationwide French poison centres study 2010-2020.

INTRODUCTION: In 2023, two fatalities attributed to the ingestion of uncooked morels (Morchella spp.) were reported in the United States; both patients developed severe gastrointestinal symptoms. Morel-induced gastrointestinal toxicity is well recognized, but no deaths had been reported until 2023, suggesting a potential shift in the severity of morel poisoning. METHODS: Using the Poisoning Severity Score, we analyzed the severity of symptomatic cases of morel ingestion recorded in the French National Database of Poisonings from 2010 to 2020. RESULTS: We found 446 cases of exposure in which morels were the sole mushroom species involved. Of these, 83.6 per cent and 53.3 per cent developed gastrointestinal and neurological symptoms, respectively. Eight patients developed shock attributed to severe gastrointestinal symptoms, resulting in two deaths. DISCUSSION: Morel ingestion can lead to severe complications. As in the United States, the deaths reported in this study were attributed to imported cultivated morels. The shift, since 2006, towards a predominance of cultivated over wild morel sales may have played a role in the reporting of severe cases of morel poisoning. CONCLUSIONS: Reports of severe morel poisoning highlight the need for cautious consumption, particularly of raw or undercooked preparations. Emerging complications signal potential changes in toxicity. Surveillance and awareness are key to reducing the risks of consuming morels.

Amanita phalloides poisoning and treatment with silibinin in the Australian Capital Territory and New South Wales.

OBJECTIVES: To report the frequency and clinical outcomes of Amanita phalloides poisoning in the Australian Capital Territory and New South Wales, and the treatments used (including silibinin). DESIGN, SETTING AND PATIENTS: Retrospective case series of patients admitted to public hospitals in Canberra and Sydney for suspected A. phalloides poisoning between 1999 and 2012 (identified from hospital records and calls to the New South Wales Poisons Information Centre). MAIN OUTCOME MEASURES: Frequency of poisoning and the clinical outcomes. RESULTS: Twelve patients presented with a history suggesting A. phalloides poisoning, 10 with probable poisoning and two with possible poisoning. Eight of those with probable poisoning developed significant hepatotoxicity and four died. Silibinin was administered to nine of those with probable poisoning (the other presented before 2005). Maintaining silibinin supply became a challenge during two clusters of poisoning. Eight of the patients with probable poisoning were not long-term residents of the ACT, and six were immigrants from Asia. CONCLUSIONS: The mortality rate due to A. phalloides poisoning in this case series was high despite treatment according to current standards, including use of silibinin, and the frequency of hepatotoxicity was more than double that for the previous decade. Ongoing public health campaigns are required.

[Mushroom poisoning]. / Intoxication par les champignons.

Mushroom poisoning is a regular complaint for consultation in emergency facilities. These situations are usually benign and symptomatic treatment is sufficient. However, severe damage can occur, potentially life-threatening. We review the various syndromes associated with the toxins involved, their management and the major signs that are suggestive of serious injury and requiring hospitalization.

[Recent trends of mushroom poisoning in Japan].

The incidence of mushroom poisoning was studied statistically from 2001 to 2010 in Japan. The total incident of mushroom poisoning was 569 cases, which involved 1,920 patients and 10 deaths. The average incident was 56.9 cases per year, involving 192 patients and 1 death. On regional differences, the mushroom poisoning was more frequent in the northeastern part of Japan. The rate of total incidents for each type of poisoning, which were classified according to symptoms caused, 54.6% in the type of gastro-intestinal disorder, 11.6% in the type of neurological symptoms, and 2.4% in the type of intracellular disorder (violent vomiting, diarrhea and dehydration and hepato-nephrosis, or rhabdomyolysis, or erroneous perception, etc.), respectively. Two species of poisonous mushrooms with gastro-intestinal disorder, Lampteromyces japonicus and Rhodophyllus rhodopolius caused the majority (52%) of all poisonings in Japan.

[Mushroom consumption and toxicity, state of the art]. / Consumo di funghi ed intossicazioni associate:lo stato dell'arte.

Mushroom consumption is widespread throughout the world and mushroom foraging is often seen as a recreational activity. However, mushroom hunters, especially if inexperienced, may not fully perceive the risks associated with ingesting potentially toxic mushroom species. It is fundamental that mushrooms must be professionally inspected and their quality and safety approved before being ingested. This article analyzes the main scientific documents and current regulations regarding this topic.