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Hepatotoxic mushroom poisoning: diagnosis and management

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Abstract

Hepatotoxic mushroom poisoning (due to Amanita, Lepiota and Galerina species) may be considered as a real medical emergency, since an early diagnosis and immediate treatment are required for a successful outcome. In this review the physio-pathological features and the clinical picture of amatoxin poisonings are described, as the basis for diagnosis and therapeutic decisions. The treatment schedule proposed is analyzed in some points: Symptomatic and supportive measures, toxin removal and extraction procedures, and the possibility of using antidotes. Some parameters with prognostic significance are commented on. Finally, the mortality rate and its evolution throughout the present century is also considered.

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References

  1. Berkson B. Treatment of four delayed-mushroom poisoned patients with thioctic acid. In: Faulstich H, Kommerell B, Wieland T, eds. Amanita Toxins and Poisoning. New York: Gerhard Wizstrock, 1980:203–207.

    Google Scholar 

  2. Piqueras J. Intoxicación de tipo Ciclopeptídico (Faloidiano) producida por pequeñas Lepiotas. Butll Soc Catalana Micol 1984; 8:33–37.

    Google Scholar 

  3. Haines J, Lichstein E, Glickerman D. A fatal poisoning from an amatoxin containing Lepiota. Mycopathologia 1985; 93:15–17.

    Google Scholar 

  4. Faulstich H. The Amatoxins. In: Hahn FE, ed. Progress in Molecular and Subcellular Biology. Vol 7. New York: Springer Verlag, 1980:88–134.

    Google Scholar 

  5. Piqueras J. Concentración de amatoxinas en ejemplares de Amanita phalloides (Vaill.: Fr) Secr. recolectados en España. Bol Soc Micol Madrid 1987; 11:283–286.

    Google Scholar 

  6. Piqueras J. Nuevas Aportaciones al Conocimiento de la Etiología, Fisiopatología, Clínica y Terapeútica de las Intoxicaciones por Hongos Macromicetos Hepatotóxicos. Tesis Doctoral. University Microfilms, University of Barcelona, 1988.

  7. Beutler JA, Verger PP. Amatoxins in American Mushrooms: Evaluation of the Meixner Test. Mycologia, 1980; 72:1142–1149.

    Google Scholar 

  8. Wieland T, Faulstich H. Peptide Toxins from Amanita. In: Keeler RF, Tu AT, eds. Handbook of Natural Toxins. Vol 1. Plant and Fungal Toxins. New York: Marcel Dekker Inc, 1980:585–635.

    Google Scholar 

  9. Faulstich H, Talas A, Wellhöner HH. Toxicokinetics of labeled amatoxins in the dog. Arch Toxicol 1985; 56:190–194.

    Google Scholar 

  10. Fauser U, Faulstich H. Beobachtungen zur Therapie der Knollenblätterpilzvergiftung. Deutsch Med Wochenschr 1973; 98:2259.

    Google Scholar 

  11. Busi C, Fiume L, Costantino D, Langer M, Vesconi S. Amanita toxins in gastroduodenal fluid of patients poisoned by the mushroom Amanita phalloides. New Eng J Med 1979; 300:800.

    Google Scholar 

  12. Jahn W, Faulstich H, Wieland T. Pharmacokinetics of (3H-)Methyl-Dehydroxy-Methyl-α-Amanitin in the isolated perfused rat liver. In: Faulstich H, Kommerell B, Wieland T, eds. Amanita Toxins and Poisoning. New York: Gerhard Wizstrock, 1980:79–87.

    Google Scholar 

  13. Costantino D, Langer M, Vesconi S. Il trattamento di emergenza e l'intossicazione phalloidea. Nuove prospettive in rapporto alla cinetica delle amatossine nell'uomo. Recent Prog Med 1980; 6:649–685.

    Google Scholar 

  14. Sese J, Piqueras J, Morlans G, Mercade V, Valls X, Herrero A. Intoxicación por Amanita phalloides. Diagnóstico por Radioinmunoanálisis y tratamiento con diuresis forzada. Med Clin (Barc) 1985; 84:660–662.

    Google Scholar 

  15. Piqueras J. Intoxicación por setas tipo Amanita phalloides. Med Clin (Barc) 1985; 85:330–340.

    Google Scholar 

  16. Homann J, Rawer P, Bleyl H, Matthes KJ, Heinrich D. Early detection of amatoxins in human mushroom poisoning. Arch Toxicol 1986; 59:190–191.

    Google Scholar 

  17. Busi C, Fiume L, Costantino D et al: Détermination des amanitines dans le sérum de patients intoxiqués par l'amanite phalloïde. Nouv Press Med 1977; 6:2855–2857.

    Google Scholar 

  18. Fischer M, Faulstich H, Schmal W, Hilber C. Autoradiographic localization of amatoxins in the pig liver. In: Faulstich H, Kommerell B, Wieland T, eds. Amanita Toxins and Poisoning. New York: Gerhard Wizstrock, 1980:98–105.

    Google Scholar 

  19. Kroncke KD, Fricker G, Meiers PJ, Gerok W, Wieland T, Kurz G. Alpha-Amanitin Uptake into Hepatocytes. J Biol Chem, 1986; 27:12562–12567.

    Google Scholar 

  20. Czigan P, Zimmermann R, Leuschner U, Stielh A, Kommerell B. Clinical, biochemical and morphological alterations in patients with Amanita phalloides intoxication. In: Faulstich H, Kommerell B, Wieland T, eds. Amanita Toxins and Poisoning. New York: Gerhard Wizstrock, 1980:131–136.

    Google Scholar 

  21. Floersheim GL. Treatment of Human Amatoxin Mushroom Poisoning. Myths and Advances in Theraphy. Medical Toxicol, 1987; 2:1–9.

    Google Scholar 

  22. Guardia J, Pedreira JD, Vilaseca J, Benet JM, Leon C. Hepatitis por tóxicos químicos y hongos. Rev Clin Esp 1978; 150:341–344.

    Google Scholar 

  23. Fantozzi R, Ledda F, Caramelli LL et al. Clinical findings and follow-up evaluation of an outbreak of mushroom poisoning — Survey of Amanita phalloides poisoning. Klin Wochenschr 1986; 64:38–43.

    Google Scholar 

  24. Faulstich H, Zobeley S, Trischmann H. A rapid radioimmunoassay using a nylon support for amatoxins from Amanita mushrooms. Toxicon 1982; 20:913–924.

    Google Scholar 

  25. Pastorelo L, Tolentino D, D'alterio M. Determination of α- amanitin by Hihg-Performance Liquid Chromatography. J Chromatograph 1982; 233:398–403.

    Google Scholar 

  26. Andres RI, Frei W, Gautschi K, Vonderschmitt J. Radioimmunoassay for amatoxins by use of a rapid, 125I-tracer-based system. Clin Chem 1986; 32:1751–1755.

    Google Scholar 

  27. Faulstich H. Analytical Studies with Amatoxins. In: TorresRodriguez JM, ed. X Congress of The International Society for Human and Animal Mycology — ISHAM. June 27–July 1, 1988. Barcelona-Spain. Proceedings. Barcelona: J.R. Prous Science Publishers, 1988:347–349.

    Google Scholar 

  28. Lincoff G, Mitchel DH. Toxic and Hallucinogenic Mushroom Poisoning. New York: Van Nostrand Reinhold Co, 1977.

    Google Scholar 

  29. Tenenbein M. Whole bowel irrigation for toxic ingestions. Clinical Toxicology 1985; 23:177–184.

    Google Scholar 

  30. Berg MG, Berlinger WG, Goldberg MJ, Spector R, Johnson GF. Acceleration of the body clearance of phenobarbital by oral activated charcoal. New Engl J Med 1982; 307:642–644.

    Google Scholar 

  31. Langer M, Costantino D, Vesconi S. Pharmacokinetics of Amatoxins in Human Poisoning and the Role of Early Removal. The Experience at the ‘Ospedale Maggiore-Policlinico’ in Milan. In: Torres-Rodriguez JM, ed. X Congress of The International Society for Human and Animal Mycology — ISHAM. June 27–July 1, 1988. Barcelona-Spain. Proceedings. Barcelona: J.R. Prous Science Publishers, 1988:350–355.

    Google Scholar 

  32. Langer M, Vesconi S, Iapichino G, Costantino D, Radriazzani D. Die frühzeitige Elimination der amanita Toxine in der Therapie der Knollenblätterpilzvergiftung. Klin Wochenschr 1980; 58:117–123.

    Google Scholar 

  33. Piqueras J, Durán-Suárez JR, Massuet L, Hernández-Sánchez JM. Mushroom poisoning. Therapeutic apheresis or forced diuresis. Transfusion 1987; 27:116–117.

    Google Scholar 

  34. Floersheim GL. Therapie der Knollenblätterpilzvergiftung. Deutsch Med Wochenschr 1983; 108:866–867.

    Google Scholar 

  35. Vogel G. The anti-Amanita effects of Sylimarin. In: Faulstich H, Kommerell B, Wieland T, Eds. Amanita Toxins and Poisoning. New York: Gerhard Wizstrock, 1980:180–187.

    Google Scholar 

  36. Sonnenbichler J, Zetl I. Mechanism of Silibinin action. V. Influence of Silibinin on the synthesis of Ribosomal RNA, mRNA, and tRNA in rat. Hoppe-Seylers's Z Physiol Chem 1984; 365:550–556.

    Google Scholar 

  37. Parish RC, Doering PL. Treatment of Amanita mushroom poisoning: A review. Vet Hum Toxicol 1986; 28:318–322.

    Google Scholar 

  38. Hruby K. Treatment of Death Cap Fungus Poisoning with Silibinin. In: Torres-Rodriguez JM, ed. X Congress of The International Society for Human and Animal Mycology — ISHAM. June 27–July 1, 1988. Barcelona-Spain. Proceedings. Barcelona: J.R. Prous Science Publishers, 1988:361–363.

    Google Scholar 

  39. Nakai S. Liver-function-promoting agents by experimental liver perfusion. I: Effect of Thioctic acid on the detoxifying function of the liver. Chem Abst 1960; 54:11274.

    Google Scholar 

  40. Kubicka J. Traitement des empoisonnements fongiques phalloidiennes a Tchecoslovaquie. Acta Mycol 1968; 4:373–377.

    Google Scholar 

  41. Socha J. Mushroom Poisoning in Children. In: TorresRodriguez JM, ed. X Congress of The International Society for Human and Animal Mycology — ISHAM. June 27–July 1, 1988. Barcelona-Spain. Proceedings. Barcelona: J.R. Prous Science Publishers, 1988:356–360.

    Google Scholar 

  42. Floersheim GL, Weber O, Tsuchumi P, Ulbrich M. Die klinische Knollenblätterpilzvergiftung (Amanita phalloides): Prognostiche Faktoren und Terapeutische Mmassnahmen. Schweiz Med Wochenschr 1982; 112:1169–1177.

    Google Scholar 

  43. Alder AE. Erkennung und Behandlung von Pilzvergiftungen. Deutsch Med Wochenschr 1961; 86:1121–1127.

    Google Scholar 

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Authors and Affiliations

  1. Department of Hematology and Hemotherapy, Hospital General ‘Vall d'Hebrón’, E-08035, Barcelona, Spain

    Josep Piqueras

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Piqueras, J. Hepatotoxic mushroom poisoning: diagnosis and management. Mycopathologia 105, 99–110 (1989). https://doi.org/10.1007/BF00444032

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