MUSHROOMS

1. MUSHROOMS

2. Cyclopeptide Containing Mushrooms

3. http://www.inf.unitn.it./~mflorian/mycology/fungi/amanphal.htmlhttp://www.inf.unitn.it./~mflorian/mycology/fungi/amanphal.html

4. 95% of mushroom fatalities are due to these • Include A. verna (death angel), A. virosa (destroying angel), A. phalloides (death cap) • Also, Galerina autumnalis, G. marginata, G. Venenata, and Lepiota helveola

5. Symptoms • Usually not before 6-12 hours • Include profuse, watery diarrhea, and gastroenteritis at 12-24 hours; transient improvement • 1-6 days later; hepatic, renal and at times pancreatic toxicity and death

6. Toxin is heat-stable, insoluble in water and loses activity very slowly over years • Mortality related to age and dose(0.1 mg/kg is lethal) • Children are more susceptible

7. Toxicity of alpha-aminitin is through interference with RNA polymerase II, prevents the transcription of DNA • Phalotoxins are rapid-acting and interrupt actin polymerization, impair cell membrane function, has limited absorption.

8. Therapy • Continuous gastrointestinal charcoal lavage to decontaminate (theoretically, up to five days) • Watch for altered mental status due to hypoglycemia • Supportive therapy

9. Antidotes • Penicillin displaces amatoxin from plasma protein-binding sites • May inhibit penetration of amatoxin into hepatocytes • Doses of 300,000 to 1,000,000 units benzyl penicillin daily • N-acetylcysteine may be helpful as in any patient with liver injury

10. Other Antidotes • Thioctic acid (alpha-lipoic acid) • Silibinin (extract of silymarin from Silybum marianum) • Cimetidine may be hepatoprotective. • Consider liver transplantation early(Prior to grade III hepatic encephalopathy)

11. Monomethylhydrazine -Containing Mushrooms

12. http://www.wisc.edu/botany/fungi/apr97

13. Associated with mortality of 40% • Include G. californica, G. brunnea, G. esculenta

14. Toxicity is due to gyromitrin which is metabolized to monomethylhydrazine • This metabolite reacts with pyridoxine resulting in inhibition of pyridoxal phosphate-related enzymatic reactions

15. Symptoms • Headache, nausea, vomiting, seizures, and hepatorenal failure • Symptoms occur 6-10 hours after ingestion • Toxin may be eliminated with cooking but inhalation of cooking fumes may cause poisoning

16. Therapy • Pyridoxine, in dose of 25 mg/kg

17. Glutamate  Glutamic Acid  GABA Pyridoxal 5' phosphate

18. Muscarine-Containing Mushrooms

19. http://www.inf.unitn.it./~mflorian/mycology/fungi/clitphae

20. No lethality • Includes Clitocybe dealbata (the sweater), C. Illudens (omphalotus olearius) and Inocybe lacera • Small amounts of muscarine are in Amanitia muscaria

21. Symptoms: SLUDGE within 0.5-2 hours • Therapy: Atropine

22. Coprine-Containing Mushrooms

24. Rarely fatal • Coprinus atramentarius (inky caps) • Coprine has a disulfiramlike effect(Blocks acetaldehyde dehydrogenase) • Requires ingestion of alcohol 48-72 hours after mushroom

25. Symptoms: Flushing, headache, hypotension, histamine induced vasodilation • Therapy: Supportive, anti H1 and anti H2, prostaglandin inhibitors

26. Ibotenic Acid- and Muscimol-Containing Mushrooms

27. http://www.inf.unitn.it./~mflorian/mycology/fungi/amanpant

28. Not lethal • Amanita gemmata, A. muscaria and A. pantherina • Symptoms: Within 0.5-2 hours, somnolence, hallucinations and delirium, in adults • Also, myoclonus, seizures and other neurologic effects in children

29. Action is due to stimulation of GABA receptors • Therapy: Benzodiazepine

30. Psilocybin-Containing Mushrooms

31. http://www.halcyon.com/mycomed/gallery1

32. Rare mortality • Symptoms: In 0.5-1 hour, CNS effects: ataxia, hyperkinesis, hallucinations, and seizures • Psilocybe cubensis, P. caerulescens, Conocybe cyanopus, Panaeolus foenisecii, Gymnopilus spectabilis, Psathyrella foenisecii

33. Gastrointestinal Toxins

34. http://www.inf.unitn.it./~mflorian/mycology/fungi/bolevent

35. Death is rare • “Little brown mushrooms” • Boletes, Lactarius, Rhodophyllus, Tricholoma, Chlorophyllum molybidites, C. esculentum

36. Symptoms • Variable but usually in 0.5-3 hours • Nausea, vomiting diarrhea and epigastric distress • Supportive therapy • Resolution of symptoms in 6-24 hours

37. Orelline-and Orellanine-Containing Mushrooms

38. http://www.inf.unitn.it./~mflorian/mycology/fungi/corteleg

39. May be lethal • Symptoms: In 24-36 hours, headache, chills, anorexia, nausea, gastritis • Hepatotoxicity, and oliguric renal failure may develop • Therapy: Supportive

40. Ralph's Rules • If uncertain of the identity of a species, don't try it

41. Try to Identify New Species • Draw no conclusions until definitive spore print, cross section of gill, stem and bruise color. • Be able to state with confidence what distinguishes specimen from 3-5 look alikes

42. Confidence of limits of variability of species • Photos confirm identity • Odor, bruising, brittleness, habit,...support identification

43. Avoid LBM's, amanita, cortinarius • Use recent texts and monographs • Must be worth eating

44. Eat slowly: first taste the species. Second taste is more than 24 hours later. • Wait another 24 hours before trying a full-sized serving • Do not over-indulge

45. Gather only one species at a time • Do not eat more than one species at a time • Do not eat any species raw