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General Aspect of the Assessment and Management of the Poisonous Mushrooms in Turkiye

Year 2023, Volume: 1 Issue: 2, 92 - 109, 29.08.2023

Aynur Şahin Aylin Arici Semih Korkut Yeşim Tunçok

Abstract

Patients who exposed with poisonous mushrooms may apply to emergency services with a serious clinical conditions ranging from simple gastrointestinal complaints to liver failure. The clinical findings of mushroom poisoning differ according to the toxin of the mushroom species consumed. Poisonings are typically classified as acute onset (<6 hour), late onset (6-24 hours) and delayed onset (>1 day) toxicity. Acute onset mushroom poisonings occure within 6 hours after consuming the mushroom and cause cholinergic toxicity, gastrontestinal findings, disulfiram like reaction, seizures and hallucinations. Late onset mushroom poisonings occure within 6-24 hours with the hepatotoxicity, nephrotoxicity and erythromelalgia. Delayed onset mushroom poisonings occure after 1 day of consuming mushroom with nephrotoxicity, neurotoxicity and rhabdomyolysis. While the prognosis is good in case of early onset of symptoms in mushroom poisoning, the prognosis is poor in case of late onset of symptoms. Most mushroom poisonings that cause gastrointestinal symptoms improve with adequate supportive treatment. Hepatotoxic mushrooms containing cyclopeptide are largely responsible for deaths due to mushroom poisonings. In all cases, basic laboratory evaluation and symptomatic supportive treatment approach are required. There are no antidotes with proven efficacy in the treatment of mushroom poisoning. Specific treatment approaches should be applied according to mushrom species.

Keywords

Mushroom poisoning Acute onset Late onset Delayed onset Treatment

References

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  • Arici, M. A., Sahin, A., Cavdar, Z., Ergur, B. U., Ural, C., Akokay, P., Kalkan, S., & Tuncok, Y. (2020). Effects of resveratrol on alpha-amanitin-induced nephrotoxicity in BALB/c mice. Human and Experimental Toxicology, 39(3), 328–337. https://doi.org/10.1177/0960327119888271
  • Arıcı A, T. Y. (2021). Mushroom-related toxins, alpha amanitin, and usage of antioxidants: Directions toward antioxidant capacity. In Oxidative Stress and Dietary Antioxidants (pp. 447–456).
  • Arłukowicz-Grabowska, M., Wójcicki, M., Raszeja-Wyszomirska, J., Szydłowska-Jakimiuk, M., Piotuch, B., & Milkiewicz, P. (2019). Acute liver injury, acute liver failure and acute on chronic liver failure: A clinical spectrum of poisoning due to Gyromitra esculenta. Annals of Hepatology, 18(3), 514–516. https://doi.org/10.1016/j.aohep.2018.11.009
  • Borowiak, K. S., Ciechanowski, K., & Waloszczyk, P. (1998). ) Intoxication with Myocardial Infarction. Clinical Toxicology, 36, 47–49.
  • Cho, J. T., & Han, J. H. (2016). A case of mushroom poisoning with Russula subnigricans: Development of rhabdomyolysis, acute kidney injury, cardiogenic shock, and death. Journal of Korean Medical Science, 31(7), 1164–1167. https://doi.org/10.3346/jkms.2016.31.7.1164 Clinical toxicology, 30(. (1992). 30, 13–22.
  • Colak, S., Kandis, H., Afacan, M. A., Erdogan, M. O., Gunes, H., Kaya, E., Akdemir, H. U., & Saritas, A. (2015). Assessment of patients who presented to the emergency department with mushroom poisoning. Human and Experimental Toxicology, 34(7), 725–731. https://doi.org/10.1177/0960327114557902
  • Colomer-Carbonell, A., Sanabria-Mazo, J. P., Hernández-Negrín, H., Borràs, X., Suso-Ribera, C., Garciá-Palacios, A., Muchart, J., Munuera, J., D’Amico, F., Maes, M., Younger, J. W., Feliu-Soler, A., Rozadilla-Sacanell, A., & Luciano, J. V. (2022). Study protocol for a randomised, double-blinded, placebo-controlled phase III trial examining the add-on efficacy, cost-utility and neurobiological effects of low-dose naltrexone (LDN) in patients with fibromyalgia (INNOVA study). BMJ Open, 12(1). https://doi.org/10.1136/bmjopen-2021-055351
  • Diaz, J. H. (2005). Syndromic diagnosis and management of confirmed mushroom poisonings. Critical Care Medicine, 33(2), 427–436. https://doi.org/10.1097/01.CCM.0000153531.69448.49
  • Diaz, J. H. (2018). Amatoxin-Containing Mushroom Poisonings: Species, Toxidromes, Treatments, and Outcomes. Wilderness and Environmental Medicine, 29(1), 111–118. https://doi.org/10.1016/j.wem.2017.10.002
  • Dinis-Oliveira, R. J., Soares, M., Rocha-Pereira, C., & Carvalho, F. (2016). Human and experimental toxicology of orellanine. Human and Experimental Toxicology, 35(9), 1016–1029. https://doi.org/10.1177/0960327115613845
  • Durukan, P., Yildiz, M., Cevik, Y., Ikizceli, I., Kavalci, C., & Celebi, S. (2007). Poisoning from wild mushrooms in Eastern Anatolia region: Analyses of 5 years. Human and Experimental Toxicology, 26(7), 579–582. https://doi.org/10.1177/0960327106079545
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  • Forrester, M. B. (2020). Hallucinogenic mushroom misuse reported to Texas poison centers. Journal of Addictive Diseases, 38(4), 482–488. https://doi.org/10.1080/10550887.2020.1785817
  • Garcia, J., Costa, V. M., Carvalho, A., Baptista, P., de Pinho, P. G., de Lourdes Bastos, M., & Carvalho, F. (2015). Amanita phalloides poisoning: Mechanisms of toxicity and treatment. Food and Chemical Toxicology, 86, 41–55. https://doi.org/10.1016/j.fct.2015.09.008
  • Gold, J. A. W., Kiernan, E., Yeh, M., Jackson, B. R., & Benedict, K. (2021). Health Care Utilization and Outcomes Associated with Accidental Poisonous Mushroom Ingestions — United States, 2016–2018. MMWR Surveillance Summaries, 70(10), 337–341. https://doi.org/10.15585/mmwr.mm7010a1
  • Gundala, S., Wells, L. D., Milliano, M. T., Talkad, V., Luxon, B. A., & Neuschwander-Tetri, B. A. (2004). The hepatocellular bile acid transporter Ntcp facilitates uptake of the lethal mushroom toxin α-amanitin. Archives of Toxicology, 78(2), 68–73. https://doi.org/10.1007/s00204-003-0527-y
  • Haberl, B., Pfab, R., Berndt, S., Greifenhagen, C., & Zilker, T. (2011). Case series: Alcohol intolerance with Coprine-like syndrome after consumption of the mushroom Lepiota aspera (Pers.:Fr.) Quél., 1886 (Freckled Dapperling). Clinical Toxicology, 49(2), 113–114. https://doi.org/10.3109/15563650.2011.554840
  • Hedman, H., Holmdahl, J., Mölne, J., Ebefors, K., Haraldsson, B., & Nyström, J. (2017). Long-term clinical outcome for patients poisoned by the fungal nephrotoxin orellanine. BMC Nephrology, 18(1), 14–18. https://doi.org/10.1186/s12882-017-0533-6
  • Horowitz BZ, M. M. (2022). Amatoxin Mushroom Toxicity. Stat Pearls, 28613706.
  • Karahan, S., Erden, A., Cetinkaya, A., Avci, D., Ortakoyluoglu, A. I., Karagoz, H., Bulut, K., & Basak, M. (2016). Acute Pancreatitis Caused By Mushroom Poisoning: A Report of Two Cases. Journal of Investigative Medicine High Impact Case Reports, 4(1), 10–12. https://doi.org/10.1177/2324709615627474
  • Kaygusuz, O., Battistin, E., Life, T. J., Türk, S., Dergisi, Y. B., Amoenolens, P., Nadir, :, Bir, Z., Türkiye’deki, T., Kaydı, İ., & Çolak, Ö. F. (2017). Paralepistopsis amoenolens: First Record of A Rare and Poisonous Taxon in Turkey. 1999. http://dergipark.gov.tr/tjls
  • Kirchmair, M., Carrilho, P., Pfab, R., Haberl, B., Felgueiras, J., Carvalho, F., Cardoso, J., Melo, I., Vinhas, J., & Neuhauser, S. (2012). Amanita poisonings resulting in acute, reversible renal failure: New cases, new toxic Amanita mushrooms. Nephrology Dialysis Transplantation, 27(4), 1380–1386. https://doi.org/10.1093/ndt/gfr511
  • Kosentka, P., Sprague, S. L., Ryberg, M., Gartz, J., May, A. L., Campagna, S. R., & Matheny, P. B. (2013). Evolution of the Toxins Muscarine and Psilocybin in a Family of Mushroom-Forming Fungi. PLoS ONE, 8(5). https://doi.org/10.1371/journal.pone.0064646
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  • Lampe, K. F., & McCann, M. A. (1987). Differential diagnosis of poisoning by north american mushrooms, with particular emphasis on Amanita Phalloides-like intoxication. Annals of Emergency Medicine, 16(9), 956–962. https://doi.org/10.1016/S0196-0644(87)80740-0
  • Laubner, G., & Mikulevičienė, G. (2016). A series of cases of rhabdomyolysis after ingestion of Tricholoma equestre. Acta Medica Lituanica, 23(3), 193–197. https://doi.org/10.6001/actamedica.v23i3.3385 Lin, S., Mu, M., Yang, F., & Yang, C. (2015). Russula subnigricans Poisoning: From Gastrointestinal Symptoms to
  • Rhabdomyolysis. Wilderness and Environmental Medicine, 26(3), 380–383. https://doi.org/10.1016/j.wem.2015.03.027
  • Lurie, Y., Wasser, S. P., Taha, M., Shehade, H., Nijim, J., Hoffmann, Y., Basis, F., Vardi, M., Lavon, O., Suaed, S., Bisharat, B., & Bentur, Y. (2009). Mushroom poisoning from species of genus Inocybe (fiber head mushroom): A case series with exact species identification Inocybe mushroom poisoning. Clinical Toxicology, 47(6), 562–565. https://doi.org/10.1080/15563650903008448
  • Meisel, E. M., Morgan, B., Schwartz, M., Kazzi, Z., Cetin, H., & Sahin, A. (2022). Two Cases of Severe Amanita Muscaria Poisoning Including a Fatality. Wilderness and Environmental Medicine, 33(4), 412–416. https://doi.org/10.1016/j.wem.2022.06.002
  • Michelot, D., & Toth, B. (1991). Poisoning by Gyromitra esculenta–a review. Journal of Applied Toxicology, 11(4), 235–243. https://doi.org/10.1002/jat.2550110403
  • Nakajima, N., Ueda, M., Higashi, N., & Katayama, Y. (2013). Erythromelalgia associated with Clitocybe acromelalga intoxication. Clinical Toxicology, 51(5), 451–454. https://doi.org/10.3109/15563650.2013.792933
  • Nakajima, Nobuhito, Ueda, M., Higashi, N., & Katayama, Y. (2013). Therapeutic potential of nicotinic acid in erythromelalgia associated with Clitocybe acromelalga intoxication. Clinical Toxicology, 51(8), 815. https://doi.org/10.3109/15563650.2013.823202
  • Nowakowski, P., Naliwajko, S. K., Markiewicz-Żukowska, R., Borawska, M. H., & Socha, K. (2020). The two faces of Coprinus comatus—Functional properties and potential hazards. Phytotherapy Research, 34(11), 2932–2944. https://doi.org/10.1002/ptr.6741
  • Passie, T., Seifert, J., Schneider, U., & Emrich, H. M. (2002). The pharmacology of psilocybin. Addiction Biology, 7(4), 357–364. https://doi.org/10.1080/1355621021000005937
  • Pilzvergiftungen, K. P. (2007). Toxidrome, Diagnose und Therapie [Mushroom poisonings: syndromic diagnosis and treatment]. Wien Med Wochenschr, 157(19–120), 493–502. RAPORLARI. (2021).
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Year 2023, Volume: 1 Issue: 2, 92 - 109, 29.08.2023

Aynur Şahin Aylin Arici Semih Korkut Yeşim Tunçok

Abstract

References

  • Akata, I. (2017). Poisonous Mushrooms of Turkey. January.
  • Altintepe, L., Yazici, R., Yazici, M., Solak, Y., Topal, M., Isik, A., & Guney, I. (2014). Temporary left ventricular dysfunction in mushroom poisoning: Report of three cases. Renal Failure, 36(8), 1337–1339. https://doi.org/10.3109/0886022X.2014.930649
  • Arici, M. A., Sahin, A., Cavdar, Z., Ergur, B. U., Ural, C., Akokay, P., Kalkan, S., & Tuncok, Y. (2020). Effects of resveratrol on alpha-amanitin-induced nephrotoxicity in BALB/c mice. Human and Experimental Toxicology, 39(3), 328–337. https://doi.org/10.1177/0960327119888271
  • Arıcı A, T. Y. (2021). Mushroom-related toxins, alpha amanitin, and usage of antioxidants: Directions toward antioxidant capacity. In Oxidative Stress and Dietary Antioxidants (pp. 447–456).
  • Arłukowicz-Grabowska, M., Wójcicki, M., Raszeja-Wyszomirska, J., Szydłowska-Jakimiuk, M., Piotuch, B., & Milkiewicz, P. (2019). Acute liver injury, acute liver failure and acute on chronic liver failure: A clinical spectrum of poisoning due to Gyromitra esculenta. Annals of Hepatology, 18(3), 514–516. https://doi.org/10.1016/j.aohep.2018.11.009
  • Borowiak, K. S., Ciechanowski, K., & Waloszczyk, P. (1998). ) Intoxication with Myocardial Infarction. Clinical Toxicology, 36, 47–49.
  • Cho, J. T., & Han, J. H. (2016). A case of mushroom poisoning with Russula subnigricans: Development of rhabdomyolysis, acute kidney injury, cardiogenic shock, and death. Journal of Korean Medical Science, 31(7), 1164–1167. https://doi.org/10.3346/jkms.2016.31.7.1164 Clinical toxicology, 30(. (1992). 30, 13–22.
  • Colak, S., Kandis, H., Afacan, M. A., Erdogan, M. O., Gunes, H., Kaya, E., Akdemir, H. U., & Saritas, A. (2015). Assessment of patients who presented to the emergency department with mushroom poisoning. Human and Experimental Toxicology, 34(7), 725–731. https://doi.org/10.1177/0960327114557902
  • Colomer-Carbonell, A., Sanabria-Mazo, J. P., Hernández-Negrín, H., Borràs, X., Suso-Ribera, C., Garciá-Palacios, A., Muchart, J., Munuera, J., D’Amico, F., Maes, M., Younger, J. W., Feliu-Soler, A., Rozadilla-Sacanell, A., & Luciano, J. V. (2022). Study protocol for a randomised, double-blinded, placebo-controlled phase III trial examining the add-on efficacy, cost-utility and neurobiological effects of low-dose naltrexone (LDN) in patients with fibromyalgia (INNOVA study). BMJ Open, 12(1). https://doi.org/10.1136/bmjopen-2021-055351
  • Diaz, J. H. (2005). Syndromic diagnosis and management of confirmed mushroom poisonings. Critical Care Medicine, 33(2), 427–436. https://doi.org/10.1097/01.CCM.0000153531.69448.49
  • Diaz, J. H. (2018). Amatoxin-Containing Mushroom Poisonings: Species, Toxidromes, Treatments, and Outcomes. Wilderness and Environmental Medicine, 29(1), 111–118. https://doi.org/10.1016/j.wem.2017.10.002
  • Dinis-Oliveira, R. J., Soares, M., Rocha-Pereira, C., & Carvalho, F. (2016). Human and experimental toxicology of orellanine. Human and Experimental Toxicology, 35(9), 1016–1029. https://doi.org/10.1177/0960327115613845
  • Durukan, P., Yildiz, M., Cevik, Y., Ikizceli, I., Kavalci, C., & Celebi, S. (2007). Poisoning from wild mushrooms in Eastern Anatolia region: Analyses of 5 years. Human and Experimental Toxicology, 26(7), 579–582. https://doi.org/10.1177/0960327106079545
  • Erden, A., Esmeray, K., Karagöz, H., Karahan, S., Gümüşçü, H. H., Başak, M., Çetinkaya, A., Avci, D., & Poyrazoǧlu, O. K. (2013). Acute liver failure caused by mushroom poisoning: A case report and review of the literature. International Medical Case Reports Journal, 6(1), 85–90. https://doi.org/10.2147/IMCRJ.S53773
  • Forrester, M. B. (2020). Hallucinogenic mushroom misuse reported to Texas poison centers. Journal of Addictive Diseases, 38(4), 482–488. https://doi.org/10.1080/10550887.2020.1785817
  • Garcia, J., Costa, V. M., Carvalho, A., Baptista, P., de Pinho, P. G., de Lourdes Bastos, M., & Carvalho, F. (2015). Amanita phalloides poisoning: Mechanisms of toxicity and treatment. Food and Chemical Toxicology, 86, 41–55. https://doi.org/10.1016/j.fct.2015.09.008
  • Gold, J. A. W., Kiernan, E., Yeh, M., Jackson, B. R., & Benedict, K. (2021). Health Care Utilization and Outcomes Associated with Accidental Poisonous Mushroom Ingestions — United States, 2016–2018. MMWR Surveillance Summaries, 70(10), 337–341. https://doi.org/10.15585/mmwr.mm7010a1
  • Gundala, S., Wells, L. D., Milliano, M. T., Talkad, V., Luxon, B. A., & Neuschwander-Tetri, B. A. (2004). The hepatocellular bile acid transporter Ntcp facilitates uptake of the lethal mushroom toxin α-amanitin. Archives of Toxicology, 78(2), 68–73. https://doi.org/10.1007/s00204-003-0527-y
  • Haberl, B., Pfab, R., Berndt, S., Greifenhagen, C., & Zilker, T. (2011). Case series: Alcohol intolerance with Coprine-like syndrome after consumption of the mushroom Lepiota aspera (Pers.:Fr.) Quél., 1886 (Freckled Dapperling). Clinical Toxicology, 49(2), 113–114. https://doi.org/10.3109/15563650.2011.554840
  • Hedman, H., Holmdahl, J., Mölne, J., Ebefors, K., Haraldsson, B., & Nyström, J. (2017). Long-term clinical outcome for patients poisoned by the fungal nephrotoxin orellanine. BMC Nephrology, 18(1), 14–18. https://doi.org/10.1186/s12882-017-0533-6
  • Horowitz BZ, M. M. (2022). Amatoxin Mushroom Toxicity. Stat Pearls, 28613706.
  • Karahan, S., Erden, A., Cetinkaya, A., Avci, D., Ortakoyluoglu, A. I., Karagoz, H., Bulut, K., & Basak, M. (2016). Acute Pancreatitis Caused By Mushroom Poisoning: A Report of Two Cases. Journal of Investigative Medicine High Impact Case Reports, 4(1), 10–12. https://doi.org/10.1177/2324709615627474
  • Kaygusuz, O., Battistin, E., Life, T. J., Türk, S., Dergisi, Y. B., Amoenolens, P., Nadir, :, Bir, Z., Türkiye’deki, T., Kaydı, İ., & Çolak, Ö. F. (2017). Paralepistopsis amoenolens: First Record of A Rare and Poisonous Taxon in Turkey. 1999. http://dergipark.gov.tr/tjls
  • Kirchmair, M., Carrilho, P., Pfab, R., Haberl, B., Felgueiras, J., Carvalho, F., Cardoso, J., Melo, I., Vinhas, J., & Neuhauser, S. (2012). Amanita poisonings resulting in acute, reversible renal failure: New cases, new toxic Amanita mushrooms. Nephrology Dialysis Transplantation, 27(4), 1380–1386. https://doi.org/10.1093/ndt/gfr511
  • Kosentka, P., Sprague, S. L., Ryberg, M., Gartz, J., May, A. L., Campagna, S. R., & Matheny, P. B. (2013). Evolution of the Toxins Muscarine and Psilocybin in a Family of Mushroom-Forming Fungi. PLoS ONE, 8(5). https://doi.org/10.1371/journal.pone.0064646
  • Kraft, J., Bauer, S., Keilhoff, G., Miersch, J., Wend, D., Riemann, D., Hirschelmann, R., Holzhausen, H. J., & Langner, J. (1998). Biological effects of the dihydroorotate dehydrogenase inhibitor polyporic acid, a toxic constituent of the mushroom Hapalopilus rutilans, in rats and humans. Archives of Toxicology, 72(11), 711–721. https://doi.org/10.1007/s002040050565
  • Lampe, K. F., & McCann, M. A. (1987). Differential diagnosis of poisoning by north american mushrooms, with particular emphasis on Amanita Phalloides-like intoxication. Annals of Emergency Medicine, 16(9), 956–962. https://doi.org/10.1016/S0196-0644(87)80740-0
  • Laubner, G., & Mikulevičienė, G. (2016). A series of cases of rhabdomyolysis after ingestion of Tricholoma equestre. Acta Medica Lituanica, 23(3), 193–197. https://doi.org/10.6001/actamedica.v23i3.3385 Lin, S., Mu, M., Yang, F., & Yang, C. (2015). Russula subnigricans Poisoning: From Gastrointestinal Symptoms to
  • Rhabdomyolysis. Wilderness and Environmental Medicine, 26(3), 380–383. https://doi.org/10.1016/j.wem.2015.03.027
  • Lurie, Y., Wasser, S. P., Taha, M., Shehade, H., Nijim, J., Hoffmann, Y., Basis, F., Vardi, M., Lavon, O., Suaed, S., Bisharat, B., & Bentur, Y. (2009). Mushroom poisoning from species of genus Inocybe (fiber head mushroom): A case series with exact species identification Inocybe mushroom poisoning. Clinical Toxicology, 47(6), 562–565. https://doi.org/10.1080/15563650903008448
  • Meisel, E. M., Morgan, B., Schwartz, M., Kazzi, Z., Cetin, H., & Sahin, A. (2022). Two Cases of Severe Amanita Muscaria Poisoning Including a Fatality. Wilderness and Environmental Medicine, 33(4), 412–416. https://doi.org/10.1016/j.wem.2022.06.002
  • Michelot, D., & Toth, B. (1991). Poisoning by Gyromitra esculenta–a review. Journal of Applied Toxicology, 11(4), 235–243. https://doi.org/10.1002/jat.2550110403
  • Nakajima, N., Ueda, M., Higashi, N., & Katayama, Y. (2013). Erythromelalgia associated with Clitocybe acromelalga intoxication. Clinical Toxicology, 51(5), 451–454. https://doi.org/10.3109/15563650.2013.792933
  • Nakajima, Nobuhito, Ueda, M., Higashi, N., & Katayama, Y. (2013). Therapeutic potential of nicotinic acid in erythromelalgia associated with Clitocybe acromelalga intoxication. Clinical Toxicology, 51(8), 815. https://doi.org/10.3109/15563650.2013.823202
  • Nowakowski, P., Naliwajko, S. K., Markiewicz-Żukowska, R., Borawska, M. H., & Socha, K. (2020). The two faces of Coprinus comatus—Functional properties and potential hazards. Phytotherapy Research, 34(11), 2932–2944. https://doi.org/10.1002/ptr.6741
  • Passie, T., Seifert, J., Schneider, U., & Emrich, H. M. (2002). The pharmacology of psilocybin. Addiction Biology, 7(4), 357–364. https://doi.org/10.1080/1355621021000005937
  • Pilzvergiftungen, K. P. (2007). Toxidrome, Diagnose und Therapie [Mushroom poisonings: syndromic diagnosis and treatment]. Wien Med Wochenschr, 157(19–120), 493–502. RAPORLARI. (2021).
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There are 47 citations in total.

Details

Primary Language English
Subjects Clinical Pharmacology and Therapeutics, Clinical Sciences
Journal Section Reviews
Authors

Aynur Şahin 0000-0002-2679-6276

Aylin Arici 0000-0003-2221-9356

Semih Korkut 0000-0002-5409-3586

Yeşim Tunçok 0000-0002-4049-336X

Publication Date August 29, 2023
Published in Issue Year 2023 Volume: 1 Issue: 2

Cite

APA Şahin, A., Arici, A., Korkut, S., Tunçok, Y. (2023). General Aspect of the Assessment and Management of the Poisonous Mushrooms in Turkiye. Recent Trends in Pharmacology, 1(2), 92-109.