Poisoning with Amanita phalloides (Vaill. ex Fr.) Link  - 25-years retrospective analysis in Varna region, Bulgaria

Dobri Ivanov; Petko Marinov; Snezha Zlateva; Tsonka Dimitrova

doi:10.14748/ssp.v1i1.5015

Poisoning with Amanita phalloides (Vaill. ex Fr.) Link - 25-years retrospective analysis in Varna region, Bulgaria

Dobri Ivanov, Petko Marinov, Snezha Zlateva, Tsonka Dimitrova

Abstract

Fungal intoxications are important in the ethology of acute exogenous intoxications and A. phalloides mushrooms intoxications are the most important for clinical toxicology. Poisonings with A. phalloides mushrooms are infrequent, but they have high lethality due to their high toxicity. A retrospective analysis of poisonings with A. phalloides mushrooms in Varna region for a period of 25 years (1991-2015) was conducted and 147 patients have been registered. The frequency relative to all hospitalised patients with acute poisoning is 0.8%. Such intoxications are more common in males and the ratio of men to women is 1.62:1. The largest number of intoxications was registered in the age group of 45 to 60 years - 62 (42.2%). All intoxications occured following oral ingestion of A. phalloides mushrooms by mistake instead of edible mushrooms such as field mushroom - Agaricus campestris L. A lethal outcome was registered in 25 patients (17%). A. phalloides mushrooms account for 11.4% of the lethality in acute poisonings.

Keywords

Amanita phalloides, poisoning, amatoxin, liver failure

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References

Erden A, Esmeray K, Gumuscu H, Basak M, Cetinkaya A, Avci D, et al. Acute liver failure caused by mushroom poisoning: a case report and review of the literature. Int Med Case Rep J. 2013; 6:85-90. doi: 10.2147/IMCRJ.S53773.

Roberts D, Hall M, Falkland M, Strasser S, Buckley N. Amanita phalloides poisoning and treatment with silibinin in the Australian Capital Territory and New South Wales. Med J Aust. 2013; 198(1):43-7.

Enjalbert F, Rapior S, Nouguier J, Guillon S, Amouroux N, Cabot C. Treatment of amatoxin poisoning: 20-year retrospective analysis. J Toxicol Clin Toxicol 2002; 40(6):715-57.

Karlson-Stiber C, Persson H. Cytotoxic fungi - an overview. Toxicon. 2003; 42(4):339-49.

Vanooteghem S, Arts J, Decock S, Pieraerts P, Meersseman W, Verslype C, et al. Four patients with Amanita phalloides poisoning. Acta Gastroenterol Belg. 2014; 77(3):353-6.

Rudbaek TR, Kofoed P, Bove J, Haastrup P, Ebbehoi N. Management of poisoning with Amanita phalloides. Ugeskr Laeger. 2014; Mar 31;176(7): Pii:V01130022.

Garcia J, Oliveira A, de Pinho PG, Freitas V, Carvalho A, Baptista P, et al. Determination of amatoxins and phallotoxins in Amanita phalloides mushrooms from northeastern Portugal by HPLC-DAD-MS. Mycologia. 2015; 107(4):679-87. doi: 10.3852/14-253.

Ferenz T, Lukasiewicz B, Ciecwierz J, Kowalczyk E. Poisoning with Amanita phalloides. Med Pr. 2009; 60(5):415-26.

Yilmaz I, Kaya E, Sinirlioglu ZA, Bayram R, Surmen MG, Colakoglu S. Clinical importance of toxin concentration in Amanita verna mushroom. Toxicon. 2014; 87:68-75. doi: 10.1016/j.toxicon.2014.05.019.

Broussard CN, Aggarwal A, Lacey SR, Post AB, Gramlich T, Henderson JM, et al. Mushroom poisoning-from diarrhea to liver transplantation. Am J Gastroenterol. 2001; 96(11):3195-8. doi: 10.1111/j.1572-0241.2001.05283.x.

Vetter J. Toxins of Amanita phalloides. Toxicon. 1998; 36(1):13-24.

Mengs U, Pohl RT, Mitchell T. Legalon® SIL: The antidote of choice in patients with Amanita phalloides poisoning. Curr Pharm Biotechnol. 2012; 13(10):1964-70.

Mas A. Mushrooms, amatoxins and the liver. J Hepatol. 2005; 42(2):166-9. doi: 10.1016/j.jhep.2004.12.003.

Diaz JH. Syndromic diagnosis and management of confirmed mushroom poisonings. Crit Care Med. 2005; 33(2):427-36.

Himmelmann A, Mang G, Schnorf-Huber S. Lethal ingestion of stores Amanita phalloides mushrooms. Swiss Med Wkly. 2001; 131(41-42):616-7. doi: 2001/41/smw-09831.

Santi L, Maggioli C, Mastroroberto M, Tufoni M, Napoli L, Caraceni P. Acute liver failure caused by Amanita phalloides poisoning. Int J Hepatol. 2012; doi:10.1155/2012/487480.

Magdalan J, Ostrowska A, Piotrowska A, Gomulkiewicz A, Podhorska-Okolow M, Patrzalek D, et al. Benzylpenicillin, acetylcysteine and silibinin as antidotes in human hepatocytes intoxicated with alpha-amanitin. Exp Toxicol Pathol. 2010 Jul; 62(4):367-73. doi: 10.1016/j.etp.2009.05.003.

Smith MR, Davis RL. Mycetismus: a review. Gastroenterol Rep (Oxf). 2016; 4(2):107-12. doi: 10.1093/gastro/gov062.

Baniasad N, Oghabian Z, Mehrpour O. Hepatotoxicity due to mushroom poisoning: A case report. Int J Med Tox Foren Med. 2014; 4(2):68-73. doi: 10.22037/ijmtfm.v4i2(Spring).4915

Escudie L, Francoz C, Vinel JP, Moucari R, Cournot M, Paradis V, et al. Amanita phalloides poisoning: reassessment of prognostic factors and indications for emergency liver transplantation. J Hepatol. 2007; 46(3):466-73. doi: 10.1016/j.jhep.2006.10.013.

Garcia J, Costa VM, Carvalho A, Baptista P, de Pinho PG, de Lourdes Bastos M, et al. Amanita phalloides poisoning: Mechanisms of toxicity and treatment. Food Chem Toxicol. 2015; 86:41-55. doi: 10.1016/j.fct.2015.09.008.

Bergis D, Friedrich-Rust M, Zeuzem S, Betz C, Sarrazin C, Bojunga J. Treatment of Amanita phalloides intoxication by fractionated plasma separation and adsorption (Prometheus®). J Gastrointestin Liver Dis. 2012; 21(2):171-6.

French LK, Hendrickson RG, Horowitz BZ. Amanita phalloides poisoning. Clin Toxicol (Phila). 2011; 49(2):128-9. doi: 10.3109/15563650.2011.557663.

Garrouste C, Hemery M, Boudat AM, Kamar N. Amanita phalloides poisoning-induced end-stage renal failure. Clin Nephrol. 2009; 71(5):571-4.

Lukasik-Glebocka M, Popiolek A, Nawrocka K. Some issues of death cap (Amanita phalloides) poisoning based on cases treated in Poznan Department of Toxicology in 2010. Przegl Lek. 2011; 68(8):444-8.

Hydzik P, Gawlikowski T, Ciszowski K, Kwella N, Sein Anand J, Wojcicki M, et al. Liver albumin dialysis (MARS)-treatment of choice in Amanita phalloides poisoning? Przegl Lek. 2005; 62(6):475-9.

Ganzert M, Felgenhauer N, Schuster T, Eyer F, Gourdin C, Zilker T. Amanita poisoning-comparison of silibinin with a combination of silibinin and penicillin. Dtsch Med Wochenschr. 2008; 133(44):2261-7. doi: 10.1055/s-0028-1091268.

Wittebole X, Hanston P. Use of the molecular adsorbent recirculating system (MARS) for the treatment of acute poisoning with or without liver failure. Clin Toxicol. 2011; 49(9):782-93. doi: 10.3109/15563650.2011.624102.

Mullins ME, Horowitz BZ. The futility of hemodialisys in Amanita phalloides poisoning. Vet Hum Toxicol. 2000; 42(2):90-1.

Ward J, Kapadia K, Brush E, Salhanick SD. Amatoxin poisoning: Case report and review of current therapies. J Emerg Med. 2013; 44(1):116-21. doi: 10.1016/j.jemermed.2012.02.020.

Ganzert M, Felgenhauer N, Zilker T. Indication of liver transplantation following amatoxin intoxication. J Hepatol. 2005; 42(2):202-9. DOI: 10.1016/j.jhep.2004.10.023.

Sorodoc L, Lionte C, Sorodoc V, Petris O, Jaba I. Is MARS system enough for A. phalloides-induced liver failure treatment? Hum Exp Toxicol. 2010; 29(10): 823-32. doi: 10.1177/0960327110363327.

Oeckinghaus R, Cuneo A, Brockmeier J, Oeckinghaus GS, Drewek-Platena S, Hochreuther S, et al. Acute hepatic failure after ingestion of mushrooms. Internist (Berl). 2012 May; 53(5):619-24. doi: 10.1007/s00108-011-3008-z.

Li P, Deng W, Li T. The molecular diversity of toxin gene families in lethal Amanita mushrooms. Toxicon. 2014; 83:59-68. doi: 10.1016/j.toxicon.2014.02.020.

DOI: http://dx.doi.org/10.14748/ssp.v1i1.5015