Abstract
Amanita phalloides, colloquially known as the "death cap," belongs to the Phalloideae section of the Amanita family of mushrooms and is responsible for most deaths following ingestion of foraged mushrooms worldwide (1). On November 28, 2016, members of the Bay Area Mycological Society notified personnel at the California Poison Control System (CPCS) of an unusually large A. phalloides bloom in the greater San Francisco Bay Area, coincident with the abundant rainfall and recent warm weather. Five days later, CPCS received notification of the first human A. phalloides poisoning of the season. Over the following 2 weeks, CPCS was notified of an additional 13 cases of hepatotoxicity resulting from A. phalloides ingestion. In the past few years before this outbreak, CPCS received reports of only a few mushroom poisoning cases per year. A summary of 14 reported cases is presented here. Data extracted from patient medical charts revealed a pattern of delayed gastrointestinal manifestations of intoxication leading to dehydration and hepatotoxicity. Three patients received liver transplants and all but one recovered completely. The morbidity and potential lethality associated with A. phalloides ingestion are serious public health concerns and warrant medical provider education and dissemination of information cautioning against consuming foraged wild mushrooms.
Highlights
She returned to the emergency department (ED) the following day with persistent nausea, vomiting, diarrhea, and abdominal cramping. Her AST was 1,712 IU/L, ALT 1,025 IU/L, total bilirubin 2.0 mg/dL, and international normalized ratio (INR) 1.8 units. She was treated with aggressive IV fluid hydration, IV octreotide, and IV silibinin, as well as the placement of a biliary drain, but developed irreversible fulminant hepatic failure and underwent liver transplant on hospital day 4, with subsequent improvement of her hepatic function
Intravenous silibinin is licensed in Europe, and a clinical trial to evaluate its efficacy in treatment of hepatic failure induced by Amanita mushroom poisoning is currently underway in the United States.§ The majority of silibinin-treated patients in this report received the drug as participants of this trial.¶ Medical providers should contact the regional poison control center or a medical toxicology consultant to assist in the management of any patient with suspected amatoxic mushroom ingestion
In patients with severe poisoning, early contact with the nearest liver transplant center is recommended
Summary
The sister of the woman who prepared the meal (patient E) visited the ED before her other family members, but was discharged home after administration of IV fluids and antiemetic medications, with a diagnosis of gastroenteritis She returned to the ED the following day with persistent nausea, vomiting, diarrhea, and abdominal cramping. Her AST was 1,712 IU/L, ALT 1,025 IU/L, total bilirubin 2.0 mg/dL, and INR 1.8 units She was treated with aggressive IV fluid hydration, IV octreotide, and IV silibinin, as well as the placement of a biliary drain, but developed irreversible fulminant hepatic failure and underwent liver transplant on hospital day 4, with subsequent improvement of her hepatic function. Weatherwax, Lead Technical Writer-Editor Soumya Dunworth, PhD, Kristy Gerdes, MPH, Teresa M.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
