Poisoning due to ingestion of amatoxin-containing mushrooms in South Korea: a systematic review and meta-analysis

Abstract

Objective: Poisoning caused by the ingestion of amatoxin-containing mushrooms is life-threatening and requires urgent attention. However, only few studies have evaluated the factors that predict mortality owing to mushroom poisoning. We conducted a systematic review of amatoxin poisoning in South Korea and meta-analysis of the association between severe early-stage central nervous system symptoms and mortality in cases of amatoxin poisoning. Methods: The Embase, MEDLINE, Web of Science, KMbase, and Korean Studies Information System databases were searched for articles up to July 2020. We included case reports, case series, and observational studies on Amanita poisoning in South Korea. Outbreak area, incubation time, clinical course, management, and outcomes were evaluated. We then conducted a meta-analysis of the association between severe central nervous system symptoms and mortality. Results: Sixteen articles were included in the review and five in the meta-analysis. Outbreaks occurred principally in Gyeongbuk and in the western part of Gangwon. All patients had gastrointestinal symptoms, such as watery diarrhea. Liver failure occurred 2-3 days after mushroom intake in most patients, and ingestion of amatoxins from mushroom consumption was associated with high mortality risk. The risk of mortality among patients with altered mental status or seizures was 10 times higher than that among patients without these symptoms (risk ratio = 10.56, 95% confidence interval = 2.73-40.83). Conclusions: Amanita mushrooms are often mistaken for edible mushrooms, and their ingestion is frequently fatal. Aggressive treatment must be pursued in patients with severe central nervous system symptoms, such as altered mental status or seizures.