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Amanita phalloides Poisoning

 

Amanita phalloides accounts for over 50% of all cases of mushroom poisoning, some sources record it as high as 90%, earning it the common name "Death Cap". Over the past sixty years, scientists have identified the formulas of the toxic cyclopeptides responsible for poisoning, but no antidote has been developed. In the Amanita, amatoxins block the production of DNA, which causes cell necrosis especially in those areas that first interact with the toxins and have a high rate of degeneration, like the liver and kidneys.

The initial symptoms of A. phalloides posioning appear 6 to 24 hours after ingestion. For 12 to 24 hours, the patient will have abdominal pain, nausea, vomiting, and diarrhea. With proper fluid replacement the symptoms will subside, wherein lies a primary danger of A. phalloides poisoning. In many cases, the doctors will assume the danger has passed (especially when misdiagnoses has occurred), and the patient will be discharged; however, in the case of this mushroom the liver and kidneys will continue to be attacked, leading to jaundice and renal shutdown, which can lead to coma, organ failure, and/or death.

There is no known antidote or therapy for A. phalloides poisoning. Death occurs in 20-30% of cases (with rates of over 50% for children under 10 years old). Liver transplants can reverse the toxin's progress when hepatic failure threatens. In most cases, however, hospitalization and close monitoring is the only treatment.

According to the North American Mycological Association (NAMA), the victims of Amanita phalloides poisoning are usually either amateur mushroom enthusiasts or emigrants from a country in which mushroom picking is a common activity (especially those in Asia). NAMA reports that 13 cases of A. phalloides poisoning were reported in 2004, with one fatality. Also, one patient suffers from permanent liver and kidney damage. All of these reported poisonings occurred in the Pacific Northwest.

Select Poisoning Cases

CASE 1:
"Poisoning by Amanita phalloides ("deathcap") mushrooms in the Australian Capital Territory"
by Geoffrey M Trim
Mushroom Journal of Australia
1999; vol. 171

In 1995, a 46-year-old man ate eight mushrooms which he had picked in a north Canberra suburb. He presented with vomiting and diarrhoea the next day, but, as he was confident that the mushrooms were not A. phalloides, he was discharged home after receiving intravenous rehydration. He presented again two days later with hepatic and renal failure."

Initial investigations revealed the following serum levels: alanine aminotransferase (ALT) > 10 000 U/L (reference range [RR], 5-55 U/L); bilirubin, 114 µmol/L (RR, 3-20 µmol/L); creatinine, 535 µmol/L (RR, 40-90 µmol/L); and prothrombin time - international normalised ratio (PT-INR) > 10. A mycologist identified A. phalloides growing in the street where the patient had picked the mushrooms and also identified the mushroom stalks that he had discarded in a rubbish bin.

The patient was transferred to a liver transplant unit but died from hepatic failure six days after mushroom ingestion. Postmortem examination of his liver revealed complete necrosis of parenchyma, with one residual island of intensely vacuolated hepatocytes with severe intracanalicular biliary stasis. No viable hepatocytes were seen.

CASE 2:
"A Fatal Sunday Brunch"
by Barbara O'Brien
The American Journal of Gastroenterology
vol 91, no 3, 1996

On a summer day in 1995, a 51-year-old grandmother in Alabama sent her husband to collect mushrooms for a family Sunday brunch. On his return to the kitchen, she breaded and fried the morsels, then proudly served her brunch specialty to her children and grandchildren.

The chef and her husband had recently moved from Illinois to the South, and they were happy to find that the mushrooms that they loved to collect up North were plentiful in Alabama as well.

Within twelve hours, the cook and three of the brunch guests were sickened with abdominal pain, diarrhea, and vomiting. The three adults eventually recovered, but the youngest patient, her 3-year-old granddaughter, did not survive- a victim of fulminate liver failure. Unknowingly, the Alabama grandmother had mistakenly served her precious loved ones a heaping platter of deep fried deathcap mushrooms, Amanita phalloides, perhaps the most deadly of the 2000 species of mushrooms found on our planet.

CASE 3:
S Zevin, MD, D Dempsey, MD, K Olson MD,
California Poison Control System, Div of Clinical Pharmacology and Experimental Therapeutics, Univ of California, San Francisco.
Morbidity and Mortality Weekly Report
June 06, 1997, vol. 46, n. 22

A 32-year-old man gathered and ate wild mushrooms that he believed were similar to other mushrooms he had previously gathered and eaten. Eight hours later, he developed vomiting and profuse diarrhea; he was admitted to a hospital 19 hours after ingestion. On admission, he was dehydrated, and laboratory findings included an aspartate aminotransferase (AST) level of 81 U/L (normal: 0-48 U/L), prothrombin time (PT) of 12.3 seconds (normal: 11.0-12.8 seconds), and bilirubin level of 0.9 mg/dL (normal: 0-0.3 mg/dL). He received intravenous fluids, intravenous penicillin, repeated oral doses of activated charcoal, and oral N-acetylcysteine. Although the diarrhea resolved after 24 hours, his PT and AST and bilirubin levels continued to rise. On the third day after eating the mushrooms, abnormal findings included an AST level of 2400 U/L, alanine aminotransferase (ALT) level of 4100 U/L (normal: 0-53 U/L), PT of greater than 60 seconds, and total bilirubin level of 11 mg/dL. Six days after eating the mushrooms, his bilirubin level was 16 mg/dL, and his AST level had decreased to 355 U/L; he developed metabolic acidosis and hypotension. Seven days after eating the mushrooms, he developed hepatic encephalopathy, oliguric renal failure, and adult respiratory distress syndrome requiring intubation and mechanical ventilation. He died from multiple organ failure 9 days after eating the mushrooms. One mushroom cap remaining after the meal was identified as A. phalloides.

CASE 4:
"'Death cap' claims one life"
by Henry Lee
San Francisco Chronicle
November 30, 2004

A 70-year-old woman died Monday and her husband and two friends were hospitalized after they ate poisonous "death cap" wild mushrooms collected in the Oakland hills, authorities said. The adult victims fell ill after ingesting the toxic Amanita phalloides mushrooms on Thanksgiving Day, said Sherri Willis, spokeswoman for the Alameda County public health department. Yu-Chin Lai died at 2:35 p.m. Monday at Highland Hospital in Oakland. An autopsy is scheduled for today at the Alameda County coroner's office.

The family friend said the women, picked the mushrooms Thanksgiving morning during a hike near Merritt College. The four people ate the mushrooms at lunch and dinner that day, the friend said, though Chiang ate only a small amount.

By nighttime, the four began vomiting, and they saw doctors during the day Friday, who gave them medicine that didn't help, the friend said.

On Saturday, the sickness continued, and one of the visiting women went to the emergency room but had to wait nearly four hours after registering before being seen by a doctor, the friend said. Once the doctor saw the woman and learned that she had consumed mushrooms, he asked that the three others immediately come for treatment.

CASE 5:
"Death Angel' Mushrooms Poison Mother, Son
Newton Residents Eat Mushrooms Found Near Their Yard, Officials Say"
The Boston Channel
October 21, 2009

BOSTON --Two Newton residents were in the intensive care unit of a local hospital after eating poisonous mushrooms they found near their yard, city officials said.

An elderly Oak Hill resident picked the mushrooms and used them in a recipe that she and her adult son ate. The city's health commissioner said the woman and son, whose names have not been released, ate mushrooms that are in the Amanita family, also known as the "Death Angel," because its amino acids attack the liver, kidney and nervous system.

City Health Commissioner David Naparstek said the pair were "critically ill," but are expected to recover. "Both have been hospitalized in very serious condition," he said. Mayor David Cohen warned residents they should not eat wild mushrooms. "This incident is a very painful reminder of that," said Cohen. It's hard for people who are not trained professionals to identify dangerous fungi from harmless ones, John McNally, a senior environmental health specialist said. "Some are so poisonous that getting the residue on your hands is taking a chance," McNally said. "They're lucky they didn't die, from what I understand, because of what they ate."

Cohen cautioned parents to keep young children away from wild mushrooms. McNally added that residents should use gloves to pull them up and dispose of them in double plastic bags. "Most people who are poisoned get some gastrointestinal problems, and they are not seriously poisoned," said David Hibbett, of Clark University. McNally said he's been collecting different varieties around Newton to aid researchers. "There's someone working on a treatment for mushroom poisoning in another state," he said.

Meanwhile, neighbors are hoping the pair sickened by the mushrooms will have a swift recovery. "I'm really sorry to hear it but I really hope that helps other people realize not to pick the mushrooms," one woman said. Meanwhile, another woman from Finland said she routinely picked mushrooms "back home" to make sauces and stews, but not here in the U.S.

Back to Introduction

 

The naming of Amanita phalloides

 

Images of Amanita phalloides

 

The Death Cap in popular culture

 

 

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Last updated September 2011.
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