Mushroom poisoning (mycetism)

Question 1

Different mushroom groups

Answer 1

• Mushrooms containing alkaloids
  
  • Inocybe (fiber cap)
  • Amanita muscaria and pantherina
• Mushrooms containing toxic polypeptides
  
  • Amanita phalloides (death cup), virosa and verna

Question 2

What kind of onset do the mushrooms containing alkaloids have?

Answer 2

Rapid onset

Question 3

What kind of onset do the mushrooms containing toxic polypeptides have?

Answer 3

Delayed onset

Question 4

Inocybe-type (fiber cap) of the mushrooms containing alakaloids:

Content

Symptoms

Therapy

Answer 4

• Contains muscarine (more potent than atropine)
• Symptoms:
  
  • ​Parasympathomimetic effects
• Therapy:
  
  • ​Atropine 1-2mg every 30min

Question 5

Amanita muscaria and pantherina of the mushrooms containing alkaloids:

Content

Symptoms

Therapy

Answer 5

• Content:
  
  • ​Muscarine
  • Muscimol GABA_A agonist
  • Ibotenic acid
• Symptoms (12-16h, rarely fatal):
  
  • Initially:
    
    • ​Salivation
    • Sweating
    • Vomiting
    • Diarrhea
  • Later:
    
    • Similar to atropine intoxication (restlessness, hallucinations, delirium)
• Therapy:
  
  • ​Symptomatic (NO ATROPINE!)

Question 6

Amanita phalloides (death cup), virosa and verna of the mushrooms containing toxic polypeptides:

Content + mechanism of action

Answer 6

• Amanitin alpha: inhibits RNA polymerase
• Phalloidin: not absorbed

Question 7

Amanita phalloides (death cup), virosa and verna of the mushrooms containing toxic polypeptides:

Symptoms

Answer 7

Early phase (8-24h):

• Emesis, diarrhea, shock
  
  • Leads to fluid loss, inhibition of vasomotor center and cardiac effects

Late phase (48h):

• Hepatotoxicity: icterus + fulminant hepatitis
• May lead to toxic nephrosis

Question 8

Amanita phalloides (death cup), virosa and verna of the mushrooms containing toxic polypeptides:

Therapy

Answer 8

• Supportive:
  
  • Liver and kidney protection
    
    • Forced diuresis
    • Hemoperfusion
    • GC
• High dose G-penicillin
• Silibilin (inhibition of amatoxin uptake into hepatocytes)
• N-acetylcysteine