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 “Thus far, I have only seen one case of mushroom poisoning during my
residency,” said Dr. Corey M. Stein, lead author of a case report
about the woman in CMAJ. “I imagine that (foraging) is relatively
common but most people are not picking poisonous mushrooms so we
don't hear about it as physicians.”
Stein, of the University of Toronto, and his coauthors describe the
condition of the woman, an immigrant of Asian descent who had been
foraging in a local park with her husband. She appeared at the
hospital with acute abdominal pain, nausea, vomiting and watery
diarrhea, about 12 hours after eating the mushrooms.
As she had brought a sample of the mushrooms to the emergency
department, experts were able to identify them as Amanita
bisporigera, a deadly fungus especially toxic to the liver. Common
throughout eastern and central North America, this tall, white,
smooth-capped mushroom is also known as the “eastern North American
destroying angel.”
The patient was initially rehydrated and given regular doses of
activated charcoal to help clear the toxins as well as medications
to protect the liver, but within two days her liver function
worsened and she was transferred for an emergency liver transplant.
Mushrooms of the Amanita genus cause the majority of reported deaths
from mushroom poisoning, the authors write in CMAJ. In the U.S.
there are about 6,000 reported cases of mushroom poisoning each
year, most being mild cases, though many may go unreported, Stein
said.
“The Ontario Poison Centre fields on average 200 calls per year on
mushroom exposures,” Stein told Reuters Health by email.
Foraging is much less common in the U.S. and Canada than in other
countries, according to Dr. Tri Tong, an emergency medicine
physician in La Jolla, California, who has studied mushroom
toxicity.
“Because there are many toxic mushrooms that mimic the appearance of
benign ones (that's how nature intended it - it's a defense
mechanism), no one should forage alone for wild mushrooms to eat
unless they are truly an expert with years of experience,” Tong, who
was not part of this case study, told Reuters Health by email.
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However, he noted, poisoning from pharmaceuticals is hundreds of
times more likely than from plants and mushrooms, especially in
places like the U.S. and Canada, which are not foraging cultures.
In the case of this woman who foraged in the park, little more could
have been done to save her liver, Stein said.
“There is no specific antidote for mushroom poisoning,” he said.
“Many therapies have been studied including N-acetylcysteine (which
is an antioxidant used in tylenol overdose) and high dose penicillin
but none have been shown to improve outcomes.”
The toxin in the mushroom is not made safer by cooking or by
freezing, so preparation does not affect the ultimate poisonous
outcome, he said.
“I do think that mushroom foraging can be done safely but the
general public needs to be aware of the dangers of ingesting the
wrong kind of mushroom,” Stein said. “Foragers should be advised
that poisonous mushrooms and edible mushrooms can look very similar
and mushrooms of uncertain identity should not be eaten.”
Policymakers and doctors should focus on reminding people that wild
mushrooms, despite sometimes growing in environments we consider to
be safe, can pose extreme health risks, he said.
SOURCE: http://bit.ly/1K4xyn2 CMAJ, online July 13, 2015.
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