head JofIMAB
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing
ISSN: 1312-773X (Online)
Issue: 2018, vol. 24, issue1
Subject Area: Medicine
DOI: 10.5272/jimab.2018241.1887
Published online: 26 January 2018

Original article

J of IMAB. 2018 Jan-Mar;24(1):1887-1890
Petko Marinov1,2, Georgi Bonchev1ORCID logo Corresponding Autoremail, Dobri Ivanov3, Snezha Zlateva1,2, Tsonka Dimitrova3, Kaloyan Georgiev4,
1) Clinic for Intensive Treatment of Acute Intoxications and Toxicoallergies, Naval Hospital – Varna, Military Medical Academy, Bulgaria
2) Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University – Varna, Bulgaria
3) Department of Biology, Faculty of Pharmacy, Medical University – Varna, Bulgaria
4) Department of Pharmaceutical Technologies, Faculty of Pharmacy, Medical University – Varna, Bulgaria.

Purpose: To perform a retrospective analysis of mushroom poisonings in Varna region for 25 years (1991-2015). Mushroom poisonings account for 10.7% of hospitalizations associated with acute exogenous intoxication. Poisoning with Amanita phalloides, Amanita pantherina, Amanita muscaria and various fungi that cause only gastrointestinal symptoms are of greatest importance for the clinical toxicology in the Republic of Bulgaria.
Material/Methods: Objects of the study were 1872 patients who received treatment at the Clinic for Intensive Treatment of Acute Intoxications and Toxicoallergies, Naval Hospital – Varna, Military Medical Academy, Bulgaria after eating mushrooms.
Results: Patients with irritative gastroenteritis – 1703 (91%) were with the highest frequency, followed by those with Amanita phalloides intoxication - 147 (7.8%). Amanita phalloides poisonings are not common and have a low relative share to all mushroom intoxications, but they are characterized by severe course and high lethality. Poisonings with Amanita pantherina and Amanita muscaria are even less common – 22 (1.2%). Patients accepted for treatment were both male (50.5%) and female (49.5%). Patients in age between 25 and 60 years were prevalent – 1171 (62.6%). A fatal outcome was registered in only 25 patients with Amanita phalloides intoxications, which represents 17% of all patients with Amanita phalloides poisoning and 1.3% of all patients with mushroom intoxications.
Conclusion: Mushroom poisonings causing irritant gastroenterocolitis and those with Amanita pantherina and Amanita muscaria have a good prognosis. Amanita phalloides intoxications are characterized by the development of life-threatening organ damages and high lethality.

Keywords: mushroom poisoning, Amanita phaloides, Amanita pantherina, Amanita muscaria,

pdf - Download FULL TEXT /PDF 483 KB/
Please cite this article in PubMed Style or AMA (American Medical Association) Style:
Marinov P, Bonchev G, Ivanov D, Zlateva S, Dimitrova T, Georgiev K. Mushrooms intoxications. J of IMAB. 2018 Jan-Mar;24(1):1887-1890. DOI: 10.5272/jimab.2018241.1887

Corresponding AutorCorrespondence to: Georgi Bonchev, PhD, Head, Laboratory of Analytical Toxicology, Military Medical Academy, Naval Hospital – Varna; 3, Chr. Smirnenski Str., 9010 Varna, Bulgaria; E-mail: toxilab.varna@abv.bg

1. Erden A, Esmeray K, Karagoz H, Karahan S, Gumuscu HH, Basak M, et al. Acute liver failure caused by mushroom poisoning: a case report and review of the literature. Int Med Case Rep J. 2013 Nov 22;6:85-90. [PubMed] [CrossRef]
2. Vanooteghem S, Arts J, Decock S, Pieraerts P, Meersseman W, Verslype C, et al. Four patients with Amanita phalloides poisoning. Acta Gastroenterol Belg. 2014 Sep;77(3):353-6. [PubMed]
3. Rudbaek TR, Kofoed P, Bove J, Haastrup P, Ebbehoi N. [Management of poisoning with Amanita phalloides]. [in Danish] Ugeskr Laeger. 2014 Mar 31;176(7). Pii:V01130022. [PubMed]
4. Karlson-Stiber C, Persson H. Cytotoxic fungi – an overview. Toxicon. 2003 Sep;42(4)339-49. [PubMed] [CrossRef]
5. Garcia J, Oliveira A, de Pinho PG, Freitas V, Carvalho A, Baptista P, et al. Determination of amatoxins and phallotoxins in Amanita phalloides mushrooms from northeastern Portugal by HPLC-DAD-MS. Mycologia. 2015 Jul-Aug;107(4):679-87. [PubMed] [CrossRef]
6. Enjalbert F, Rapior S, Nouguier J, Guillon S, Amouroux N, Cabot C. Treatment of amatoxin poisoning: 20-year retrospective analysis. J Toxicol Clin Toxicol. 2002;40(6):715-57. [PubMed]
7. Ferenz T, Lukasiewicz B, Ciecwierz J, Kowalczyk E. [Poisoning with Amanita phalloides.] [in Polish] Med Pr. 2009; 60(5):415-26. [PubMed]
8. Lukasik-Glebocka M, Druzdz A, Naskret M. [Clinical symptoms and circumastances of acute poisonings with fly agaric (Amanita muscaria) and panther cap (Amanita pantherina)] [in Polish] Przegl Lek. 2011; 68(8):449-52. [PubMed]
9. Tupalska-Wilczynska K, Ignatowicz R, Poziemski A, Wojcik H, Wilczynski G. [Amanita pantherina and Amanita muscaria poisonings-pathogenesis, symptoms and treatment.] [in Polish] Pol Merkur Lekarski. 1997 Jul;3(13):30-2. [PubMed]
10. Satora L, Pach D, Ciszowski K, Winnik L. Panther cap Amanita pantherina poisoning case report and review. Toxicon. 2006 Apr;47(5):605-7. [PubMed] [CrossRef]
11. Stribrny J, Sokol M, Merova B, Ondra P. GS/MS determination of ibotenic acid and muscimol in the urine of patients intoxicated with Amanita pantherina. Int J Legal Med. 2012 Jul;126(4):519-24. [PubMed] [CrossRef]
12. Broussard CN, Aggarwal A, Lacey SR, Post AB, Gramlich T, Henderson JM, et al. Mushroom poisoning – from diarrhea to liver transplantation. Am J Gastroenterol. 2001 Nov;96(11):3195-8. [PubMed] [CrossRef]
13. Mas A. Mushrooms, amatoxins and the liver. J Hepatol. 2005 Feb;42(2):166-9. [PubMed] [CrossRef]
14. Diaz JH. Syndromic diagnosis and management of confirmed mushroom poisonings. Crit CareMed. 2005 Feb;33(2):427-36. [PubMed]
15. Santi L, Maggioli C, Mastroroberto M, Tufoni M, Napoli L, Caraceni P. Acute liver failure caused by Amanita phalloides poisoning. Int J Hepatol. 2012; 2012:487480. [PubMed] [CrossRef]
16. Escudie L, Francoz C, Vinel JP, Moucari R, Cournot M, Paradis V, et al. Amanita phalloides poisoning: reassessment of prognostic factors and indications for emergency liver transplantation. J Hepatol. 2007 Mar;46(3):466-73. [PubMed] [CrossRef]
17. Garcia J, Costa VM, Carvalho A, Baptista P, de Pinho PG, de Lourdes Bastos M, et al. Amanita phalloides poisoning: Mechanisms of toxicity and treatment. Food Chem Toxicol. 2015 Dec;86:41-55. [PubMed] [CrossRef]
18. Bergis D, Friedrich-Rust M, Zeuzem S, Betz C, Sarrazin C, Bojunga J. Treatment of Amanita phalloides intoxication by fractionated plasma separation and adsorption (Prometheus®). J Gastrointestin Liver Dis. 2012 Jun;21(2):171-6. [PubMed]
19. Michelot D, Melendez-Howell LM. Amanita muscaria: chemistry, biology, toxicology and ethnomycology. Mycol Res. 2003 Feb;107(Pt 2):131-46. [PubMed]
20. Vendramin A, Brvar M. Amanita muscaria and Amanita pantherina poisoning:two syndromes. Toxicon. 2014 Nov;90:269-72. [PubMed] [CrossRef]
21. Ogawa Y, Sato H, Yamamoto M, Tada H, Hashimoto T. Burst suppression electroencephalogram with mushroom poisoning, Amanita pantherina. Epilepsy Behav Case Rep. 2015 Sep;4:82-3. [PubMed] [CrossRef]
22. Satora L, Pach D, Butryn B, Hydzik P, Balicka-Slusarczyk B. Fly agaric (Amanita muscaria) poisoning, case report and review. Toxicon. 2005 Jun 1;45(7):941-3. [PubMed] [CrossRef]
23. Marciniak B, Ferenc T, Kusawska J, Ciecwierz J, Kowalczyk E. [Poisoning with selected mushrooms with neurotropic and hallucinogenic effect.] [in Polish] Med Pr. 2010;61(5):583-95. [PubMed]
24. Ganzert M, Felgenhauer N, Schuster T, Eyer F, Gourdin C, Zilker T. [Amanita poisoning – comparison of silibinin with a combination of silibinin and penicillin.] [in German] Dtsch Med Wochenschr. 2008 Oct;133(44):2261-7. [PubMed] [CrossRef]
25. Wittebole X, Hanston P. Use of the molecular adsorbent recirculating system (MARS) for the treatment of acute poisoning with or without liver failure. Clin Toxicol (Phila). 2011 Nov;49(9):782-93. [PubMed] [CrossRef]
26. Mullins ME, Horowitz BZ. The futility of hemodialisys in Amanita phalloides poisoning. Vet Hum Toxicol. 2000 Apr;42(2):90-1. [PubMed]
27. Ward J, Kapadia K, Brush E, Salhanick SD. Amatoxin poisoning: Case report and review of current therapies. J Emerg Med. 2013 Jan;44(1):116-21. [PubMed] [CrossRef]
28. Ganzert M, Felgenhauer N, Zilker T. Indication of liver transplantation following amatoxin intoxication. J Hepatol. 2005 Feb; 42(2):202-9. [PubMed] [CrossRef]
29. Sorodoc L, Lionte C, Sorodoc V, Petris O, Jaba I. Is MARS system enough for A. phalloides-induced liver failure treatment? Hum Exp Toxicol. 2010 Oct;29(10):823-32. [PubMed] [CrossRef].

Received: 29 November 2017
Published online: 26 January 2018

back to Online Journal