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The world?s most poisonous mushroom, Amanita phalloides, is growing in BC
Issue: BCMJ, vol. 61 , No. 1 , January February 2019 , Pages 20-24 Clinical Articles By: Maxwell Moor-Smith, BSc Raymond Li, BSc(Pharm), MSc Omar Ahmad, MD, FRCPC
ABSTRACT: Amatoxins in Amanita phalloides, commonly known as the death cap mushroom, are responsible for 90% of the world?s mushroom-related fatalities. The most deadly amatoxin for humans is α-amanitin, a bicyclic octapeptide that irreversibly binds RNA polymerase II, thus preventing protein synthesis and causing cell death. Three recent poisoning cases in British Columbia show how the death cap can be easily mistaken for edible mushrooms such as the puffball and the paddy straw mushroom. Since being introduced from Europe to the west and mid-Atlantic coasts of North America, A. phalloides has spread to south coastal BC, and has the potential to spread to vast areas of the continent. Following ingestion of A. phalloides, there is a latency period (6 hours) followed by intoxication, classically described as triphasic: a dysentery phase (6 to 24 hours), a false recovery phase (24 to 72 hours), and a hepatorenal phase (4 to 9 days) consisting of multisystem organ failure, seizures, coma, and death.
Treatment is based on decontamination and liver transplantation if acute liver failure occurs. Management of the symptomatic patient consists of providing supportive care, promoting renal elimination of amatoxins, interrupting enterohepatic recirculation of amatoxins, and administering proposed antidotes. Although no established antidote for A. phalloides has been identified, N-acetylcysteine and silibinin have shown some benefit in a retrospective survival analysis. With the expanded range of A. phalloides in BC, physicians should be alert to the possibility of amatoxin poisoning and include it in the differential diagnosis of a patient presenting with gastroenteritis or hepatotoxicity and a history of ingesting foraged mushrooms.
Issue: BCMJ, vol. 61 , No. 1 , January February 2019 , Pages 20-24 Clinical Articles By: Maxwell Moor-Smith, BSc Raymond Li, BSc(Pharm), MSc Omar Ahmad, MD, FRCPC
ABSTRACT: Amatoxins in Amanita phalloides, commonly known as the death cap mushroom, are responsible for 90% of the world?s mushroom-related fatalities. The most deadly amatoxin for humans is α-amanitin, a bicyclic octapeptide that irreversibly binds RNA polymerase II, thus preventing protein synthesis and causing cell death. Three recent poisoning cases in British Columbia show how the death cap can be easily mistaken for edible mushrooms such as the puffball and the paddy straw mushroom. Since being introduced from Europe to the west and mid-Atlantic coasts of North America, A. phalloides has spread to south coastal BC, and has the potential to spread to vast areas of the continent. Following ingestion of A. phalloides, there is a latency period (6 hours) followed by intoxication, classically described as triphasic: a dysentery phase (6 to 24 hours), a false recovery phase (24 to 72 hours), and a hepatorenal phase (4 to 9 days) consisting of multisystem organ failure, seizures, coma, and death.
Treatment is based on decontamination and liver transplantation if acute liver failure occurs. Management of the symptomatic patient consists of providing supportive care, promoting renal elimination of amatoxins, interrupting enterohepatic recirculation of amatoxins, and administering proposed antidotes. Although no established antidote for A. phalloides has been identified, N-acetylcysteine and silibinin have shown some benefit in a retrospective survival analysis. With the expanded range of A. phalloides in BC, physicians should be alert to the possibility of amatoxin poisoning and include it in the differential diagnosis of a patient presenting with gastroenteritis or hepatotoxicity and a history of ingesting foraged mushrooms.