Amanita smithiana mushroom poisoning
- Patrick West, MD
Patrick West, MD
- Clinical Instructor, Medical Toxicology Fellow
- Department of Emergency Medicine, Oregon Health and Sciences University
- Staff Physician, Department of Emergency Medicine
- Portland Veterans Affairs Medical Center
- Section Editor
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Amanita smithiana is a mushroom found primarily on the West Coast of North America. Toxic ingestion causes a syndrome of acute gastroenteritis within minutes to hours of consumption followed by delayed onset renal failure within one week. Although uncommon, Amanita smithiana poisoning has increased in frequency over the last two decades . It represents the only known mushroom poisoning syndrome where ingestion of a single type of mushroom can have immediate acute effects that are followed by serious delayed toxicity (table 1).
This topic will discuss the epidemiology, toxicity, clinical manifestations, and management of Amanita smithiana mushroom poisoning. Evaluation and management of other poisonous mushrooms are discussed separately. (See "Clinical manifestations and evaluation of mushroom poisoning" and "Management of mushroom poisoning" and "Amatoxin-containing mushroom poisoning including ingestion of Amanita phalloides".)
Amanita smithiana is a white mushroom that grows in pine forests on the West coast of North America, primarily from British Columbia to Northern California, though they have been observed as far south as the mountains of New Mexico . Ingestion has also been reported in Southeast Asia . A. smithiana mushrooms grow in the autumn until the time of the first frost, typically growing near dead or rotting wood.
Toxicity from Amanita smithiana was first described in 1964, although its toxic effects were misattributed to A. phalloides . Following the initial report, almost 30 years passed without a documented case. In the 1990s, A. smithiana mushroom poisoning became more commonly described in association with increasing culinary popularity and economic value of the matsutake or pine mushroom (Tricholoma magnivelare), which has a similar habitat and appearance [2,5-7]. Publication of the book "Matsutake Mushroom: White gold rush of the 1990s" in 1997 coincided with the largest spike in reports of these ingestions in 1997 and 1998 . In all cases of poisoning reported to date, A. smithiana have been ingested by individuals collecting and preparing the look-alike matsutake or pine mushroom (picture 1) for personal culinary use.
Matsutake mushrooms are also extremely desirable for commercial culinary use. Matsutakes have been gathered in regions where A. smithiana is native and sold to restaurants in areas where A. smithiana is not, making poisoning possible outside of the West coast of North America or Southeast Asia .
- Broussard CN, Aggarwal A, Lacey SR, et al. Mushroom poisoning--from diarrhea to liver transplantation. Am J Gastroenterol 2001; 96:3195.
- Tulloss RE, Lindgren JE. Amanita smithiana - taxonomy, distribution, and poisonings. Mycotaxon 1992; 45:373. http://www.cybertruffle.org.uk/cyberliber/index.htm (Accessed on October 20, 2009).
- Yang WS, Lin CH, Huang JW, Fang CC. Acute renal failure caused by mushroom poisoning. J Formos Med Assoc 2006; 105:263.
- Myler, R, Lee, J, Hopper, J. Renal tubular necrosis caused by mushroom poisoning. Ann Intern Med 1964; 114:196.
- Leathem AM, Purssell RA, Chan VR, Kroeger PD. Renal failure caused by mushroom poisoning. J Toxicol Clin Toxicol 1997; 35:67.
- Warden CR, Benjamin DR. Acute renal failure associated with suspected Amanita smithiana mushroom ingestions: a case series. Acad Emerg Med 1998; 5:808.
- West PL, Lindgren J, Horowitz BZ. Amanita smithiana mushroom ingestion: a case of delayed renal failure and literature review. J Med Toxicol 2009; 5:32.
- Guin, J. Matsutake Mushroom: The White Gold Rush of the 1990s, A Guide and Journal, Naturegraph Publishers, 1997.
- Kirchmair M, Carrilho P, Pfab R, et al. Amanita poisonings resulting in acute, reversible renal failure: new cases, new toxic Amanita mushrooms. Nephrol Dial Transplant 2012; 27:1380.
- Chilton WS, Ott J. Toxic metabolites of Amanita pantherina, A. cothurnata, A. muscaria and other Amanita species. Lloydia 1976; 39:150.
- Pelizzari V, Feifel E, Rohrmoser M, et al. Partial purification and characterization of a toxic component of Amanita smithiana. Mycologia 1994; 86:555. http://www.cybertruffle.org.uk/cyberliber/index.htm (Accessed on October 20, 2009).
- Chilton WS, Tsou G, De Cato L Jr, Malone MH. The unsaturated norleucines of Amanita solitaria. Chemical and pharmacological studies. Lloydia 1973; 36:169.
- Apperley S, Kroeger P, Kirchmair M, et al. Laboratory confirmation of Amanita smithiana mushroom poisoning. Clin Toxicol (Phila) 2013; 51:249.
- Beuhler MC, Sasser HC, Watson WA. The outcome of North American pediatric unintentional mushroom ingestions with various decontamination treatments: an analysis of 14 years of TESS data. Toxicon 2009; 53:437.
- MUSHROOM APPEARANCE
- PHARMACOTOXICOLOGY AND PATHOPHYSIOLOGY
- Clinical manifestations
- Ancillary studies
- Mushroom identification
- DIFFERENTIAL DIAGNOSIS
- Possible amatoxin-containing mushroom
- Vomiting and diarrhea
- Acute kidney injury
- GI decontamination
- Elimination enhancement
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS