Clinical manifestations and evaluation of mushroom poisoning
- Timothy J Wiegand, MD, DABAM, FACMT, FAACT
Timothy J Wiegand, MD, DABAM, FACMT, FAACT
- Director of Medical Toxicology and Toxicology Consult Service
- Associate Clinical Professor of Emergency Medicine
- URMC and Strong Memorial Hospital
- Section Editors
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics
- Harvard Medical School
- 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)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Mushroom poisoning occurs frequently, but serious toxicity is uncommon. There are 12 groups of identified mushroom toxins with 14 described clinical syndromes (table 1). Defining which clinical syndrome predominates, initiating general supportive care, and administering any specific treatments for that syndrome are the key steps in the recognition and management of mushroom poisoning [1,2].
The clinical manifestations of mushroom poisoning syndromes and the diagnostic evaluation of patients with mushroom poisoning are reviewed here. The general management of mushroom poisoning, and the diagnosis and treatment of poisoning caused by potentially lethal amatoxin-containing mushrooms (eg, Amanita phalloides) or by Amanita smithiana are discussed in detail separately. (See "Management of mushroom poisoning", section on 'General management' and "Amatoxin-containing mushroom poisoning (eg, Amanita phalloides): Clinical manifestations, diagnosis, and treatment" and "Amanita smithiana mushroom poisoning".)
There are over 10,000 species of mushrooms worldwide, but of these, only 50 to 100 are potentially toxic [1,3,4]. In the United States, approximately 6000 mushroom exposures occur annually . Most of these patients experience no toxic effects or only mild or moderate symptoms. Over half of mushroom ingestions occur in children less than six years of age. In most cases, pediatric exposures are limited to a partial or single bite of nontoxic or minimally toxic mushrooms (picture 1 and picture 2). Even in the uncommon cases of amatoxin-containing mushroom exposures (picture 3 and picture 4), children typically do well due to the limited amount of toxins available in the small amount of mushroom usually ingested. In the United States, no pediatric fatalities due to ingestion of a single mushroom have been reported in over 25 years of National Poison Data System surveillance [1,5].
When serious toxicity or mortality due to mushroom ingestion does occur, it typically results from consumption of misidentified mushrooms by foraging adults and others who shared the meal [1,2,6]. A common scenario involves amateur mushroom hunters or recent immigrants who mistake a toxic mushroom for an edible variety with similar morphologic features (eg, Gyromitra esculenta mistaken for Morchella esculenta (picture 5); Amanita species (picture 3 and picture 4) mistaken for Agaricus species) [1,7].
In up to 95 percent of cases, the species of mushroom ingested is not identified . Thus, one must rely upon the presenting signs and symptoms to aid in the clinical diagnosis and to guide treatment recommendations. (See 'Mushroom poisoning syndromes' below and 'Evaluation' below and "Management of mushroom poisoning", section on 'General management'.)
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- MUSHROOM POISONING SYNDROMES
- Acute symptom onset (<6 hours after ingestion)
- - Acute gastroenteritis
- - Hallucinations
- - CNS excitation and depression
- - Cholinergic poisoning
- - Disulfuram-like reaction
- Delayed symptom onset (>6 hours after ingestion)
- - Acute gastroenteritis and delayed renal failure
- - Delayed gastroenteritis and liver toxicity
- - Delayed gastroenteritis, seizures, and liver toxicity
- - Delayed renal failure
- - Delayed rhabdomyolysis
- Rare manifestations
- - Erythromelalgia
- - Delayed encephalopathy
- - Immune-mediated hemolytic anemia
- - Allergic bronchioalveolitis
- - Shiitake dermatitis
- Physical examination
- Ancillary studies
- - Interpretation of results
- Mushroom identification
- DIFFERENTIAL DIAGNOSIS
- ADDITIONAL RESOURCES