Amatoxin-containing mushroom poisoning (eg, Amanita phalloides): Clinical manifestations, diagnosis, and treatment
- Tamas R Peredy, MD, FACEP, FACMT
Tamas R Peredy, MD, FACEP, FACMT
- Medical Director
- Florida Poison Information Center (FPIC) - Tampa
- Section Editors
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics and Emergency Medicine
- 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 — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The clinical manifestations, diagnosis, and treatment of amatoxin-containing mushroom poisoning will be reviewed here.
Clinical manifestations, diagnosis, and management of poisoning caused by other types of mushroom toxins are presented separately. (See "Clinical manifestations and evaluation of mushroom poisoning" and "Management of mushroom poisoning" and "Amanita smithiana mushroom poisoning".)
More than 35 mushroom species across three genera (Amanita, Galerina, and Lepiota) contain amatoxin [1-3]. Amatoxin-containing mushrooms (eg, Amanita phalloides (picture 1 and figure 1), A. virosa, A. bisporigera (picture 2), Galerina autumnalis) cause approximately 50 deaths annually in Europe and Asia compared with a few deaths annually in the United States [1,4-8]. This difference in frequency of lethal exposures reflects the relative popularity of mushroom foraging in Europe and Asia rather than significant variance in intrinsic toxicity or prevalence of harmful mushroom species among the regions.
When serious toxicity due to mushroom ingestion does occur, it typically results from consumption of a meal of misidentified mushrooms by foraging adults and others who shared their food [2,9]. Amatoxins are not removed by boiling or otherwise cooking the mushroom. A common scenario involves amateur mushroom hunters or recent immigrants who mistake a toxic mushroom for an edible variety with similar morphologic features (eg, Amanita species (picture 1 and picture 2 and figure 1) mistaken for Agaricus species). (See "Clinical manifestations and evaluation of mushroom poisoning", section on 'Epidemiology'.)
By contrast, pediatric exposures to amatoxin-containing mushroom exposures (picture 1 and picture 2), rarely cause serious toxicity because of the limited amount of toxins available in the small amount of mushroom typically 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 .
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- AMATOXIN-CONTAINING MUSHROOMS
- PATHOPHYSIOLOGY AND TOXICOKINETICS
- CLINICAL MANIFESTATIONS
- DIFFERENTIAL DIAGNOSIS
- Gastroenteritis with delayed hepatotoxicity
- - Supportive care
- - Gastrointestinal decontamination
- - Elimination enhancement
- - Amatoxin uptake inhibitors
- Silibinin dihemisuccinate
- Penicillin G
- Oral milk thistle products
- - Antioxidant therapy
- Cimetidine and vitamin C
- Liver transplantation
- Experimental therapies
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS