A Rare Case of Amatoxin Poisoning in the State of Texas

Abstract

Ingestion of mushrooms from the genus Amanita can present detrimental consequences to the human body. The mushroom is frequently found in the coastal Pacific Northwest, Pennsylvania, New Jersey, and Ohio. Amanitin, one of the two distinct toxins isolated from the Amanita mushroom, is responsible for the majority of symptoms and signs seen with mushroom poisoning. Clinically, ingestion of these mushrooms can result in a wide range of clinical symptoms including nausea, vomiting, crampy abdominal pain, and diarrhea. There have been several case reports of patients who developed severe hepatic failure that required liver transplantation. Thus, it is important to recognize the symptoms early and treat the patients with the available agents including multidose activated charcoal, N-acetylcysteine, penicillin G, and Silybum. Through an extensive literature search, we found no published literature on amatoxin poisoning in the state of Texas. With new cases of amatoxin poisoning emerging in the state, it is important for healthcare providers and workers to have a better awareness and early recognition of the detrimental effects of Amanita species poisoning and to be educated to provide the proper care for this group of patients.

Mycetism: A Review of the Recent Literature

“…A. phalloides (Death Cap), A. bisporigera, A. rubescens, A. ocreata, A. verna, and Amanita virosa (the last three are referred to as Death Angels and Destroying Angels; however, A. phalloides is also sometimes referred to as Death Angel and A. verna is sometimes referred to as White Death Cap), A. fuliginea, A. subjunquillea, A. exitialis, A. suballiacea, A. tenuifolia, A. hygroscopica as well as some Galerina and Lepiota (e.g., L. brunneoincarnata and L. helveola) species contain amatoxin. As little as 0.1 mg amatoxin/kg body weight may be lethal in adults [36,37,[84][85][86][87][88].…”

“…While the amount of amatoxin varies among species, a single mushroom may contain 5-7 mg of amatoxin and could be fatal if ingested [36,37,[84][85][86][87][88]. Children are particularly sensitive to amatoxin [14,37,[89][90][91][92].…”

“…Some recommend multiple-dose activated charcoal (20-40 g every 3-4 h for 24 h or 50 g every 6 h) and nasoduodenal suctioning to limit enterohepatic recirculation of amatoxin, because approximately 60 % of absorbed alpha-amanitin is excreted into the bile and is then returned to the liver via recirculation [29,38,73,84,85]. The antidotes benzylpenicillin, ceftazidime, Nacetyl-cysteine (NAC), rifamycin, and silibinin have been advocated by some [26,34,36,88,[110][111][112], and questioned by others [113,114]. Of these, silibinin and NAC show the most promise [32,34,111,115].…”

Successful Treatment of Mushroom Poisoning with Silybin: A Case Report

“…ALT en çok 1227 IU/L, AST de en çok 1378 IU/L olarak ölçülmüş, INR ise en çok 3-3,5 arasında seyretmiştir. Yoğun bakımdaki takipleri sırasından istenen hepatoloji konsültasyonu sonrasında penisilin G tedavisi başlanmış ve tedavi sonrasında hastanın laboratuvar sonuçları hızlıca düzelmiş ve 2 gün sonra servise alınarak taburcu edilmiştir (7). Sunduğumuz olgularda da gastrointestinal şikayetler mevcut olup, ALT ve AST değerleri yükselmiş, INR değerleri her iki olguda da 24. saatte normalin üzerinde ölçülmüştür.…”

Discovery of an effective antidote for Amanita phalloides poisoning

“…It is one of the most poisonous known toadstools, being associated with severe symptoms, high morbidity and mortality (85,125). Despite warnings, wild edible and A. phalloides mushrooms are frequently mistaken and every year several cases of intoxications are reported (6,50,120,126,127). Other authors has indicated a potentially significant variation in the amount of amatoxins contained in mushrooms collected at different geographical areas (27).…”