Air Quality and Health Impacts (22)
Poisoning and overdose treatments (20)
Silymarin and Mushroom Poisoning (16)
Climate Change and Health Impacts (7)
Air Quality Monitoring and Forecasting (5)
Several new mushroom poisoning syndromes have been described since the early 1990s. In these syndromes, the onset of symptoms generally occurs >6 hours after ingestion. Treatment is mainly supportive. The syndrome induced by Amanita smithiana/proxima consists of acute tubulopathy, which appears earlier and does not have the same poor prognosis as the orellanine-induced syndrome. It has been described since 1992 in the US and Canada with A. smithiana; in France, Spain and Italy with A. proxima; and in Japan with A. pseudoporphyria. The responsible toxin is probably 2-amino-4,5-hexadienoic acid. The erythromelalgia syndrome has been described as early as the late 19th century in Japan and South Korea with Clitocybe acromelalga, and since 1996 in France and then Italy with C. amoenolens. Responsible toxins are probably acromelic acids identified in both species. Several cases of massive rhabdomyolysis have been reported since 1993 in France and 2001 in Poland after ingestion of large amounts of an edible and, until then, valuable species called Tricholoma equestre. These cases of rhabdomyolysis are associated with respiratory and cardiac (myocarditis) complications leading to death. Rhabdomyolysis with an apparently different mechanism was described in Taiwan in 2001 with Russula subnigricans. Finally, cases of encephalopathy were observed twice after ingestion of Hapalopilus rutilans in Germany in 1992 and Pleurocybella porrigens in Japan in 2004, where a convulsive encephalopathy outbreak was reported in patients with history of chronic renal failure.
Bessard J, Saviuc P, Chane-Yene Y, Monnet S, Bessard G
Journal of chromatography. A •
As Clitocybe acromelalga, the mushroom Clitocybe amoenolens is responsible for erythermalgia. Acromelic acids isolated from C. acromelalga have been suspected to be to some extend the active principles. The objective was to develop a specific and sensitive liquid chromatographic-mass spectrometric method that would allow acromelic acid A identification and quantification in mushrooms. The method involved a single-step methanol-water extraction followed by a selective cleanup of the extract with solid-phase extraction cartridges (strong-anion exchange). The chromatographic separation was achieved on a porous graphitic carbon column with acetonitrile-water-formic acid as mobile phase. Detection was done with a mass analyzer equipped with a TurboIonSpray source, operated in the negative ionization mode. Acromelic acid A concentration was determined in dried mushroom at around 325 ng/mg in C. amoenolens and 283 ng/mg in C. acromelalga.
The various mushroom poisoning syndromes are summarised together with elements underlining uncertainty and lack of knowledge. For each of the classical syndromes concerned, classified in delays inferior or superior to 6 hours, the toxins and their mechanisms of action, the main mushrooms responsible, the symptoms and their treatment are all presented. Characterised by early onset within 6 hours, these represent the majority of intoxications. There are 6 syndromes: gastro-intestinal (resinoid), muscarine (sudorien, cholinergic), pantherine (myco-atropine, anticholinergic), coprine (similar to the antabuse syndrome), narcotine (psilocybin, hallucinatory) and paxillus syndrome (exceptional). Characterised by an onset after six hours, they regroup the phalloid syndrome that is responsible for 90 to 95% of deaths due to higher funghi mushrooms, the orellanine and gyromitrin syndrome and new syndromes identified over the past decade concerning acute renal failure with shorter onset than during the orellanine syndrome (Amanita proxima), erythermalgia (Clitocybe amoenolens), rhabdomyolysis (Tricholoma equestre) and central nervous system failure (Hapalopilus rutilans).
Saviuc P, Dematteis M, Mezin P, Danel V, Mallaret M
Veterinary and human toxicology •
Ingestion of Clitocybe amoenolens, a mushroom collected in Savoie (France), induced erythermalgia in 5 patients. To assess C. amoenolens toxicity, increasing doses were given randomly to 4 rats corresponding to 1 to 25 fold the dose eaten by the most severely poisoned patient. The 2 rats receiving the highest doses had loss of bodyweight, locomotor disability and erythema of the toes. Examination of sciatic nerves showed decreased axon density and neuronal fiber degeneration. Oral administration of C. amoenolens to rats led to lesions that might be explained by the presence of acromelic acid A, a kainate analogue.
Saviuc PF, Danel VC, Moreau PA, Claustre AM, Ducluzeau R , et al.
La Revue de medecine interne •
To describe the first European observation of erythromelalgia due to mushroom poisoning. Seven cases observed and followed over 4 years are reported. All ill patients had eaten the same mushroom species, gathered in the same French alpine valley. Clinical features of erythromelalgia were observed. This syndrome was first described in Japan after Clitocybe acromelalga ingestion. It had never been observed in Europe before. Clitocybe acromelalga does not grow in Europe. Clitocybe amoenolens was identified as the possible cause of poisoning in our cases. This species can be confused with an edible mushroom, Lepista inversa. Even in Europe, recent mushroom poisoning is a possible cause of erythromelalgia.
Saviuc PF, Danel VC, Moreau PA, Guez DR, Claustre AM , et al.
Journal of toxicology. Clinical toxicology •
To report the first European observations of erythromelalgia due to mushroom poisoning. Clinical features of erythromelalgia were observed in 7 cases seen over 3 years. All patients had eaten the same mushrooms species, gathered in the same French alpine valley. Erythromelalgia was first described in Japan after Clitocybe acromelalga ingestion. Clitocybe amoenolens was identified as the possible cause of poisoning in our cases.