Answering questions about the identity, edibility, or toxic content of fungi --- email mycosATshawDOTca

(35+ yrs. experience)

Sunday, February 26, 2006

Thirty + Years of Mushroom Poisoning: A Case Registry

Thirty plus Years of Mushroom Poisoning: Summary of Reports in the NAMA Case Registry

By Michael W. Beug, Marilyn Shaw, and Kenneth W. Cochran

In the early years of NAMA, toxicology was one of the concerns of the Mycophagy Committee. The existence of toxicology committees in the Puget Sound and Colorado clubs stimulated the NAMA officers to separate the good and bad aspects of ingesting mushrooms. In 1973 they established a standing Toxicology Committee, initially chaired by Dr. Duane H. (Sam) Mitchel.

In response to a suggestion by Dr. Orson Miller, on a motion by Kit Scates at the 1982 East Stroudsburg meeting, the NAMA trustees created the Mushroom Poisoning Case Registry. Dr. Kenneth Cochran laid the groundwork for maintaining the Registry at the University of Michigan. Dr. Cochran continues to maintain the gateway through which individuals can report mushroom poisonings using the NAMA website (

The reporting is an entirely volunteer effort and at the end of each year members of the NAMA toxicology committee assemble all of the reports for the previous year as well as any other earlier cases that can still be documented. Individuals are encouraged to submit reports directly through the NAMA website. In addition members of the toxicology committee work with Poison Centers to directly gather mushroom poisoning reports. Marilyn Shaw (Colorado, Montana, Idaho, Hawaii and Las Vegas, NV)), Dr. Bill Freedman (California), Jan Lindgren(Washington and Oregon), Judy Roger (Washington and Oregon), Dr. Ken Cochran (Michigan and the upper Midwest), Hanna Tschekunow (Florida and Eastern U.S., now Washington), Dr. Denis Benjamin (Washington and now Texas) and many others have worked hard to track down and record details of mushroom poisoning cases.

The first annual NAMA report of mushroom poisoning cases was published by Dr. Cochran in Mushroom: The Journal in 1985 (Cochran, 1985). All subsequent reports are in McIlvainea (Beug 2006; Cochran, 1986, 1988, 1999, 2000; Lampe, 1989; and Trestrail 1991, 1992, 1994, 1995, 1996, 1997, 1998). In some of Dr. Trestrail’s reports (Trestrail 1992, 1994, 1995, 1996) he compares numbers of mushroom toxic exposures reported to NAMA to reports to the Poison Control Centers compiled through the Toxic Exposure Surveillance System of the American Association of Poison Control Centers. From this data we can infer that mushrooms account for about 0.4 to 0.5% of total toxic exposures. NAMA is receiving reports totaling about 1% of mushroom poisoning cases that are reported to Poison Control Centers each year. While about 90% of mushrooms in the Toxic Exposure Surveillance System are unidentified, NAMA involvement drops the percentage of unidentified mushrooms into the range of 10 to 30%. Also, since approximately 80% of the reports to PCCs involve asymtomatic events, we conclude that NAMA reports get filed for about 10% of the symptomatic poisoning cases (and probably well over 50% of the cases involving a fatality).

The NAMA database that is maintained of all of the poisoning case reports that have been received by the toxicology committee is not readily accessible when questions arise. This paper summarizes all reports in the database where the mushroom could be reasonably well identified. We cover all material through December 2005. Unlike the annual reports, we will not delve into treatments or why the person may have consumed the mushroom (e.g. for food, for recreation, mistaken identification, etc.). The only age determination we make is for adults (and here we treat teenagers as adults) versus children. However, bear in mind that symptoms can be most severe in individuals whose health is previously compromised (due to age, alcohol or chronic disease) and in children whose digestive and immune systems are not yet fully developed.

There are unusual cases where the death is not directly due to mushroom toxins. These include a previously severely ill elderly man who ate several successive huge meals of a Gyromitra species but the symptoms related to his death did not match any known mushroom symptoms.
A adult quadriplegic purchased and consumed Psilocybe cubensis that were of uncertain quality, went into anaphylactic shock and died.
One woman of a group of 5 ate what was probably Laetiporus sulphureus suffered severe GI symptoms, dermatitis, and died within 19 hours, yet no one else in the group suffered the slightest of symptoms.
After passing unconscious from a large meal of Amanita muscaria, a man froze to death in his tent in Michigan.

On the other side of the coin, we have not entered numerous cases where someone consumed an Amanita in the “Destroying Angel” group and had no ill effects; others consume a plateful of Chlorophyllum molybdites or some Amanita muscaria, etc. without getting sick.

We have also not reported on the huge number of cases (roughly 33% of the total) where the cause of the poisoning is unclear due to the ingestion of several species at a time or due to the failure to preserve or produce any of the mushrooms for later identification.

The reports that have been summarized here are voluntary reports. In some regions (the Rocky Mountain region and the Pacific Northwest) the reporting is quite extensive (though undoubtedly not complete). In other regions the reporting is very spotty because at times during the past 23 years there have been few active experts in the area. Sometimes one can be quite certain about what mushroom was consumed but at other times it is just an educated guess based on mushrooms gathered near where the suspect mushrooms were picked or from pictures that the victim pointed out in a book.

We have generally not attempted to use the most current name but have followed the names used in the reports. The approach has also been that of a “lumper.” For example, Armillaria mellea and Laetiporus sulphureus are now each recognized to be complexes of several species, which often leaves no way of figuring out the actual culprit to the species, although by looking at the location one can sometimes make an educated guess.

A confounding factor here is that mushrooms can become contaminated by bacteria and other molds whose symptoms are extremely similar to most mushroom poisoning symptoms. Some of the cases certainly do appear to have been a result of consumption of spoiled mushrooms that were old before consumption or had been frozen raw, which can still allow for some bacterial growth to occur. For mushrooms growing in lawns, flower beds, along roads and on golf courses, there is the question of contamination by insecticides or heavy metals from car exhaust  In a few cases a recollection specifically of a recent Malathion or other insecticide spray was obtained. We also have a Table of Poisonings where alcohol is implicated because individuals stated their observation of being able to safely eat the mushrooms but only if they did not drink alcohol. We are certain that several additional GI cases were also alcohol related.

We have tabulated all of the reported dermatitis cases because that information has remained scattered. Where the case involved both dermatitis and GI symptoms, the event was tabulated in both tables.

We were surprised at some of the things that we found (or did not find). In over 2,000 reports, there were only three cases total involving a Cortinarius species, even though that is a huge genus with many large fleshy fungi. We did not find a single mention of a poisoning that matched the symptoms of orellanine poisonings. So far orellanine has been found in only one small brown Cortinarius species in North America. A further check of other available sources also failed to come up with any orellanine cases anywhere in North America.
While we have often seen 50% quoted as a death rate for consumption of mushrooms containing amatoxins, we calculated an 11% death rate for reported cases of people who became ill. The overall rate of death from amatoxins is well under 10% when you count the people who showed no symptoms. Furthermore, we only found record of 5 liver transplants for a transplant rate of 3.5% in amatoxin cases. From other sources, we know that Galerina autumnalis can be fatal, but none of those reports have made their way into the database. Similarly, many cases of Galerina autumnalis ingestion that did not lead to death did not make this report.
The one death reported from mushrooms causing GI symptoms with unknown toxins/irritants was from Boletus pulcherrimus. To our surprise, there were no reported deaths from the mushrooms noted for causing kidney failure, specifically Amanita smithiana and Paxillus involutus. Though Amanita smithiana was at one time thought to contain orellanine, we now know that is not true. The toxins in both Amanita smithiana and Paxillus involutus are unknown.
We found cases where mothers became ill from a mushroom ingestion and nursing infants (and nursing puppies) became ill (the puppy died) from toxins in the milk. Though many people still eat Gyromitra esculenta, the large number of cases found where there was liver and/or kidney damage will hopefully lead individuals to cease this practice.

In examining animal poisoning cases, we were struck by how frequently dogs (and even cats) consume either Amanita muscaria or Amanita pantherina. Neither of these species is deadly in humans, but both can be lethal to cats and dogs. Similarly there were deaths of dogs from both Inocybe species and Scleroderma species, though we have no record of human deaths from these same species. We looked for mushroom poisonings of horses or cows. There were no poisonings recorded for these animals, though there were two poisonings recorded for a pig, including one death. We tried to answer a question for a woman from Oregon whose prize horse was healthy one day and dead the next. Her pasture was full of mushrooms. Her vet said that similar deaths of horses are not all that unusual. We hope that someone who reads this will become curious and some day have an answer of whether or not mushrooms are involved in these mysterious
horse deaths.

Monday, February 20, 2006

2005 Mushroom Toxicology Committee Report

2005 Toxicology Committee Report

Compiled by Michael W. Beug, Ph.D.

Toxicology Committee Chair

After a busy 2004 season with many mushroom poisonings, 2005 was a relief. We received a total of 46 reports involving 67 humans and 16 reports involving 23 dogs. I want to thank everyone who sent in reports, especially Marilyn Shaw who submitted 25 of the 62 reports.

Several dogs died in the past year due to mushroom poisoning but there were no human fatalities reported where in the final analysis mushrooms appeared to be at fault. A number of calls to poison centers came from parents whose child had mushrooms in his/her mouth or had been seen eating a mushroom. Most of these cases were asymptomatic. A few calls came in where someone ate mushrooms and then suffered a panic attack from concern that they may have made an error. It is best to confirm your identification before eating the mushroom!

There were a few first time or otherwise unique inquiries regarding mushroom poisoning. An email was forwarded to me from a person in Oregon who was concerned about a woman at a workshop who consumed a Cortinarius in the subgenus Dermocybe. She was asymptomatic but there was concern about symptoms showing up later. Orellanine poisoning is characterized by a delayed onset of 2 to 21 days and the symptoms are headache, GI distress, sweating, lethargy, anorexia, marked polyurua and polydypsia with ultimate evidence of progressive kidney failure, oliguria and anuria. However, there are no cases of orellanine poisoning ever recorded in North America, though since 1952 in Europe it has been a recognized poisoning cause when an astute Polish epidemiologist traced 102 serious poisonings and 11 deaths to consumption of certain Cortinarius species. There is still debate about what causes the orellanine poisoning but all investigators agree that the chemicals show a very strong turquoise or blue fluorescence under ultraviolet light and the fluorescence can be demonstrated not only in the mushrooms but in biopsy tissues.

A second intriguing case involved a notification of a human death from ingestion of a Gyromitra species. A couple had picked tons of “morels” and the wife, a neighbor and the husband ate them all. The husband became ill and died the next day. Further correspondence revealed that the symptoms were slurred speech, stomach pains, and dizziness. He “blacked out”, vomited black stomach contents. He was very hungry and very thirsty. Liver enzyme tests were negative. The victim was an elderly man who did not believe in doctors or in going to the hospital. He had suffered diarrhea for the previous 7 months and had been nauseated for a couple of weeks prior to the mushroom meal. A review of NAMA poisoning reports for the past 30 years did not reveal any deaths attributed to consumption of Gyromitra species, thought there were 9 reports of liver damage and three cases where the kidneys failed as well. This case involved neither liver nor kidney failure and the cause of death was ultimately determined not to be the mushrooms, though they may possibly have hastened the man’s demise.

A third puzzling case involved a horse. The NAMA Mushroom Poisoning Case Registry contains no reports of horses that had been poisoned by mushrooms. Here is the situation:

I found my prize broodmare Isabeau ill with severe diarrhea and fever. She had been perfectly healthy and fit the day before. Now she wouldn’t eat or drink and was very lethargic. I called the vet immediately but despite (extensive treatment) she showed no improvement…until the 9th day… One of my forest pastures contained a larger amount of mushrooms than we had ever seen before… Have you ever had a horse owner suspect mushroom poisoning in his horses…She was tested for Potomac Horse fever, Salmonella, EPM, West Nile Virus and everything came out negative. She has no organ damage. No founder. I talked with my vet and the vets at OSU. They see cases like this every fall. Half of the horses die. No one knows what causes them… Could mushrooms be a factor in these diarrhea cases?

I had no answer. Maybe others will have a chance to examine similar cases in the future and see whether or not there is a mushroom connection in these illnesses occurring in horses.

Table 1. Principal Poisonous Mushrooms in 2005

1. In several cases the age of the adult is not reported and so the total number in column
2 is less than the total number of individuals poisoned. The percentages in column 3 for    age 26 and over are adjusted to reflect a prorating of the additional 25 adults of unknown age. Many of the individuals in the 15-25 year age class were experimenting with hallucinogenic mushrooms.

Table 3. Summary of the Reports by Species: Ingestion by Humans

Table 4. Summary of Reports by Species:Ingestion by Dogs


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