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Toxicol Lett 2018 Oct 11;296:95-104. Epub 2018 Aug 11.

School of Pharmacy, Xi'an Jiaotong University, 76(#) Yanta West Road, Xi'an 710061, Shaanxi, PR China; School of Forensic Science and Medicine, Xi'an Jiaotong University Health Science Center, 76(#) Yanta West Road, Xi'an 710061, Shaanxi, PR China. Electronic address:

Rapid and accurate identification of multiple toxins for clinical diagnosis and treatment of mushroom poisoning cases is still a challenge, especially with the lack of authentic references. In this study, we developed an effective method for simultaneous identification of amanita peptide toxins by liquid chromatography coupled with photodiode array detection and ion trap time-of-flight mass spectrometry. The accuracy and selectivity of the methodology were validated through similar multiple fragmentation patterns and characteristic ions of standard α- and β-amanitin. Read More

Toxins (Basel) 2018 May 25;10(6). Epub 2018 May 25.

National Institute of Occupational Health and Poison Control, Chinese Centre for Disease Control and Prevention, Beijing 100050, China.

Amatoxin poisoning induces delayed-onset acute liver failure, which are responsible for more than 90% of deaths in mushroom poisoning. It has been postulated from animal and human studies that biliary drainage interrupting enterohepatic amatoxin circulation may affect amatoxin poisoning. Dogs were randomly divided into four groups of six animals each. Read More

Toxicon 2018 Mar 16;143:59-67. Epub 2018 Jan 16.

National Institute of Occupational Health and Poison Control, Chinese Centre for Disease Control and Prevention, Beijing 100050, China. Electronic address:

In this study, the toxicology of A. exitialis, a lethal mushroom found in China, and the toxicokinetics of peptide toxins contained in it were evaluated. Beagles were fed A. Read More

Wilderness Environ Med 2018 03 8;29(1):111-118. Epub 2018 Jan 8.

Department of Environmental and Occupational Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA. Electronic address:

Amatoxins are produced primarily by 3 species of mushrooms: Amanita, Lepiota, and Galerina. Because amatoxin poisonings are increasing, the objective of this review was to identify all amatoxin-containing mushroom species, present a toxidromic approach to earlier diagnoses, and compare the efficacies and outcomes of therapies. To meet these objectives, Internet search engines were queried with keywords to select peer-reviewed scientific articles on amatoxin-containing mushroom poisoning and management. Read More

Int J Gen Med 2017 3;10:395-400. Epub 2017 Nov 3.

Ramthibodi Poison Center.

Objective: To describe and analyze the clinical characteristics and outcome of amatoxin poisoning cases.

Methods: We performed a retrospective cohort study of amatoxin poisoning cases from Ramathibodi Poison Center Toxic Exposure Surveillance System, from May 2013 to August 2015.

Results: There were 30 consultations with a total of 55 poisoning cases. Read More

Hum Exp Toxicol 2018 Jul 14;37(7):697-703. Epub 2017 Sep 14.

5 Section of Clinical Biochemistry, University of Verona, Verona, Italy.

Background: Limited information exists about epidemiology and management of mushroom poisoning. We analyzed and described epidemiology, clinical presentation, and clinical course of mushroom-poisoned patients admitted to emergency departments (EDs) of the Province of Parma, Italy.

Methods: Data from the database of mycological service were matched with clinical information retrieved from hospitals' database, from January 1, 1996 to December 31, 2016. Read More

Rocz Panstw Zakl Hig 2017;68(3):247-251

Gdansk University of Technology, Department of Molecular Biotechnology and Microbiology, Gdansk, Poland

Background: As the currently known diagnostic DNA targets amplified in the PCR assays for detection of poisonous mushrooms have their counterparts in edible species, there is a need to design PCR primers specific to the genes encoding amanitins and phallotoxins, which occur only in poisonous mushrooms.

Objective: The aim of the study was testing of PCR-based method for detection of all genes encoding hepatotoxic cyclic peptides - amanitins and phallotoxins present in the most dangerous poisonous mushrooms.

Material And Methods: Degenerate primers in the PCR were designed on the basis of amanitins (n=13) and phallotoxins (n=5) genes in 18 species of poisonous mushrooms deposited to Genbank of the National Center for Biotechnology Information. Read More

Hong Kong Med J 2017 Feb;23(1):93-6

Department of Surgery, Queen Mary Hospital, Pokfulam, Hong Kong.

Toxicon 2016 Sep 28;120:78-88. Epub 2016 Jul 28.

College of Life Science, Hunan Normal University, Changsha 410081, China. Electronic address:

Lethal amanitas (Amanita sect. Phalloideae) are responsible for 90% of all fatal mushroom poisonings. Since 2000, more than ten new lethal Amanita species have been discovered and some of them had caused severe mushroom poisonings in China. Read More

Liver Int 2016 07 4;36(7):1043-50. Epub 2016 Mar 4.

Organ Transplant Program, Swedish Medical Center, Seattle, WA, USA.

Background & Aims: Published estimates of survival associated with mushroom (amatoxin)-induced acute liver failure (ALF) and injury (ALI) with and without liver transplant (LT) are highly variable. We aimed to determine the 21-day survival associated with amatoxin-induced ALI (A-ALI) and ALF (A-ALF) and review use of targeted therapies.

Methods: Cohort study of all A-ALI/A-ALF patients enrolled in the US ALFSG registry between 01/1998 and 12/2014. Read More

Wilderness Environ Med 2015 Dec 9;26(4):491-6. Epub 2015 Oct 9.

Department of Pharmacology, Duzce University School of Medicine, Duzce, Turkey (Dr Kaya).

There are few data estimating the human lethal dose of amatoxins or of the toxin level present in ingested raw poisonous mushrooms. Here, we present a patient who intentionally ingested several wild collected mushrooms to assess whether they were poisonous. Nearly 1 day after ingestion, during which the patient had nausea and vomiting, he presented at the emergency department. Read More

Toxicon 2015 Sep 16;103:55-9. Epub 2015 Jun 16.

UCIBIO-REQUIMTE/Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua José Viterbo Ferreira nº 228, 4050-313 Porto, Portugal. Electronic address:

Mushroom poisonings occur when ingestion of wild mushrooms containing toxins takes place, placing the consumers at life-threatening risk. In the present case report, an unusual multiple poisoning with isoxazoles- and amatoxins-containing mushrooms in a context of altered mental state and poorly controlled hypertension is presented. A 68-year-old female was presented to São João hospital (Portugal) with complaints of extreme dizziness, hallucinations, vertigo and imbalance, 3 h after consuming a stew of wild mushrooms. Read More

Pediatr Emerg Care 2015 Apr;31(4):277-8

From the *Department of Pediatric Emergency, †Department of Pediatrics, and ‡Department of Pediatric Intensive Care, CHU Nord, Chemin des Bourrelly; and §Poison Control Center in Marseille, Marseille, France.

Serious to fatal toxicity may occur with amanitin-containing mushrooms ingestions. A Lepiota brunneoincarnata familial poisoning with hepatic toxicity is reported. In such poisonings, acute gastroenteritis may be firstly misdiagnosed leading to delay in preventing liver dysfunction by silibinin or penicillin G. Read More

Wilderness Environ Med 2015 Sep 12;26(3):350-4. Epub 2015 Mar 12.

Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey (Drs Kose and Guler).

Amatoxin poisoning from the genus Lepiota may have a deadly outcome, although this is not seen as often as it is from the genus Amanita. In this report, we present a patient who was poisoned by a sublethal dose of Lepiota brunneoincarnata mushrooms. The patient was hospitalized 12 hours after eating the mushrooms. Read More

J Clin Exp Hepatol 2014 Dec 26;4(4):361-5. Epub 2014 Sep 26.

Department of Hepatology, PGIMER, Chandigarh 160012, India.

Mushroom is an important constituent of diet in many ethnic tribes in India. Ethnic Indian tribes are known to consume nearly 283 species of wild mushrooms out of 2000 species recorded world over. Although they are experts in distinguishing the poisonous from edible mushrooms, yet occasional cases of toxicity are reported due to accidental consumption of poisonous mushrooms. Read More

Acta Biomed 2014 Dec 17;85(3):275-6. Epub 2014 Dec 17.

Department of Emergency Medicine, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.

Mushroom poisoning is an important reason of plant toxicity. Wild mushrooms that gathered from pastures and forests can be dangerous for human health. The clinical outcomes and symptoms of mushroom toxicity vary from mild gastrointestinal symptoms to acute multiple organ failure. Read More

Acta Biomed 2014 Dec 17;85(3):269-70. Epub 2014 Dec 17.

Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.

Mushroom poisoning is an important reason of plant toxicity. Wild mushrooms that gathered from pastures and forests can be dangerous for human health. The clinical outcomes and symptoms of mushroom toxicity vary from mild gastrointestinal symptoms to acute multiple organ failure. Read More

Ugeskr Laeger 2014 Mar;176(7)

Lægerne Banepladsen, 5450 Otterup.

Death cap (Amanita phalloides) is commonly found and is one of the five most toxic fungi in Denmark. Toxicity is due to amatoxin, and poisoning is a serious medical condition, causing organ failure with potential fatal outcome. Acknowledgement and clarification of exposure, symptomatic and focused treatment is of primary importance. Read More

Toxicon 2014 Sep 7;87:68-75. Epub 2014 Jun 7.

Duzce University School of Medicine, Department of Anatomy, Duzce, Turkey.

Poisoning from Amanita group of mushrooms comprises approximately 3% of all poisonings in our country and their being responsible for nearly the entire fatal mushroom poisonings makes them important. These mushrooms contain primarily two types of toxins, amatoxins and phallotoxins. Phallotoxins have a more limited toxicity potential and they primarily consist of phalloidin (PHN) and phallacidin (PCN). Read More

Praxis (Bern 1994) 2013 Dec;102(25):1507-15

Klinik und Poliklinik für Innere Medizin, Universitätsspital Zürich.

Toxicol Ind Health 2015 Dec 29;31(12):1172-7. Epub 2013 May 29.

Department of Emergency Medicine, School of Medicine, Düzce University, Düzce, Turkey.

Most of the fatal cases of mushroom poisoning are caused by Amanita phalloides. The amount of toxin in mushroom varies according to climate and environmental conditions. The aim of this study is to measure α-, β-, and γ-amanitin with phalloidin and phallacidin toxin concentrations. Read More

Eur J Intern Med 2012 Jun 17;23(4):e85-91. Epub 2012 Apr 17.

Swiss Toxicological Information Centre, Associated Institute of the University of Zurich, Freiestrasse 16, 8032 Zurich, Switzerland.

Background: Picking wild mushrooms is a popular pastime in Switzerland. Correct identification of the species is difficult for laypersons. Ingestion of toxic mushrooms may result in serious toxicity, including death. Read More

J Emerg Med 2013 Jan 1;44(1):116-21. Epub 2012 May 1.

University of Massachusetts Medical School, Worcester Massachusetts 01655, USA.

Background: Diagnosis and management of Amanita mushroom poisoning is a challenging problem for physicians across the United States. With 5902 mushroom exposures and two resultant deaths directly linked to Amanita ingestion in 2009, it is difficult for physicians to determine which patients are at risk for lethal toxicity. Identification of amatoxin poisoning can prove to be difficult due to delay in onset of symptoms and difficulty with identification of mushrooms. Read More

Eukaryot Cell 2010 Dec 1;9(12):1891-900. Epub 2010 Oct 1.

Department of Energy Plant Research Laboratory, Michigan State University, East Lansing, MI 48824, USA.

Fungi in the basidiomycetous genus Amanita owe their high mammalian toxicity to the bicyclic octapeptide amatoxins such as α-amanitin. Amatoxins and the related phallotoxins (such as the heptapeptide phalloidin) are encoded by members of the "MSDIN" gene family and are synthesized on ribosomes as short (34- to 35-amino-acid) proproteins. Antiamanitin antibodies and confocal microscopy were used to determine the cellular and subcellular localizations of amanitin accumulation in basidiocarps (mushrooms) of the Eastern North American destroying angel (Amanita bisporigera). Read More

Folia Histochem Cytobiol 2010 Jan;48(1):58-62

Department of Pharmacology, Wrocław Medical University, Wrocław, Poland.

Amatoxin poisoning is caused by mushroom species belonging to the genera Amanita, Galerina and Lepiota with the majority of lethal mushroom exposures attributable to Amanita phalloides. High mortality rate in intoxications with these mushrooms is principally a result of the acute liver failure following significant hepatocyte damage due to hepatocellular uptake of amatoxins. A wide variety of amatoxins have been isolated; however, alpha-amanitin (alpha-AMA) appears to be the primary toxin. Read More

Ann Emerg Med 2007 Sep 7;50(3):282-8. Epub 2007 Jun 7.

University of California San Diego Medical Center, Division of Medical Toxicology, Department of Emergency Medicine, San Diego, CA 92103, USA.

Study Objective: The foraging of wild mushrooms can be complicated by toxicity from several mushroom types. Amatoxin, a peptide contained in several mushroom species, accounts for the majority of severe mushroom poisonings by binding to RNA polymerase II irreversibly, leading to severe hepatonecrosis. There is no effective antidote for severe amatoxin poisoning. Read More

Wei Sheng Wu Xue Bao 2006 Jun;46(3):373-8

Institute of Microbiology, Chinese Academy of Sciences, Beijing 100080, China.

Isolate of Amanita spissa was obtained from basidiome stipe material collected from environment. It could utilize a broad range of carbon and nitrogen resources. Study on the influence of different conditions for solid culture was carried out. Read More

Ann Univ Mariae Curie Sklodowska Med 2004 ;59(1):130-8

Department of Animal Physiology, Maria Curie-Skłodowska University, Lublin.

This paper presents species of fungi of high toxicity. Their consumption might have serious consequences for health and in many cases it might lead to death. Toxic compounds present in fungi have also been characterised, mechanisms of their toxic activity have been presented and clinical symptoms of poisoning have been described. Read More

J Hepatol 2005 Feb;42(2):202-9

Toxicological Department, II Medizinische Klinik, Klinikum rechts der Isar, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany.

Background/aims: Indication of liver transplantation in acute liver failure following amatoxin intoxication is still uncertain.

Methods: One hundred and ninety-eight patients were studied retrospectively. The laboratory parameters alanine-aminotransferase, serum bilirubin, serum creatinine and prothrombin index were analyzed over time. Read More

J Hepatol 2005 Feb;42(2):166-9

J Emerg Med 2005 Jan;28(1):53-62

Department of Emergency Medicine, Beverly Hospital, Beverly, MA, USA.

Mushrooms are ubiquitous in nature. They are an important source of nutrition; however, certain varieties contain chemicals that can be highly toxic to humans. Industrially cultivated mushrooms are historically very safe, but foraging for mushrooms or accidental ingestion of mushrooms in the environment can result in serious illness and death. Read More

Mycol Res 2003 Aug;107(Pt 8):969-79

DOE Plant Research Laboratory, Michigan State University, East Lansing, MI 48824-1312, USA.

Conocybe lactea was examined as part of a larger study on the distribution of amatoxins and phallotoxins in fungi, and the taxonomic relationships between these fungi. As amatoxins are present in the congener C. filaris, the locally abundant C. Read More

Toxicon 2003 Sep;42(4):339-49

Swedish Poisons Information Centre, Karolinska Sjukhuset, Stockholm S-171 76, Sweden.

Among fungal toxins causing organ damage in the human body, amatoxins and orellanine remain exceptional. Amatoxins, a group of bicyclic octapeptides occurring in some Amanita, Galerina and Lepiota species, induce deficient protein synthesis resulting in cell death, but might also exert toxicity through inducing apoptosis. Target organs are intestinal mucosa, liver and kidneys. Read More

J Toxicol Clin Toxicol 2001 ;39(4):413-6

Department of Pediatrics, Gunma University School of Medicine, Maebashi, Japan.

Background: Although some Japanese Galerina species poisonings manifest as gastrointestinal symptoms followed by late-onset hepatorenal failure (phalloides syndrome), the toxin responsible for this has not been determined.

Case Report: We report a 6-year-old boy who developed characteristic cholera-like diarrhea and late-onset severe hepatic deterioration after eating mushrooms, later identified as a Galerina species, most likely Galerina fasciculata. A residual mushroom revealed alpha-amanitin. Read More

J Toxicol Clin Toxicol 1995 ;33(2):165-71

Service de Chirurgie Digestive et de Transplantation d'Organes, Centre Hospitalier Regional Universitaire, Rue Henri le Guillou, Rennes, France.

Four cases of severe Lepiota poisoning, including three which developed toxic fulminant hepatitis treated by orthotopic hepatic transplantation, are reported here. The toxicity of the Lepiota is discussed as well as the indications for hepatic transplantation in poisonings due to amatoxin-containing mushrooms. Read More

J Chromatogr 1992 Sep;580(1-2):279-91

Clinical Chemistry Laboratory, Hospital of Legnago, Italy.

Methods for the chromatographic determination of amanitins, toxins of Amanita phalloides (Fr.), Link mushrooms and related toxins are reviewed; particular emphasis is given to high-performance liquid chromatographic methods. The main chemical and toxicological aspects are discussed, but the focus of the present review is on the analytical problems arising in a laboratory charged with the setting up of a procedure which can direct the appropriate clinical management of an intoxicated patient or solve a forensic case. Read More

Toxicon 1988 ;26(5):491-9

Max-Planck-Institut für Medizinische Forschung, Heidelberg, F.R.G.

A monoclonal antibody, with high affinity against the mushroom toxin alpha-amanitin, was prepared. Administration of the Fab fragment of the monoclonal antibody to mice caused a 50-fold increase in alpha-amanitin toxicity. Electron micrographs showed normal appearance of hepatocytes but typical, amanitin-induced lesions in cells of the proximal convoluted tubules of the kidney. Read More

Toxicon 1986 ;24(3):273-83

Rabbits were immunized with fetuin-beta-amanitin. They produced amatoxin-specific immunoglobulins of various classes, predominantly IgG. The crude IgG fraction was isolated by gel filtration on Sephacryl S-300. Read More

Toxicon 1982 ;20(5):913-24

A fetuin derivative of alpha-amanitin was prepared and used as an antigen in rabbits. The antigen was superior to previous bovine serum albumin derivatives of beta-amanitin by its lower toxicity and high immunogenicity. On the other hand, the antibodies raised with the alpha-amanitin derivative did not show full crossreactivity with the other amatoxins, as did the immunoglobulins induced by protein derivatives of beta-amanitin. Read More