Pilzvergiftungen – die Schattenseiten des Myzetismus

Most mushroom poisonings cause vomiting and diarrhea within 12 hours. Cases with symptoms appearing after a long latency (8–18 hours) strongly suggest amatoxin poisoning, especially after eating wild mushrooms, though shorter latencies do not rule it out. Large meals, chitin-rich mushrooms, mixed meals, and individual factors can shorten latency. Any vomiting and diarrhea after mushroom consumption is suspicious. Unless an expert can identify the mushrooms within 30 minutes, specific amatoxin treatment should begin; starting treatment before analysis can keep mortality rates as low as 5%. Urine analysis for amatoxins is crucial. The text also covers early gastrointestinal syndrome, psychotropic symptoms from psilocybin mushrooms, and renal failure linked to orellanin-containing mushrooms.

Study at a glance

Abstract

Most mushroom intoxications become evident within 12 hours with vomiting and diarrhea. They can be divided into incidents with a short latency (less than four hours) and incidents with a long latency (longer than four hours). As a rule of thumb amatoxin poisonings must be considered in case of symptoms appearing with a long latency (8-12-18 h), especially after consumption of non-controlled wild mushrooms. Shorter latencies do not exclude amatoxin poisoning. Large meals of mushrooms, which are rich in chitin, mixed meals and individual factors, may shorten latency and disguise amatoxin poisoning. Any vomiting and diarrhea after mushroom consumption is suspicious. Unless the mushrooms are not to be identified within 30 minutes by an expert, specific treatment for amatoxin poisoning must be started. Identification shall be achieved by macroscopic or microscopic means; and urine analysis for amatoxins are crucial. By commencing treatment before analysis, mortality rates may be as low as 5%. Current standards in amatoxin poisoning treatment can be obtained at the Swiss Toxicological Information Centre (Phone 145), where contacts to mycologists are available as well. Emergency mycologists are listed on the website www.vapko.ch. Of the 18 different syndromes we present the most common and most important in Switzerland. In an overview all of them are listed. Early gastrointestinal syndrome with its short latency of less than 4 h and indigestion with a very variable latency are the most common. Psychotropic symptoms after consumptions of fly agaric and panther cap are rare, in case of psilocybin-containing mushrooms, symptoms are frequent, but hardly ever lead to medical treatment. In case of renal failure and rhabdomyolysis of unknown origin, completing a patient's history by questioning nutritional habits might reveal causal relationship with ingestion of orellanin-containing mushrooms or tricholoma equestre respectively. Mushrooms in the backyard are attractive for children. We discuss possible approaches.