Twenty-seven consecutive mushroom poisoning cases were followed up over a period of 14 days. Fourteen out of 27 died of liver failure. There were no deaths from renal failure. The mushrooms were identified as the amatoxin-containing Lepiota species. Therapeutic measures included nasogastric lavage, charcoal, vitamin C, vitamin B, penicillin G, corticosteroids, oral streptomycin and, in the case of a few patients, limited amounts of thiotic acid. Of the ten haemodialysed, nine died. Unfortunately charcoal haemoperfusion was not available. It appeared that therapeutic measures were ineffective and it also seemed that the amount of mushroom ingested was the determining factor for the prognosis. An important point to make is that renal failure does not occur and liver failure is always delayed (group II). For this reason all suspected cases of mushroom poisoning, regardless of absence of clinical signs and symptoms, must be hospitalised for a period of at least one week. The poisonous properties of wild mushrooms have been recognised since ancient times. However, despite awareness of their inherent dangers, serious poisoning continues to occur. Fatal intoxications can be attributed almost entirely to the amatoxin-containing species. Amanita phalloides have been blamed for over 90% of poisoning deaths in North America. There are reports of intoxications of other amatoxin-containing species in Europe, but fatalities due to Lepiota species are reported only rarely. It was previously acknowledged that the interval between ingestion of mushrooms and the onset of symptoms is longer than expected in serious poisonings. Poisoning should be presumed to be due to amatoxin if there is a latency of ten to twelve hours prior to the onset of emesis and diarrhoea, and if there is a significant elevation in serum alanine and aspartate aminotransferases. In the autumn of 1988, 27 cases of mushroom poisoning with long incubation periods were admitted to our hospital over a short period of time. Fourteen of these ended fatally. The ingested mushrooms were gathered from the same filed and were identified as Lepiota helveola and Lepiota castanea. These are known to contain amatoxins. In this report we have emphasised some of the clinical finding which were not mentioned in earlier reports.

PubMedID: 2282295