1/25. Use of acetylcysteine as the life-saving antidote in amanita phalloides (death cap) poisoning. Case report on 11 patients.alpha-amanitin is an amatoxin known to produce deleterious effects on the liver and the kidneys, when circulating in the blood. It is produced by a particular kind of mushroom called amanita phalloides. Therapeutic options employed to treat mushroom intoxication, such as haemodiaperfusion on activated charcoal, high dosages of penicillin g, oral charcoal, etc., very often failed to act properly and liver transplantation (when a graft is available) appeared to be the only solution. In recent years, as suggest by some authors, it has been postulated that the oxidant effects of alpha-amanitin could be counteracted by the use of antioxidants such as silibinin. High dosages of N-acetyl-cysteine (CAS 616-91-1, NAC), already used as antioxidant in paracetamol poisoning, were successfully used in our intensive care Unit (ICU) in the treatment of amanita phalloides poisoning. In the last two years, 11 patients (mean age of 5-72 = 38.5) were treated for amanita phalloides poisoning of various degrees, with a protocol (haemodiaperfusion on activated charcoal, high dosages of penicillin g, etc.) further comprehending NAC (fluimucil). All the patients recovered successfully but one (bearing precedent liver disease) needed liver transplantation. Daily monitoring of liver enzymes, creatinine, coagulation, LDH, blood and urinary alpha-amanitin were used to screen the progresses of the patients.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/25. Fatal mushroom poisoning caused by amanita virosa in thailand.Consumption of toxic mushrooms belonging to the genus amanita frequently leads to severe gastrointestinal distress followed by acute hepatic failure with a fatal outcome. In thailand, valuable information as to the locally prevalent poisonous species, the preferred habitat and the management of suspected victims of intoxication is basically non-existent. We report here 5 cases of fatal poisoning with amanita virosa having occurred in a family residing in the northeast of thailand who as countless others had enjoyed mushroom gathering as a pasttime. Within 4 to 6 days after ingestion of the mushrooms, all had succumbed to acute hepatic failure with subsequent hepatoencephalopathy. Treatment modalities exist in the form of penicillin and silibinin, or thioctic acid administration followed by plasmapheresis. In cases taking a lethal course apparent from the results of liver biochemistry, liver transplantation is clearly indicated. In order to prevent mushroom poisoning altogether, educating the general population to that end certainly presents the method of choice.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
3/25. Lethal ingestion of stored amanita phalloides mushrooms.We report the first case of a lethal amanita phalloides intoxication from stored mushrooms. After picking the mushrooms were kept in a freezer for 7-8 months. This case is in accordance with the well-known stability of the amatoxins and demonstrates the possibility of A. phalloides poisoning at any time of year.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
4/25. mars: optimistic therapy method in fulminant hepatic failure secondary to cytotoxic mushroom poisoning--a case report.BACKGROUND: Poisoning by cytotoxic mushrooms (amanita phalloides and related species) is associated with severe morbidity and a high mortality rate (lethality > 20% in adults and > 50% in children). The main causes of this intoxication are the amatoxines, which inhibit dna-dependent rna polymerase ii or B. This interaction leads to a tight complex, and the inhibition is of a non-competitive type (1); in addition to those tight binding inhibitors of adenosine kinase, papain, cathepsin l, cathepsin b, cysteine proteinase and bromelain (2), inhibit the synthesis of messenger RNA in the hepatocytes, decrease the formation of coagulation factors and of immunoglobulins and effect a vasoconstriction. They also have an influence on the transcription and lesions that are seen in cells with rapid protein synthesis, particularly in liver and renal cells, with the cellular changes causing the fragmentation and segregation of all nuclear components, even at low toxin concentrations (3). Phallotoxin, which is the other toxin isolated from death cap, binds with a high affinity to microfilamentous structures - in particular, to F-actin, which stimulates the polymerization of G-actin, stabilizes the F-actin filaments, irreversibly polymerizes actin filaments and causes cholestasis (4). Liver is recognized as the target organ for amanita phalloides toxins; it is presented by fatty degeneration, acute toxic dystrophy and centrilobular necroses (5). Therapeutic options employed to treat mushroom intoxication, such as hemodiaperfusion on activated charcoal, high dosages of penicillin g, oral charcoal, etc., very often failed to act properly and liver transplantation (when a graft is available) appeared to be the only solution. The most polarized debate concerns the value of extracorporeal elimination. plasmapheresis and peritoneal dialysis proved much less useful for this purpose; neither haemodialysis (HD) nor haemoperfusion (HP) contributed to the clearance of amatoxin (6, 7). Recently, Stange et al. (8). introduced a new detoxication method (referred to as mars) for protein-bound substances in patients with liver failure and grade III and IV hepatic encephalopathy. mars was performed with an albumin-containing dialysate, which is recycled in a closed loop that contains a charcoal cartridge, an anion exchanger resin adsorber and a conventional haemodialyser. With dialysis using an albumin-containing dialysate, protein-bound substances, which are usually not sufficiently dialysable, can be eliminated. The treatments increase the rate of toxin elimination to the extent that the toxic exposure of highly susceptible cells, such as hepatocytes, is minimized. This leads to the surprise recovery of the poisoning patient, despite her severe condition, even as late as up to a week after mushroom ingestion.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
5/25. Extracorporeal albumin dialysis in patients with amanita phalloides poisoning.BACKGROUND: Ingestion of amanita phalloides is the most common cause of lethal mushroom poisoning. The relative late onset of symptoms is a distinct diagnostic feature of amanita intoxication and also the main reason of failure for extracorporeal removal of amanita-specific toxins from the gut and circulation. patients AND methods: Extracorporeal albumin dialysis (ECAD) has been used on six consecutive patients admitted after A. phalloides poisoning with acute liver failure (ALF). RESULTS: Six patients, with mean age of 46 years (range: 9-70 years), underwent one to three ECAD treatments. The mean time from mushroom ingestion until the first ECAD treatment was 76 h. Two patients regenerated spontaneously under ECAD treatment and orthotopic liver transplantation (OLT) could be avoided. Two patients were successfully bridged to OLT and one patient died because of cerebral herniation. One patient was treated with ECAD immediately after OLT because of the graft dysfunction and survived without re-transplantation. CONCLUSION: ECAD appeared to be a successful treatment perspective in supporting liver regeneration or in sufficient bridging to OLT and also in treatment of graft dysfunction after OLT in patients with A. phalloides poisoning.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
6/25. Acute poisoning with tricholoma equestre of five-year old child.This report presents the first case in pediatric literature of the acute intoxication of a five-year old male child who ate 300-400 grams of tricholoma equestre daily for four consecutive days before the onset of poisoning. The symptoms included acute respiratory failure with the need of respiratorotherapy, muscle weakness concerning especially the pelvic girdle and the urinary bladder. The boy could not sit or stand up without help and the bladder had to be catheterised, several times daily, to avoid urine retention. The biochemical tests showed only minor muscle injury with maximal activity of creatine kinase 306 U/L, aspartate aminotransferase 39 U/L, alanine aminotransferase 56 U/L. No other causes responsible for the signs mentioned above such as trauma, viral, bacterial, neurologic and immune diseases or exposure to medications were found. All the symptoms and biochemical abnormalities disappeared within 12 days of hospitalisation. We believe that the clinical picture of poisoning with this wild mushroom might be different in children and adults.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
7/25. Treatment of intoxication with cortinarius speciosissimus using an antioxidant therapy.The authors present the case reports of a 30-year-old man and his 29-year-old wife who ingested a mushroom meal containing cortinarius speciosissimus. Features of this intoxication include gastrointestinal symptoms such as nausea, vomiting, and diarrhea as well as back pain. The toxin orellanine is nephrotoxic and can lead to acute renal failure. A long symptom-free interval of 2 to 21 days is characteristic of this poisoning. The diagnosis can be made by mycologic testing or by toxicologic analysis of a renal biopsy specimen. Reported therapeutic options include hemodialysis, plasmapheresis, or drug therapy with corticosteroids, all of which have yielded variable results. Here the authors report the use of antioxidant therapy in 2 patients with acute renal failure caused by cortinarius speciosissimus intoxication.- - - - - - - - - - ranking = 6keywords = intoxication (Clic here for more details about this article) |
8/25. Successful treatment of a child with fulminant liver failure and coma caused by amanita phalloides intoxication with albumin dialysis without liver transplantation.FLF is a life-threatening disease. Hepatic coma exerts dramatic impact on patient survival. At present, LTx is the treatment modality of choice that provides significant improvement in outcome of most patients with FLF. Multiple attempts have been made to reduce mortality and improve the patient's condition. One of the new options is AD - mars. We present the case of a 11-yr-old boy with FLF and hepatic coma who avoided the scheduled LTx because of rapid neurological and biochemical improvement immediately after three mars sessions.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
9/25. Molecular adsorbent recirculating system--mars as a bridge to liver transplantation in amanita phalloides intoxication.A case of a 46-year-old female intoxicated with amanita phalloides was presented. Since constant deterioration of her liver function she was put on the waiting list for urgent liver transplantation. To improve her clinical condition two sessions of Molecular Adsorbent Recirculating System were provided with transient good results. About 72 hours after the mushroom ingestion the patient had undergone liver transplantation. Conclusions: Despite good clinical condition the patients severely poisoned with amanita phalloides should be placed on a waiting list for liver transplantation as early as possible. The Molecular Adsorbent Recirculating System should be introduced as soon as possible after amanita phalloides intoxication. Albumin dialysis may be considered as a bridge for the liver transplantation in patients intoxicated with amanita phalloides.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
10/25. Panther cap amanita pantherina poisoning case report and review.An analysis of patients with mushroom poisoning hospitalized in the Clinic of toxicology in Cracow revealed that only a small percentage of cases had been caused by the death cap amanita phalloides (Vaill. ex Fr.) Secr. The most important factors contributing to intoxication are confusion of toxic mushrooms with edible species, and non-specific mushroom poisoning. The genus amanita has a global distribution and is one of the most well-known genera of macrofungi. Active toxins present in the panther cap (A. pantherina) (DC ex Fr.) Secr are ibotenic acid and muscimol, which are rapidly absorbed from the gastrointestinal tract. It is likely that other substances also participate in the psychotropic effects. Five frayed panther cap fruiting bodies were eaten by mistake by two persons (27 and 47 years of age). Symptoms onset occurred after 120 min with central nervous system (CNS) depression, ataxia, waxing and waning obtundation, religious hallucinations and hyperkinetic behaviour. In the present case, successful general symptomatic treatment was administered, which consisted of controlling the nervous symptoms and stabilizing the electrolyte balance. The poisoning regressed with no organ complications.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
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