What is Amatoxin Mushroom Toxicity?
Mushrooms that contain a toxin called amatoxin can cause serious liver failure, although this is quite rare. Interestingly, not all types of Amanita mushrooms have this toxin, and some other kinds of mushrooms, aside from Amanita, also contain amatoxin. It’s worth noting that 95% of deaths from eating poisonous mushrooms worldwide result from mushrooms containing this specific type of toxin.
The following are types of mushrooms that have amatoxin:
Amanita group:
* Amanita phalloides (also known as Death Cap)
* Amanita virosa (also known as Destroying Angel)
* Amanita verna (also known as Fool’s Mushroom)
* Amanita ocreata
* Amanita bisporigera
* Amanita suballiacea
Lepiota group:
* Lepiota helveola
* Lepiota chlorophyllum
* Lepiota brunneolilacea
* Lepiota josserandi
* Lepiota fulvella
* Lepiota subincarnata
* Lepiota brunneoincarnata
Miscellaneous:
* Galerina autumnalis (also known as Autumn skullcap)
* Galerina venenata
* Galerina sulcipes
* Conocybe filaris
It’s not uncommon for people who are collecting mushrooms to confuse toxic ones for edible kinds. In particular, the Amanita phalloides, or Death cap, which is responsible for the most deaths, is often mistaken for the paddy straw mushroom. Similarly, both Agaricus volvacea and Amanita bisporigera are commonly mistaken for the edible, non-toxic Lepiota naucina.
What Causes Amatoxin Mushroom Toxicity?
Out of the thousands of mushroom species, only about 50 to 100 are harmful to humans. Most cases of mushroom poisoning in humans are caused by a group of mushrooms called Amanita. These Amanita mushrooms have harmful substances known as amatoxins and phallotoxins. Amatoxins can disrupt the process our body uses to make proteins and can cause severe liver problems.
Some specific types of Amanita mushrooms can have other types of toxins as well. For example, Amanita smithiana contains a toxin that can harm kidneys, while Amanita muscaria and Amanita pantherina have a type of toxin called isoxazole, which can alter a person’s mental state but doesn’t damage the liver or kidneys.
Risk Factors and Frequency for Amatoxin Mushroom Toxicity
Amanita mushroom poisoning often happens because many people struggle to identify safe mushrooms when gathering in the wild. Some people may accidentally eat Amanita mushrooms when actually looking for mind-altering varieties. The danger lies in the fact that Amanita mushrooms don’t have a unique taste or smell, and their large size (5-15 cm) and color make them look like edible mushrooms.
Signs and Symptoms of Amatoxin Mushroom Toxicity
Amanita mushroom poisoning, also known as Amanita toxicity, shows symptoms in three stages:
- The first stage doesn’t start until six to twelve hours after eating the mushrooms. At first, there might be no noticeable problems. However, after that, symptoms such as nausea, stomach cramps, heavy watery diarrhea, and signs of dehydration such as dry mouth and fast heartbeat can appear. If the dehydration is severe, low blood pressure might be experienced as well.
- The second stage can deceive because the person seems to recover temporarily as the stomach-related symptoms resolve. Yet, damage to the liver continues. This stage can last two to three days, highlighting an increase in liver enzymes and bilirubin (a waste product in the blood), development of a blood clotting disorder, and ultimately, hepatic encephalopathy (a decline in brain function due to severe liver disease).
- In the third and final stage, both liver and kidney functions start to fail. Liver and kidney disease and hepatic encephalopathy can develop quickly after signs of liver damage are detected in lab tests. If not treated, this stage can lead to death within three to seven days.
Testing for Amatoxin Mushroom Toxicity
If you think you’ve eaten a mushroom that might be harmful to your liver, your doctor will likely order several tests. This will include a complete chemistry panel, which is a blood test that checks various chemicals in your blood, including how well your liver is working. They’ll also do a test called an INR, which measures how long it takes for your blood to clot. These tests will give your doctor a baseline, or starting point, to understand your current health condition.
Treatment Options for Amatoxin Mushroom Toxicity
If you accidentally eat a toxic mushroom that contains a poison called Amatoxin, medical professionals will mainly rely on supportive care to treat you. Unfortunately, no specific antidote exists to counteract this poison.
So, what does supportive care entail? First, the doctors will typically give you intravenous (IV) fluids, delivered through a needle into your vein. This is done to replace any fluid you might have lost and to correct any imbalance in important body salts (electrolytes) and blood sugar levels.
If you get to a healthcare facility soon after eating the mushroom (generally within two to four hours), you might receive a treatment called decontamination. This process involves taking activated charcoal by mouth. The charcoal can help trap the poison, which can help reduce the damage it causes to your body. Once your stomach has been cleansed, doctors can also treat any nausea you might have.
Medical professionals might use a set of treatments to help limit the damage the poison does, particularly to your liver. These treatments are not antidotes, but they have shown some usefulness against Amatoxin poisoning according to anecdotal evidence.
There are several agents used in treatment:
1. N-acetyl-cysteine: This medicine is used in the same way as it’s used in acetaminophen (a common pain reliever) overdose to reduce liver damage.
2. Penicillin: This is an antibiotic, which at high doses could outcompete the poison in getting into your liver.
3. Silymarin: This substance, derived from milk thistle, slows the entry of the poison into your liver. It’s available in two forms: a version used in Europe that’s given through an IV, and an over-the-counter version in North America that’s taken by mouth.
Continue taking activated charcoal after you ingest the poison, even hours later, to prevent the toxins from being reabsorbed into your body. Other therapies, such as intravenous cimetidine or thioctic acid, have been tried but are only backed by animal research.
In severe cases, if your liver sustains heavy damage even with intensive supportive care, a liver transplant might be your only chance for survival. Indications that a transplant might be needed can include confusion due to liver damage, a disorder that affects both your liver and kidneys, or a bleeding disorder. If you’ve ingested a toxic mushroom, healthcare professionals should aim to transfer you to a place that can perform liver transplants as soon as possible.
Lastly, if your kidneys fail due to the poison, you might need to undergo dialysis. This process helps to do some of the work your kidneys usually would, like cleaning your blood. However, even dialysis can’t remove the Amatoxin poison.
What else can Amatoxin Mushroom Toxicity be?
Generally, it’s hard to confirm amatoxin poisoning through tests – doctors usually diagnose it based on certain symptoms. As such, doctors should also consider other conditions that may cause similar symptoms. These include:
- Overdosing on acetaminophen (a common pain reliever and fever reducer)
- Infections that affect the liver
- Autoimmune disorders, where the body’s immune system attacks its own cells
It’s crucial for doctors to think about these possibilities in order to arrive at the right diagnosis.
Possible Complications When Diagnosed with Amatoxin Mushroom Toxicity
Potential Side Effects:
- Kidney and liver damage
- Brain dysfunction
- Drying out of the body
- Inflammation of the pancreas
- Nerve damage
