Gyromitra Mushroom Toxicity

What is Gyromitra Mushroom Toxicity?

The liver plays a vital role in changing substances in the body through two main processes: phase I reactions and Phase II reactions. Phase I reactions involve changing a substance’s biological activity, either by breaking down (hydrolysis) or changing the chemical structure (redox reactions). In rare cases, some substances may still work properly after going through a phase I reaction.

Phase II reactions, on the other hand, involve adding a functional group to the substance being changed through a process known as conjugation. These added elements include acids and amino acids naturally found in the body. Phase II reactions can work on the original substance or a version that has passed through a phase I reaction.

The enzyme systems that carry out phase I reactions are mainly located in the endoplasmic reticulum (a network within cells). In contrast, phase II reactions mostly occur in the cytoplasm (the liquid inside cells). These reactions are carried out by different forms of an enzyme called Cytochrome P450 isoforms.

The central nervous system (CNS), which includes the brain and spinal cord, uses amino acids as neurotransmitters. Neurotransmitters are chemicals that help in transmitting signals in the body. A prominent example of these is the γ-aminobutyric acid (GABA), which helps maintain nerve cell activity. GABA receptors are found throughout the brain and spinal cord neurons.

GABA receptors are classified into types A, B, and C. Type A GABA receptors are the most common and are the usual targets of drugs used to control seizures. Type B GABA receptors, on the other hand, play a role in decreasing certain body activities. While Type C GABA receptors are the least common, GABA has a much stronger effect on them than on Type A receptors.

Mushrooms are organisms that produce spores and are part of the fungi kingdom, with approximately 135,000 known species. While only 2% of mushrooms are poisonous to humans, some of these, like the Gyromitra esculenta, have unique toxic profiles. Despite its Latin name translating to “edible,” this mushroom, also known as the false morel, is considered toxic.

Some cultures believe that proper preparation techniques, like parboiling, can reduce the toxicity of this mushroom. However, there have been several reported cases of poisoning from people who have mistakenly picked and eaten this mushroom. This confusion happens because Gyromitra esculenta looks like the non-poisonous morel mushrooms.

The poisoning caused by Gyromitra esculenta, often referred to as Gyromitra syndrome, usually starts with gastrointestinal discomfort more than five hours after ingesting the mushroom. Over the following days, severe damage can occur to the liver, and, to a lesser extent, the kidneys. Confusion and potentially uncontrolled seizures can also occur.

The substance responsible for this poisoning is monomethylhydrazine (MMH), a toxic byproduct produced by the mushroom. MMH interferes with the production of GABA, leading to an overexcitement of the CNS and resulting in seizures. Additionally, MMH can cause damage to both the liver and the kidneys.

What Causes Gyromitra Mushroom Toxicity?

The Gyromitra esculenta mushroom creates a toxin known as gyromitrin, which can cause Gyromitra syndrome. There are other Gyromitra mushrooms, like Gyromitra gigas (Snow morel) and Gyromitra fastigiata, which also have gyromitrin. However, no human poisoning cases have been traced back to these two species. It’s not known if other Gyromitra species contain gyromitrin.

Gyromitrin is a toxin that’s attracted to water and can easily evaporate. Fresh Gyrometria esculenta mushrooms can contain quite a bit of gyromitrin, from 50 to 300 milligrams per kilogram. But, if you wash, boil, or dry these mushrooms, you can greatly lower the amount of gyromitrin they contain, making them safe to eat.

Gyromitra mushrooms become harmful after the gyromitrin in them breaks down to a compound called MMH. This compound, which happens to also be an ingredient in rocket fuel, is what causes the toxic effects of Gyromitra mushrooms. MMH and chemicals like it, referred to as hydrazines, are toxic to cells. They can permanently block several important enzymes and chemicals in our bodies and create harmful, unstable compounds called free radicals. These hydrazines can also slow down the formation of pyridoxal 5-phosphate, a molecule our bodies make from vitamin B6 that helps us produce the brain chemical GABA. Moreover, MMH can stop the body from converting folic acid, a vital nutrient, into its usable form, folinic acid.

Risk Factors and Frequency for Gyromitra Mushroom Toxicity

Gyromitra poisonings, caused by a specific type of mushroom, have been reported for centuries in both Europe and the United States. However, the mushroom’s scientific name has changed over time. Today, the mushroom causing the poisonings is known as Gyromitra esculenta, and its dangerous toxin is called gyromitrin. This toxin was first identified back in 1793 in France, and further investigation of its chemical structure happened in 1968.

These poisonings are most commonly found in Eastern Europe, namely in countries like Germany, Poland, and Finland. In North America, most reported cases are from Michigan, but less toxic variations of the mushroom also grow in places like Idaho and Western Canada. Mushroom poisonings are generally reported in the spring, in contrast to other severe mushroom poisonings that happen more frequently in the fall.

In Sweden, where the mushroom is widely found, poisonings are quite frequent. Between 1994 and 2002, the Swedish Poisons Information Centre received 706 inquiries related to human exposure to the Gyromitra esculenta mushroom. However, no life-threatening cases or any fatalities have been reported in the country in the last 50 years.

• Data gathered by the North American Mycological Association has shown that there were only 27 incidents of Gyromitra esculenta poisonings reported in over 30 years.
• Liver damage happened in 9 of these 27 cases (33%).
• Kidney damage was reported in 3 cases (11%).
• No deaths were reported because of these poisonings.

According to the National Poison Data System (NPDS), mushroom toxin exposures only make up around 0.2% of all reported poisoning cases. The NPDS recorded 133,700 cases (averaging 7,428 cases per year) from 1999 to 2016. Of these, 703 (0.55%) were caused by the Gyrometra species of mushroom, again with no reported deaths due to the poisonings.

Signs and Symptoms of Gyromitra Mushroom Toxicity

People who have consumed gyromitrin-coated mushrooms may initially experience nausea, vomiting, and stomach pain. Some might also have diarrhea. It generally takes about 5 to 12 hours before these symptoms show up after eating the mushrooms. However, symptoms can start to appear just 2 hours after consumption.

The time the person ate the mushroom can give some insight into the severity of the symptoms. If vomiting happens within 6 hours of consuming the mushrooms, it’s likely the person’s body isn’t absorbing as much of the toxic gyromitrin, which means the symptoms might be less severe. But if the vomiting starts 6 hours after eating the mushrooms, the risk of a serious condition increases. People with delayed symptoms may require intravenous (IV) fluid treatment to avoid dehydration and potential liver or kidney problems. Stomach-related symptoms might resolve on their own after a few days.

Details such as the type of mushroom consumed, the time of year it was eaten, and the amount eaten also provide useful information. The gyromitrin mushroom is typically found in temperate climates during spring and is often found near pines and aspen trees. The number of mushrooms that a person has eaten is also essential, as the severity of symptoms increases with more toxins ingested.

If these mushrooms have been bought, identifying the seller or the store may help to find out if there has been a contamination issue when the mushrooms were collected or distributed. Importing wild mushrooms has been banned by the FDA since the 1980s, and many U.S. states have regulations restricting the sale of wild mushrooms for people to eat.

Initial physical exams can vary greatly but may include dryness in the mouth, decreased bowel sound, general tenderness in the stomach, and confusion. In severe cases, a yellowing of the skin or the whites of the eyes (jaundice) may be noticed 3 days after ingesting the mushrooms. More serious neurological symptoms such as anxiety, dizziness, disorientation, hallucinations, seizures, and mental changes are usually observed after a large consumption. If neurological symptoms are present, a thorough neurological assessment is crucial. It’s very rare, but death has occurred as early as 3 days after eating these mushrooms.

Because the early symptoms are quite diverse, mushroom toxicity may often be overlooked. It’s important to consider the possibility of toxic mushroom consumption if a patient reports gastrointestinal problems after eating.

Testing for Gyromitra Mushroom Toxicity

Diagnosing Gyromitra syndrome, a condition caused by eating Gyromitra mushrooms, is generally based on examining a patient’s liver, kidney, and central nervous system (CNS, which includes the brain and spinal cord). This is linked with knowing if the patient has eaten any Gyromitra mushrooms recently. Currently, we do not have specific tests to check for the harmful substances found in this type of mushroom in a clinical (medical) setting.

Typically, if you have been poisoned by Gyromitra mushrooms, certain substances in your blood can increase within 1 to 2 days. These include transaminases (enzymes that indicate liver damage), lactate dehydrogenase (an enzyme that becomes high when there’s tissue damage), and total bilirubin (a chemical that may increase when the liver is damaged or there is an abnormal breakdown of red blood cells). One specific kind of transaminase, known as AST, usually reaches its highest level around 4 to 5 days after you eat the mushrooms. Blood urea nitrogen and creatinine—chemicals that indicate how well your kidneys are working—might also increase, showing that your kidneys may have been harmed.

Symptoms affecting the CNS can range from confusion to seizures. However, pictures of your brain made using techniques like computed tomography (CT, a type of X-ray) or magnetic resonance imaging (MRI, which uses strong magnets and radio waves) are often normal. If you continue to have seizures or if your symptoms mainly affect one side of your body, doctors will need to investigate further. In those cases, once the doctors control your seizures, they will use imaging techniques to look at your brain in more detail.

Treatment Options for Gyromitra Mushroom Toxicity

If you might develop seizures, it’s very important that your treatment starts as soon as possible. The main focus of the initial treatment is to support your body and make sure the amount of fluid and electrolytes (like sodium and potassium) in your body are balanced. To do this, doctors will need to routinely test your blood to check how well your liver and kidneys are working.

Sometimes, when toxins have been ingested, doctors need to clean out the stomach, a process known as gastric decontamination. However, in this case, that’s often not necessary because vomiting can naturally clear out the intestines of the toxin.

If you’re experiencing symptoms related to your central nervous system (the brain and spinal cord), the specific treatment is often a supplementation of a vitamin called pyridoxine. This can counteract the depletion of this vitamin caused by the particular toxin referred to as MMH. Pyridoxine is often given to control or prevent seizures. If you are still having seizures despite this supplement, a group of medications known as benzodiazepines may be recommended for you.

It’s important to note that other common anti-seizure medications, such as phenytoin, are usually not effective in this situation. However, the good news is that most patients recover smoothly within six days with proper support and pyridoxine supplementation.

What else can Gyromitra Mushroom Toxicity be?

When a patient shows symptoms of Gyromitra (a type of mushroom) poisoning, doctors will also consider other conditions that might be causing the symptoms. These include:

• Reaction to too much Acetaminophen (a common pain reliever)
• Poisonous effects of Amatoxin (another type of mushroom)
• Bad reaction to Disulfiram (a medication used to treat chronic alcoholism)
• Poisoning from mushrooms that have a similar effect to Disulfiram
• Diabetic ketoacidosis (a serious complication of diabetes)
• Stomach flu (Gastroenteritis)
• Gallstones (Cholelithiasis) or inflammation of the gallbladder (Acute Cholecystitis)
• Giardiasis (an infection in your small intestine caused by a microscopic parasite)
• Severe nausea and vomiting during pregnancy (Hyperemesis Gravidarum)
• Effects of abusing stimulants
• Iron poisoning
• Poisonous reaction to Isoniazid (a medication used to prevent tuberculosis)
• Poisoning from Orellanine (another type of mushroom)
• Poisoning from Organophosphate and Carbamate (types of pesticides)
• Stomach flu in children (Pediatric Gastroenteritis)

A thorough clinical assessment can differentiate Gyromitra poisoning from these other conditions.

What to expect with Gyromitra Mushroom Toxicity

The chances of recovering from poison caused by the Gyromitra mushroom are very high, with no reported deaths for several decades. Compared to the Amanita phalloides mushroom, less information is available about the Gyromitra mushroom.

However, it’s important to note that certain symptoms can indicate severe poisoning. These include encephalopathy (a broad term that means brain disease, brain damage, or malfunctions in the brain), kidney failure, lactic acidosis (a high level of lactic acid in the blood), and gastrointestinal symptoms, such as upset stomach, that start longer than 8 hours after consuming the mushroom. These conditions are associated with poor outcomes.

Possible Complications When Diagnosed with Gyromitra Mushroom Toxicity

Severe poisoning from a type of mushroom called Gyromitra esculenta may cause serious complications like liver and kidney failure so severe that dialysis might be needed. Consistently handling this mushroom could lead to harmful effects on both the entire body and the local area of contact. Additionally, long-term exposure could potentially cause cancer.

Common complications from severe Gyromitra esculenta poisoning:

• Liver failure
• Kidney failure
• Dialysis requirement in severe cases
• Potential systematic and local harmful effects
• Potential cancer from long-term exposure

This type of mushroom is also potentially linked to the development of amyotrophic lateral sclerosis (ALS), a specific type of nerve disease.

Preventing Gyromitra Mushroom Toxicity

The best way to prevent Gyromitra syndrome, a type of mushroom poisoning, is by informing and educating individuals about safer practices. Here are a few key points:

• Do not eat mushrooms that you know are poisonous, ones that you can’t identify, or wild ones bought from questionable places
• If you come across an unknown type of mushroom, look for guidance from a mushroom expert before eating it
• Make sure the mushrooms are fully cooked before consuming them

Even experienced mushroom pickers can sometimes make mistakes and these can have severe health consequences due to consuming toxic mushrooms. As a safety precaution, it’s advisable to completely avoid eating mushrooms if you’re unsure about whether they’re safe to eat. Moreover, if you start to feel unwell after consuming mushrooms, please seek medical help right away. These symptoms could be a sign of mushroom poisoning.