Amanita phalloides Poisoning and Treatment Approaches

Abstract

It is common to pick and eat mushrooms in nature. Poisonous mushrooms are difficult to distinguish from edible ones. Consuming poisonous mushrooms can cause severe consequences, ranging from mild gastrointestinal complaints to death.
The major fatalities happen due to mushrooms containing amatoxin. Particularly, Amanita phalloides contains high amounts of amatoxin. The targets of toxins taken into the body are the gastrointestinal mucosa, renal tubule cells, liver. Alpha amanitin is one of the most toxic among amatoxins and inhibits RNA polymerase II. Liver cells are most affected by toxicity. Amatoxins are taken into the liver by organic anion transporting polypeptides. No symptoms are seen in the first hours of poisoning. Gastroenteritis-like symptoms are seen when toxins damage the gastrointestinal epithelium. Then liver and kidney begin to be affected. Death usually occurs due to liver failure.
Early diagnosis and treatment enhance chances for survival. There is no specific antidote for amatoxins. Absorption should be prevented with activated charcoal and gastric lavage. Adequate hydration should be ensured. The most commonly used drugs in the clinic are penicillin G, silibinin, N-acetylcysteine. In addition to this, extracorporeal methods should be applied. Approaches other than liver transplantation are supportive. The mortality rate remains over 10% in large case series.
Specific substances that would prevent the uptake of toxins into the liver or eliminate their effect have not yet been developed. Since there is no effective treatment, cultivated mushrooms should be preferred instead of wild mushrooms in nature to avoid Amanita phalloides poisoning.

Keywords

• Mushroom poisoning
• Amatoxins
• Alpha amanitin
• Amanita phalloides
• therapeutic approaches

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