Current fatality rate of suspected cyclopeptide mushroom poisoning in the United States.

Abstract

OBJECTIVE:

This study was designed to determine the fatality rate of suspected cyclopeptide-containing mushroom ingestions reported to the National Poison Data System (NPDS).

BACKGROUND:

Although silibinin reportedly improves survival in suspected cyclopeptide-containing mushroom ingestions, the greater than 20% untreated fatality rate that is often cited is based on decades-old data. An ongoing open-label silibinin trial will likely use historical cases as comparators. A recent single poison control center (PCC) study showed a fatality rate of 8.3%. This study was designed to validate those findings in the NPDS.

METHODS:

This study was an 11-year (1/1/2008-12/31/2018) retrospective review of suspected cyclopeptide-containing mushroom ingestions reported to NPDS. Inclusion and exclusion criteria were the same as the ongoing silibinin trial: Age >2-years-old; history of eating foraged mushrooms; gastrointestinal symptoms within 48 h of mushroom ingestion; and aminotransferases above the upper limit of normal within 48 h after ingestion. Each original participating PCC confirmed eligibility, diagnosis, treatment, and outcome on included cases.

RESULTS:

During the study period, 8,953 mushroom exposures were reported to NPDS, of which 296 met inclusion criteria. The PCC survey response rate was 60% (28/47 PCCs), and the individual case response rate was 59% (174/296). Twenty-six cases were subsequently excluded leaving 148 included cases. The overall mortality rate was 8.8% (13/148). Mortality in silibinin/silymarin-treated vs untreated cases was 9.5% (4/42), vs 8.5% (9/106), respectively. A mycologist identified mushrooms in 16.9% of cases (25/148), of which 80% (20/25) were cyclopeptide-containing. Among these confirmed cases, the mortality rate was 10% (1/10) in both silibinin/silymarin-treated and untreated cases.

CONCLUSIONS:

The contemporary mortality rate of patients with presumed cyclopeptide-mushroom poisoning is only 8.8%. This likely represents improved supportive care for patients with acute liver injury and should be considered the current standard for historical controls in the United States.

• Authors: Jonathan De Olano, Josh J Wang, Eric Villeneuve, Sophie Gosselin, Rana Biary, Mark K Su, Robert S Hoffman
• Journal: Clinical toxicology (Philadelphia, Pa.) (Clin Toxicol (Phila)) Vol. 59 Issue 1 Pg. 24-27 (Jan 2021) ISSN: 1556-9519 [Electronic] England
• PMID: 32237919 (Publication Type: Journal Article)

Chemical References

• Antidotes
• Peptides, Cyclic
• Silymarin
• Silybin

Topics

• Antidotes (therapeutic use)
• Cause of Death
• Chemical and Drug Induced Liver Injury (diagnosis, drug therapy, etiology, mortality)
• Databases, Factual
• Humans
• Mortality
• Mushroom Poisoning (diagnosis, drug therapy, mortality)
• Peptides, Cyclic (poisoning)
• Poison Control Centers
• Prognosis
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Silybin (therapeutic use)
• Silymarin (therapeutic use)
• Time Factors
• United States