Amatoxin-containing
mushroom poisoning occurs after consumption of certain mushroom species, of the genera Amanita, Lepiota and Galerina. Amanita phalloides is the most implicated species, responsible for over more than 90% of mushroom-related deaths. The α-
amanitin is responsible for most of the observed effects. Symptoms are characterized by severe delayed
gastrointestinal disorders (more than six hours after ingestion). The liver being the main target organ, outcome is marked by an often severe
hepatitis which can evolve towards terminal
liver failure, justifying orthotopic
liver transplantation.
Acute renal failure is common. Diagnosis of
amatoxin-containing
mushroom poisoning is based primarily on clinical data; it can be biologically confirmed using detection of amatoxins, especially from urine samples. In the absence of an
antidote, early hospital management is essential. It is based on supportive care (early compensation of hydroelectrolytic losses), gastrointestinal digestive decontamination, elimination enhancement,
amatoxin uptake inhibitors and
antioxidant therapy. Combined
therapy associating
silibinin and
N-acetylcysteine is recommended. Prognosis of this severe
poisoning has greatly benefited from improved
resuscitation techniques. Mortality is currently less than 10%. In the event of a suspected or confirmed case, referral to a Poison Control Center is warranted in order to establish the diagnosis and guide the medical management of patients in an early and appropriate way.