Published in McIlvainea 13(2):86-92, 1998

John H. Trestrail, III, RPh, FAACT, DABAT
Managing Director
Spectrum Health Regional Poison Center
1840 Wealthy, S.E., Grand Rapids, MI 49506  U.S.A.
&
Chairman, Toxicology Committee
North American Mycological Association

In 1997 there were 141 reports which represented exposures of 114 humans, 20 dogs and 2 cats, with some incidents reported more than once. There were 4 fatalities (2 human, 2 dog). See TABLE #1 for the yearly tabulation of reports and patients by reporting period.

Exposures when broken down by age groups, showed that in 62% of the exposures, the human patient was 18 years of age or older.  In 4% of the cases reported the patient was less than six years old; these were "grazing" incidents.  In 16% of the cases the patient was nonhuman (dog, cat).  See TABLE #2 for a breakdown by age grouping of patients.

Exposures were reported from 19 different U.S. States, and two Canadian Provinces.  Two states, Colorado (60), and California (13) accounted for 54% of the patients.  Often the report was received from a state other than the location of the exposure case.  The distribution of reporters and incidents reflects more the diligence of individual reporters and dedication of the toxicology committees of certain local clubs than the actual geographic prevalence of mushroom poisonings.  The largest number of reports (70) was submitted, once again, by a single very dedicated NAMA reporter, Marilyn Shaw, of Denver, Colorado. TABLE #3 shows the distribution of cases by location of the case reporter (with duplicate reports consolidated) as well as the geographic location of the incident.

In 49 (36%) of the incidents, the genus or species of the mushroom was unknown or doubtful; or mixed species were involved.  The 87 cases that involved single, identified species covered a total of 27 different mushroom genera, with Amanita, 37 cases (43%; bisporigera, muscaria, pantherina, phalloides); Omphalotus olearius, 7 cases; and Chlorophyllum molybdites, 5 cases, most frequently reported.

For each species listed, one will find the total number of case reports followed by the number of exposure cases by state or province where the incident(s) occurred.  This information is followed by the symptoms reported alphabetically, and the number of cases of the total reported in which these symptoms occurred.  Appropriate notes have been included where applicable.

Agaricus californicus - 1 case (CA).  Symptoms: nausea.

Agaricus placomyces - 1 case (MO).  Symptoms: unknown.  NOTE: this was a suicide attempt in which the victim thought it was an Amanita.

Agrocybe pediades - 1 case (CA).  Symptoms: nausea, vomiting.

Amanita bisporigera - 4 cases (OH).  Symptoms: diarrhea 4/4, intestinal cramps 4/4, liver enzyme elevated 4/4, liver failure 1/4, nausea 4/4, vomiting 4/4.

Amanita muscaria - 12 cases (AK/1, CO/9, WY/2).  Symptoms: disorientation  1/12, diarrhea 3/12, hallucinations 1/12, high/intoxicated feeling 5/12, defensive 3/12, frightened 3/12, evasive 1/12, hyperactive 1/12, vomiting 2/12, intestinal cramps 2/12, salivation 2/12, weakness 1/12, unable to walk 1/12, ataxic 2/12, tremors 1/12 tachycardia 2/12, mydriasis 2/12, flatulence 1/12, constipated, tired-sleepy, 1/12.  NOTE: 4 cases involved non-human patients (3 dogs and 1 cat).

Amanita pantherina - 13 cases (CO/13).  Symptoms:  dizziness 1/13, disoriented 5/13, hallucination 3/13, muscle spasm 6/13, pain- arm and chest 1/13, ataxic 10/13, intoxicated-feeling 1/13, vision disturbed (blurred, colors, diplopia), 4/13, vomiting 1/13, mydriasis 2/13, blindness 1/13, weakness 1/13, lethargic 2/13, deep sleep 1/13, aggressive 3/13, chills 1/13, euphoria 1/13, analgesia 1/13, unresponsive 1/13, hyperactive 2/13, tremors 1/13, hypersensitive to sound 2/13, fear of dying 1/13, panting 1/13, flatulence 1/13, slurred speech 1/13.
NOTE: 7 cases involved non-human patients (6 dogs and 1 cat), and most of the canine patients showed dizziness and hyperactivity.  One canine, with prompt treatment, showed no symptoms.

Amanita phalloides - 9 cases (CA/7, WA/2).  Symptoms: nausea 7/9, vomiting 8/9, diarrhea 8/9 intestinal cramps 7/9, dizzy 2/9, drowsy 2/9, weakness 2/9, liver damage 2/9, death 1/9;
Meixner positive 3/3 tested.
NOTE: Three other cases (CA/1 dog, FL/1, NY/1, also included in the unknown species cited below)were thought to be due to toxic Amanita species based on circumstantial evidence.  Symptoms: nausea 1/3, vomiting 2/3, diarrhea 1/3, disoriented 2/3, intestinal cramps 1/3, weakness 1/3, drowsy 2/3, unconscious 1/3, muscle spasm 1/3, salivation and foaming mouth 1/3, liver failure 2/3, hypoglycemia 1/3, kidney necrosis 1/3, liver necrosis 1/3, death 2/3.  One case with liver failure received a liver transplant and survived.

Amanita virosa - 1 case (OH).  Symptoms: liver failure.  NOTE: This case, in a Taiwanese immigrant, resulted in a liver transplantation.

Boletus barrowsii - 1 case (CA).  Symptoms: nausea, vomiting.

Boletus edulus - 2 cases (CO/2).  Symptoms: dizziness 1/2, nausea 2/2, vomiting 1/2.  NOTE: These cases involved the ingestion of mixed species.
Boletus satanus - 1 case (OR).  Symptoms: nausea, salivation, sweating, vomiting, weakness.

Chlorophyllum molybdites - 5 cases (CO/5).  Symptoms: diarrhea 3/5, dizziness 1/5, intestinal cramps 3/5, headache 1/5, nausea 2/5, vomiting 5/5.

Clitocybe dealbata - 1 case (WA).  Symptoms: sweating, vomiting.

Corpinus comatus - 1 case (OR).  Symptoms: drowsiness, nausea, vomiting.  NOTE: specimens were frozen after cooking, and eaten later.

Gomphus floccsus - 1 case (OR).  Symptoms: chills, diarrhea, vomiting.  NOTE: Fungus was eaten along with Tricholoma pardinum.

Gymnopolis spectabilis - 1 case (OR).  Symptoms: anxiety, hallucinations, visual disturbances.

Gyromitra esculenta - 4 cases (IA/1, MI/3).  Symptoms: diarrhea 1/4, disorientation 1/4, drowsiness 1/4, nausea 3/4, vomiting 4/4, weakness 2/4.

Gyromitra gigas - 2 cases (ID/2).  Symptoms: diarrhea 2/2, dizziness 1/2, headache 1/2, intestinal cramps 1/2, nausea 2/2, sweating 1/2, vomiting 2/2, weakness 1/2.

Hypomyces lactiflorum - 1 case (CA).  Symptoms: dizziness, nausea, sweating, weakness.

Leccinum testaceoscabrum - 1 case (AK).  Symptoms: nausea, vomiting.  NOTE: There is a possibility that there was another cause of these symptoms, not related to the fungal exposure.

Lentinus edodes - 1 case (CO).  Symptoms: chills, weakness.

Leucocaprinus americanus - 1 case (OR).  Symptoms: light headedness, nausea, throat irritation.

Lyophyllum decastes - 1 case (AK).  Symptoms: diarrhea, dizziness, nausea, vomiting.

Nolanea sevicea - 1 case (WA).  Symptoms: no symptoms were reported.

Omphalotus olearius - 7 cases (Canada, Ontario/3, OH/1, WV/3).  Symptoms: chills 1/7, diarrhea 2/7, dizziness 1/7, intestinal cramps 1/7, nausea 4/7, vomiting 7/7, weakness 2/7.  NOTE: In one case the victim thought they had collected a Chanterelle.

Panaeolus foenescii - 1 case (OR).  Symptoms: body pain.

Phaeolepiota aurea - 2 cases (AK/2).  Symptoms: diarrhea 1/2, intestinal cramps 1/2, nausea 1/2.

Pholiota aurivella - 1 case (OR).  Symptoms: chills, diarrhea, dizziness, intestinal cramps, muscle spasms, nausea, vomiting.

Phiolota squarosa - 1 case (CO).  Symptoms: diarrhea, intestinal cramps, vomiting.

Pleurotus ostreatus - 1 case (OR).  Symptoms: diarrhea.  NOTE: Mushroom had been grown from a "kit".

Psilocybe cubensis - 1 case (MT).  Symptoms: fear, nausea, sweating.

Psilocybe cyanescens - 1 case (NC).  Symptoms: disorientation, flushing, hallucinations.

Suillus tormentosus - 1 case (CO).  Symptoms: chills, diarrhea , nausea.

Tubaria furfuracea - 1 case (CA).  Symptoms: fever, intestinal cramps, nausea, vomiting, weakness.

Unknown genus or species, or mixed species - 49 cases: 38 human (including 5 children) and 11 dogs (AK/1, CA/1, CO/28, FL/1, ID/6, MT/3, NJ/1, NS/1, NY/1, OR/3, Wa/1, WI/1, WV/1). A complete list of symptoms is too extensive to list; the most prevalent or significant: death 3/49 including 2 dogs; vomiting 19 (39%); nausea 17 (35%); diarrhea 14 (27%); muscle spasm 8 (16%); ataxic, dizzy, intestinal cramps, mydriasis 7 each (14% each).

There was also a report about a flock of ducks, apparently eating mushrooms, possibly affected with botulism, Involvement of mushrooms is problematical, and the incident was excluded from the above data .

Amanita pantherina (MPCR #97-70/71): Two adults, a 20 year old son and 38 year old mother, picked, cooked and ate six mushrooms which they had found int he mountains.  They were transients, living in a tent and apparently attempting to live off the land.  The son had obtained a book from the library to identify mushrooms, and was sure they had eaten this type of mushrooms before, and the son had eaten the largest quantity of mushrooms.  When presenting to an ER, the physician reported that the son showed no mentation, and responded to only deep pain.  When he was eventually aroused, he reported that he could not see, had a wild look, was ataxic, belligerent and was striking out at his mother.  There were muscle spasms, disorientation, and vomiting.  The son later described his experience as a "nightmare - the worst experience ever", in which he had seen lots of colors.  The patient reported he had lain down to sleep and was reading a book.  He had read 3 or 4 chapters, then thought he had fallen asleep, but he said he realized he was not sleeping and did not sleep all night (which included the time when he was completely unresponsive in the ER).  The mother reported no symptoms until her son was under control, when she then became dizzy, disoriented, unsteady and felt drunk ("everything was going around in circles").  She had muscle spasms and complained of pain in her chest and arm.  She reported that she felt like she had a 200 pound weight on her chest.  After observation, they both eventually recovered.

Chlorophyllum molybdites (MPCR #97-63): A mother, aged 50 years, picked in her urban yard.  She ate some cooked at 9:00 AM, with no ill effects.  At 5:00 PM., while preparing more, she ate a whole mushroom raw.  Her daughter, aged 27 years, ate a grape-sized piece.  Approximately 2- 3 hours later, the mother experienced nausea, vomiting (x1), diarrhea (x3). intestinal cramps, faintness, and complained of feeling cold and clammy.  The daughter developed symptoms of vomiting (x1), and diarrhea (x1), approximately 4.5-5 hours post ingestion.  The daughter did not feel well for 3 hours.  Both declined to go to an ER.  It is suspected that the mushroom eaten in the morning was a species of Agaricus.

Russula sp.(MPCR #97-102/103): Two adults, a 70 year old female, and her husband in his 70's, who were both Russian and spoke no English, had consumed mushrooms given by a friend who had collected the specimens in the mountains a month previously.  The wife had pickled the mushrooms without cooking them.  They had each eaten 1 and ½ of some 6 centimeter specimens, and after approximately 5 hours, the wife experienced vomiting and nausea, diarrhea, and severe abdominal pain.  The husband also suffered similar symptoms, after an onset of nearly 10 hours.

SPECIAL NOTICE: The Mushroom Poisoning Case Registry has a website for reporting cases, http://www.sph.umich.edu/~kwcee/mpcr. Reports are invited for all symptomatic mushroom poisoning cases and any asymptomatic cases due to known or suspected toxic species.  Reports need not be recent as long as one is confident of the data.