For 1998 the Registry received 64 reports involving 56 human cases (38 adults, 18 children) and 8 animals (7 dogs, 1 cat). This represents a decrease from the 141 reports received for 1997.A single fatality involved a dog eating Amanita virosa.

    For the human cases reported for 1998 of the 38 adults, 23 were male, 14 female, 1 gender not reported; male to female ratio, 1.6. For the children, 15 years or younger 10 were male, 7 female, 1 gender not reported; M/F, 1.4. For comparison for all cases through 1998, the M/F ratios were 1.6 for adults; 1.2 for children. Age distribution is shown in Table 2.

    For 1998 the median age for children was 2.5 years, for adults, 37.5. For 13 children 9 years or younger, all were accidental exposures to raw mushrooms- "grazers.". Eight children, 3 years and younger were all asymptomatic, with the exception of one 2-year-old who ingested an Agaricus possibly xanthodermus complex. Older grazing children, ages 5-9, experienced symptoms. One 11-year-old, part of a family, was ill from eating Amanita muscaria, misidentified as puffballs. Three 15-year olds were part of a cluster of 7, ages 15-23, ingesting mushrooms for recreation. Five other recreational users were ages 31-35; one, 57. Most adults ingested mushrooms as food, cooked; but 10% ate the mushrooms raw, 5% mixed raw and cooked; 10% preparation unreported. Alcohol use was reported in 24% of the cases.

    In comparison to the reports for 1983-98, the median age for children with reported ages was 4 years; for adults, 40. Use as food accounted for 72% of the cases; of whom 75% cooked their mushrooms; 19% ate them raw; 7% unknown, mixed, pickled or dried. Alcohol use was reported in 22% of the cases. Recreational ingesters, less than 1%, ranged from 6 to 57 years, median 19, omitting one 2-year-old given "a swallow or two" of a pyschodelic mushroom tea.

    In addition there were 10 cases where the species identification was uncertain; 2, limited to genus; 11 where the species was unknown; 2 involving mixed species. Reasons for incomplete or absent identifications include uncertainty in field("eyeball") inspection; poor condition of specimen; incomplete or absent information, e.g. in a telephone consultation; failure to get mycological advice. Cases where identifications were possible but uncertain included: Agaricus xanthodermus complex, 3; Amanita muscaria or pantherina, 2 dogs and 1 cat; Amanita gemmata or crenulata, 1; Gyromitra sp. "brain", 1; Ramaria near aurea, 2. Two cases of Psilocybe were identified to genus; 11, including 1 dog, species unknown. Two cases were reported with mixed species; 1, Hericium ramosum and Dentinum umbilicatum; 1 Russula spp. and unknown species. Symptoms are not reported with the species for these latter cases.

Chlorophyllum molybdites, 4 cases: 2 children, ate raw; vomiting, 2/2; 2 adults ate cooked for food,; diarrhea, 2/2;
vomiting, 2/2.

Agaricus xanthodermus complex: 3 adults ate cooked for food, 1 with alcohol: malaise, 2/3; vomiting, 2/3.

Amanita pantherina 3 dogs: disoriented, 3/3; lethargic, 3/3; staggering, 2/3; whining, 2/3; panting, 2/3; agitated, 2/3; muscle pain, 2/3; muscle spasm, 1/3; weakness, 1/3.

Amanita virosa 2 cases: 1 child, 8 years old and developmentally delayed ate mushroom in his yard. Vomiting and drowsiness occurred after 6 hours. His tratment included intravenous fluids, penicillin and charcoal. A puppy also ate a mushroom from the yard and vomited followed by hypoglycemia, coagulopathy, liver failure and death.

        The following species were associated with single cases in 1998.

Amanita vaginata: 1 new case and 1 previous. In the recent case an adult male ate 2 or 3 caps and 1 stipe raw. After 4 hours he developed chills, diarrhea, disorientation, drowsiness, intestinal cramps, nausea, sweating, weakness, bloody stool, anemia. A Meixner test was negative for amanitin. Treatment includes gastric lavage, charcoal, intrvenous fluids, and hemoperfusion. In the earlier case an adult male had eaten the mushroom cooked and in 4.5 hours experienced dizziness, nausea, and out-of-body feeling; eaten previously without ill effect.

Calvatia gigantea: 1 new case and 1 previous. Both cases involved adults who had eaten the species before without ill effect. In the recent case the mushroom was starting to brown and was eaten raw, and alcohol was drunk. Drowsiness and vomiting followed in 8-10 hours. The prior case appeared to be an allergic reaction, with rash, flushing and a burning sensation around the mouth.

Cantharellus cibarius: 1 new case and 10 previous. All ate the mushrooms cooked for food, the new case and 1 other with alcohol. The new case suffered vomiting and the prior cases various gastrointestinal symptoms but some of the latter also experienced numbness, pain or edema.

Gomphus floccosus: 1 new case and 1 previous. Both experienced diarrhea and the new case severe intestinal cramps.

Lepiota rachodes: 1 new case and 11 previous. All had gastrointestinal symptoms except 1 previous case, allergy.

Leucoagaricus naucinus: 1 new case (child) and 6 previous (4 children). The new case was asymptomatic, possibly due to prompt treatment with ipecac, but all previous cases had gastrointestinal effects.

Morchella elata: 1 new case, vomiting; and 5 previous, also and more extensive gastrointestinal symptoms.

Morchella esculenta: 1 new case ate a small amount raw and a few cooked, and with alcohol; intestinal cramps and vomiting followed in 1 hour. Among 16 previous cases, 1 ingesting raw specimens suffered explosive diarrhea; others, eating cooked mushrooms, 4 with alcohol, experienced various gastrointestinal symptoms.

Panaeolus foenisecii: 1 new case; a child, asymptomatic treated with ipecac. Sixteen previous cases: 12 in children, 3 asymptomatic, 9 with various central nervous system effects; 3 adults with nausea and dizziness, 1 adult with contact allergic reaction.

Phallus impudicus: 1 new case, adult with contact hypersensitivity; 2 prior cases, both with gastrointestinal symptoms.

Pholiota kodakensis: 1 new report of possible ingestion by asymptomatic child; 1 previous report of adult with gastrointestinal effects after cooked mushrooms.

Psilocybe cubensis: 1 new and 7 previous cases, all in adults, taken for recreation with inimical, central effects.

Scleroderma cepa: 1 new and 4 previous cases. The new case was a child, asymptomatic and treated with ipecac. The previous cases involved 2 child and 2 adults, all eating raw mushrooms with gastrointestinal effects.

    For mushroom species involving a single case, the associated symptoms, particularly gastrointestinal, should be regarded with caution. It may be a "bum rap" for the mushroom. The consumption of a wild mushroom, particularly if one has participated in its collection, may be a memorable event and unpleasant sequelae associated with the mushroom rather than other possible causes such as prior bacterial or chemical contamination of the specimen; concurrent infection of the patient, e.g "stomach flu"; improper storage or cooking. Each of the following species was associated with a single case in the 1998 series and reported for the first time to the Registry.

Agaricus brunnescens cultivated: 6 hours after eating purchased commercial mushrooms that "seemed old and moldy" patient developed chills, sweating fever, pallor and vomiting. Deterioration of the mushrooms, rather than toxicity is a reasonable conclusion.

Amanita flavorubescens: eaten raw by child; vomiting, onset 15 hours.

Cantharellus subalbidus: chills and vomiting; eaten by 2, only 1 ill.

Leccinum atrostipitatium: eaten raw, alcohol involved; nausea, vomiting and diarrhea in 1.5 to 2 hours.

Pleuteus cervinus: eaten raw by child; treated with ipecac and asymptomatic.

    Mycophagy is not limited to mushroom club members nor to mycologists and there should be efforts to increase awareness of and reporting to the Registry not only within organized mycology but also the medical establishment and all engaged in outdoor activities who might experience misadventures with mushroom. The following recommendations should not only benefit the Mushroom Poisoning Case Registry but also supplement NAMA's mission to promote, pursue, and advance the science of mycology.

• Urge mushroom clubs to appoint toxicology committees or toxicology liaison persons to facilitate identification of mushrooms in local exposures and the collection of data. In matters of health and safety and in its educational mission, NAMA's obligations extend beyond its memberhip.
• Invite professional mycologists to volunteer for listing with NAMA Toxicology Committee as identification consultants.
• Publicize and encourage use of the Mushroom Poisoning Case Registry and it's website <http://www.sph.umich.edu/~kwcee/mpcr>.

Blanc, PD et al. 1993. Surveillance of poisoning and drug overdose through hospital discharge coding, poison control center reporting, and the Drug Overdose Warning Network. Am. J. Emerg. Med. 11:14-9

Litovitz, TL et al. 1998. 1997 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am. J. Emerg. Med. 16:443-97