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Meunier BC, Camus CM, Houssin DP, Messner MJ, Gerault AM, Launois BG
Liver transplantation after severe poisoning due to amatoxin-containing
Lepiota--report of three cases.
Service de Chirurgie Digestive et de Transplantation d'Organes, Centre
Hospitalier Regional Universitaire, Rue Henri le Guillou, Rennes, France.
J Toxicol Clin Toxicol 1995;33(2):165-71
Article Number: UI95205514
Four cases of severe Lepiota poisoning, including three which developed
toxic fulminant hepatitis treated by orthotopic hepatic transplantation, are
reported here. The toxicity of the Lepiota is discussed as well as the
indications for hepatic transplantation in poisonings due to
Castiella A, Arenas JI
Utility of silymarin in the cyclopeptide syndrome [letter]
J Hepatol 1994 Dec;21(6):1148
Article Number: UI95213572
Nagy I, Pogatsa-Murray G, Zalanyi S Jr, Komlosi P, Laszlo F, Ungi I
Amanita poisoning during the second trimester of pregnancy. A case report
and a review of the literature.
First Department of Medicine, Albert Szent-Gyorgyi Medical University,
Clin Investig 1994 Oct;72(10):794-8
Article Number: UI95170240
Amanita phalloides-type mushroom poisoning is well recognized as causing
acute liver injury and often death. Less is known, however, of whether
maternal Amanita poisoning is associated with fetal damage or not. In August
1991 four members of a family were hospitalized with food intoxication
caused by Amanita phalloides and Amanita verna. One of them died from
hepatic and renal failure. The survivors included a 26-year-old woman in the
23rd week of pregnancy. Her clinical symptoms and blood chemistry data
(lowest prothrombin activity 23%) indicated intoxication of medium severity.
The management consisted of i.v. hydration, forced diuresis, and
administration of silibinin, high-dose penicillin, thioctic acid,
hydrocortisone, vitamin K, and fresh frozen plasma. Sonographic and
obstetric controls failed to show any fetal abnormalities in the acute phase
of poisoning. In the 38th week of pregnancy she gave birth to a healthy
baby, who has subsequently undergone an undisturbed development. This
observation indicated that severe fetal damage did not occur in maternal
Amanita poisoning in the second trimester of pregnancy. Thus, at least from
the second trimester on, maternal Amanita poisoning is not necessarily an
indication for induced abortion.
Plasmapheresis as a therapy in specific forms of acute renal failure.
Division of Nephrology, Hippokration Hospital, Aristotelian University of
Nephrol Dial Transplant 1994;9 Suppl 4():210-8
Article Number: UI95098368
Scheurlen C, Spannbrucker N, Spengler U, Zachoval R, Schulte-Witte H,
Brensing KA, Sauerbruch T
Amanita phalloides intoxications in a family of russian immigrants. Case
reports and review of the literature with a focus on orthotopic liver
Department of Internal Medicine, University of Bonn, Germany.
Z Gastroenterol 1994 Jul;32(7):399-404
Article Number: UI95066248
Alpha-amanitin, the main toxin of the death cap fungus (Amanita phalloides)
is one of the most dangerous natural poison. This toxin damages eukaryotic
cells by inhibiting their transcription. Lesions are seen in cells with
rapid protein synthesis, particular in liver and renal cells, even at low
toxin concentrations. Without adequate intensive therapy, the outcome of
alpha-amanitin poisoning is very poor. This article reports various courses
of amanitin intoxication in a family. In 3/4 patients, severe hepatic
failure developed as assessed by a decrease of all coagulation factors,
mainly Quick's test and factor V (< 10%-15%). Despite vigorous replacement
of coagulation factors, in 1 of the patients orthotopic liver
transplantation had to be performed on day 4, whereas in all other patients
liver function improved spontaneously. All patients survived their
intoxication. Both the pharmacological basis and clinical manifestations of
Amanita intoxication are discussed. On this basis a treatment scheme is
presented which the authors believe may be useful to clinicians.
Borowiak K, Ciechanowski K
[Certain enzymatic markers of liver damage in poisoning with Amanita
Pracowni Toksykologii Kliniczej Zakladu Biochemii Klinicznej i Diagnostyki
Laboratoryjnej Pomorskiej Ak. Med. w Szczecinie.
Wiad Lek 1994 Feb;47(3-4):111-3
Article Number: UI95066101
The activity of selected enzymes was studied in 12 persons on the first day
of poisoning with Amanita phalloides. It was found that the most sensitive
marker of liver damage was significant increase of activity of
cobalt-activated acylase, observed in all studied cases.
Leray H, Canaud B, Andary C, Klouche K, Beraud JJ, Mion C
[Amanita proxima poisoning: a new cause of acute renal insufficiency]
Service de nephrologie, H"opital Lapeyronie, CHR Montpellier, Faculte de
Article Number: UI95059697
To our knowledge Amanita proxima poisoning has never been reported. Amanita
proxima is a mushroom seldomy encountered, similar to a common and edible
species: Amanita ovoidae. During October 1992, we had the opportunity to
care for five cases of intoxications with Amanita proxima. In all cases
early digestive disorders, cytolytic hepatitis and acute renal failure were
noted. Outcome was favourable for all patients within three weeks with total
recovery of both renal and hepatic functions with symptomatic treatment.
Temporary dialysis was required in four patients.
Feinfeld DA, Mofenson HC, Caraccio T, Kee M
Poisoning by amatoxin-containing mushrooms in suburban New York--report of
Department of Medicine, Nassau County Medical Center, East Meadow, New York
J Toxicol Clin Toxicol 1994;32(6):715-21
Article Number: UI95055962
We report four cases of poisoning with amatoxin-producing mushrooms in
suburban Long Island. All occurred when amateur mushroom hunters picked
mushrooms from neighboring lawns. Two patients presented 30 hours post
ingestion with evidence of acute hepatic dysfunction. One survived, after
treatment with charcoal and penicillin; the other, a 90-year-old woman with
prior cardiac disease soon developed shock and subsequently died. The other
two patients were admitted 18 hours after ingestion of Lepiota chlorophyllum
and received prompt charcoal hemoperfusion. Both did well, although one had
a mild elevation of transaminases. Although most reports of amatoxin
poisoning originate in Europe, these cases confirm that amatoxin-producing
mushrooms, including Lepiota chlorophyllum, may be found in northeastern
American suburbs. Such patients who present prior to 24 hours after
ingestion should receive charcoal hemoperfusion if a lethal dose (> 50 g of
mushroom) has been eaten.
Mushrooms in medicine.
Department of Biology and Preclinical Medicine, University of Regensburg,
Folia Microbiol (Praha) 1994;39(2):91-8
Article Number: UI95047936
Fungi have played an important role as food, medicine, poison and for
religious and other purposes in the life of man since prehistoric times. The
role in medicine of higher (macro-)fungi in different countries from early
historic times through the Middle Ages until now and also their prospective
use in the future is described. Significant changes in the use of fungi for
medical purposes are shown and some current and future trends are
exemplified. Throughout the review, the role of Czechoslovak scientists in
this field, starting from taxonomy and ending in the production of
beneficial drugs from fungi is indicated.
Granda Martin MJ, Clavera Tejero I, Garcia-Andrade CR, Alonso Martin M,
Perez Tamayo I
[Amanita virosa poisoning (letter)]
An Med Interna 1994 Jun;11(6):309-10
Article Number: UI95002498
Kasilo OM, Nhachi CF
Food poisoning admissions in referral hospitals in Zimbabwe: A retrospective
Department of Pharmacy, School of Medicine, University of Zimbabwe,
Hum Exp Toxicol 1994 Feb;13(2):77-82
Article Number: UI94206622
1. A ten-year (1980-1989) retrospective study of poisoning admissions due to
food poisoning at six referral hospitals in urban Zimbabwe revealed 487
cases. This constituted 8.1% of all poisoning admission cases (6018). 2. The
majority of patients were among the 2.1-5 (20%), 5.1-10 (16%) and 21-30
(15%) year age groups in that descending order. 3. The agents implicated in
food poisoning were mushrooms (47%), food-borne and other food-related
toxins (37%), Elephants Ear (10%), alcohol (7%) and cassava (1%). 4. The
majority of poisoning cases were accidental, accounting for 99% of the
total. 5. The treatment regimens mostly used included agents for correcting
fluid and electrolyte imbalance (22.1%), antibiotics (16.7%) and supportive
measures (15.5%). 6. Mortality was recorded at 2.5% and the main agents
associated with fatality were food-related toxins (5 cases), mushrooms (4
cases) and alcohol (4 cases). 7. The prevention and treatment of poisoning
caused by food poisoning is mandatory in the effort to reduce poisoning
caused by these agents.
Dolfi F, Gonnella R
[Acute amanita phalloides poisoning in the second pregnancy trimester]
U.O. di Anestesia e Rianimazione, Ospedale Tabaracci, Viareggio (Lucca),
Regione Toscana USL n. 3 Versilia.
Minerva Anestesiol 1994 Mar;60(3):153-4
Article Number: UI94376984
A 26-year old woman who suffered from mushroom poisoning due to amanita
phalloides at 22 weeks gestation. When the life threatening maternal illness
was overcome gestation went on until full-term, natural birth. The child was
born in perfect physical conditions, without noticeable symptoms of hepatic
Castiella A, Cosme A, Arenas JI
Acute pancreatitis [letter]
N Engl J Med 1994 Oct 6;331(14):949
Article Number: UI94359585
Meunier B, Messner M, Bardaxoglou E, Spiliopoulos G, Terblanche J, Launois
Liver transplantation for severe Lepiota helveola poisoning.
Service de Chirurgie et de Transplantation d'Organes, CHU Pontchaillou
Liver 1994 Jun;14(3):158-60
Article Number: UI94359375
Orthotopic liver transplantation in patients with fulminant hepatic failure
secondary to Lepiota helveola poisoning has not, to our knowledge, been
reported. Our recent experience with liver transplantation in a 27-year-old
woman with acute hepatic failure secondary to this poisoning is described.
The indications for orthotopic liver transplantation are discussed.
Doepel M, Isoniemi H, Salmela K, Penttila K, Hockerstedt K
Liver transplantation in a patient with Amanita poisoning.
IV Department of Surgery, Helsinki University Central Hospital, Finland.
Transplant Proc 1994 Jun;26(3):1801-2
Article Number: UI94303073
Perez-Moreno J, Perez-Moreno A, Ferrera-Cerrato R
Multiple fatal mycetism caused by Amanita virosa in Mexico.
Seccion de Microbiologia, Colegio de Postgraduados, Edo. de Mexico, Mexico.
Mycopathologia 1994 Jan;125(1):3-5
Article Number: UI94301376
Mushroom poisonings caused by amatoxins are mostly lethal. Information about
mycetisms caused by white species of Amanita is scarce. The present paper
describes a case of mushroom poisoning caused by A. virosa. A prolongated
latency period (6-10 hours), followed by cholera-like, improvement and
visceral complication phases confirmed the amatoxin poisoning. The
consumption of about 3 pounds of the toadstool by seven persons caused the
death of five. Two patients survive the ingestion.
Zachoval R, Gunther C, Scheurlen C, Kluppelberg UG, Zilker T, Pape GR
[A 27-year old patient with watery diarrhea, nausea and vomiting 10 hours
after eating a mushroom dish. Interdisciplinary liver transplantation team
of the Grosshadern Clinic]
Medizinische Klinik II, Klinikum Grosshadern,
Internist (Berl) 1994 Apr;35(4):385-91
Article Number: UI94259558
Ambuhl PM, Ballmer PE, Krahenbuhl S
[Fulminant hepatitis: pathogenesis, clinical aspects and management]
Klinik B fur Innere Medizin, Kantonsspital, St. Gallen.
Schweiz Med Wochenschr 1994 Mar 5;124(9):368-80
Article Number: UI94188698
Fulminant hepatic failure may develop as a complication of liver disease of
various etiology. Infectious agents, drugs and liver toxins represent the
major causes of fulminant hepatitis. The function of many organ systems may
be impaired during acute hepatic failure because of the crucial role of the
liver in intermediary metabolism. The mortality of 50% or more is mainly due
to cerebral edema, bleeding from the gastrointestinal tract or disseminated
infections. In this review the causes, complications and pathophysiology of
fulminant hepatitis are discussed, with particular reference to the
prevention of complications and to therapeutic strategies. Moreover,
criteria for assessment of prognosis are discussed. A case report
illustrates the complex clinical picture and frequently fatal outcome of the
Clinical approach to toxic mushroom ingestion.
Family Practice Residency of Idaho, Boise 83704.
J Am Board Fam Pract 1994 Jan-Feb;7(1):31-7
Article Number: UI94182481
BACKGROUND: This review provides the physician with a clinical approach to
the diagnosis and management of toxic mushroom ingestion. It reviews the
recent literature concerning proper management of seven clinical profiles.
METHODS: Using the key words "mushroom poisoning," "mushroom toxicology,"
"mycetism," "hallucinogenic mushroom ingestion," and "Amanita poisoning,"
the MEDLINE files were searched for articles pertinent to the practicing
physician. Much of the original data were gathered at the Aspen Mushroom
Conference held each summer throughout the 1970s at Aspen, Colorado,
sponsored by Beth Israel Hospital and the Rocky Mountain Poison Center.
Texts related to poisonous plants and specific writings concerning mushroom
poisoning were also consulted; many of these texts are now out of print.
RESULTS AND CONCLUSIONS: The 100 or so toxic mushroom groups can be divided
into seven clinical profiles, each of which requires a specific clinical
approach. Two of the seven groups (amanitin and gyromitrin) have a delay in
onset of symptoms of up to 6 hours following ingestion and provide
essentially all the major mobility and mortality associated with toxic
mushroom ingestion. These two groups are the major focus of this review.
Treatment of the potential mushroom ingestion, as well as guidelines for
asking clinical questions, are included. These questions serve as a form of
algorithm to assist the clinician in arriving at the correct toxic group.
[Plant poisoning cases in Turkey]
Departement de Pharmacognosie, Faculte de Pharmacie, Universite d'Istanbul,
Ann Pharm Fr 1994;52(5):260-5
Article Number: UI95160431
In Turkey, the majority of the population live in rural areas where they use
wild plants as food and medicine. The confusion of an edible plant with a
poisonous one give rise to serious poisoning which may even result in death.
The incidence of plant poisoning in Turkey is about 6% and especially high
among children between ages of 2 and 11 living in rural areas. The number of
species that cause poisoning is around twenty and Hyoscyamus niger
(Solanaceae), Colchicum species (Liliaceae), Conium maculatum (Umbelliferae)
and Prunus species (Rosaceae) are the most important. Mushroom poisoning is
more frequent in spring and fall. The main reasons are their widespread
usage as food and the inexperience of the gatherers in distinguishing the
edibles from the poisonous. Amanita phalloides, A. verna, A. muscaria, A.
pantherina are responsible for severe cases of poisoning.
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