JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Exposure Surveillance System (TESS), for all telephone-reported poisonings in the US for over 25 years, and the US Centers for Disease Control and Prevention (CDC) often reports regional case series clusters of mushroom poisoning. 9 Over a 16- year period, 1979-1995, the AAPCC reported that mushroom poisoning represented less than 0.5% of all reported poisonings; exact species were unidentified in over 95% of cases; and the toxic genera were unidentified in over 90% of cases. 9-11 Half of all mushroom-poisoned patients exhibited no symptoms; 25% required treatment: 10-15% for minor toxicity, less than 5% for moderate toxicity, and 0.3% for major toxicity. 9-11 During this same period, 17 adults died frommushroom poisoning. 9-11 Most of the deaths (n =12) occurred from the ingestion of amatoxin- containing species, primarily Amanita phalloides (Death Cap Amanita), with remaining deaths due to unidentified species. 9-11
were expertly identified in only 3.4% of 9,208 cases, 81% of patients were less than six years of age, only 0.2% of patients experienced major toxicity, and all 3 deaths (0.03% case fatality rate) occurred following ingestion of amatoxic species. 9 In 2000, Nordt and Clark conducted a five-year retrospective analysis of mushroom ingestion reports (n = 6,317) to AAPCCs in California, and found that 67% were in children younger than six years of age, 6% experienced minor clinical toxicity, most commonly vomiting in 28.2%, 0.3% experienced major toxicity, and the single fatal case occurred in a 32-year old who consumed foraged, unidentified mushrooms. 12 In 2005, Diaz reported the results of a meta-analysis of 28,018 cases of mushroom poisonings worldwide over the period, 1951-2002, and found a significant increase in the frequency of reported mushroom poisonings over time with most poisonings due to amatoxin-containing species, especially from the genera Amanita, Galerina , and Lepiota . 2 In a 2014 review of the
In a 1991 analysis of the 1989 cases of mushroom ingestions reported to the AAPCC, Trestrail reported that suspect species
Table 1
Amanita mushrooms
Cortinarius mushrooms
Russula subnigricans
Tricholoma equestre
Taxonomy (Family)
Amanitaceae
Cortinariaceae
Russulaceae
Tricholomataceae
A yellow mushroom also known as the yellow knight & formerly considered edible. Rhabdomyolysis- associated nephrotoxicity may follow several
Largest mushroom family with 2,000-3,000 species, at least 8 known to be nephrotoxic, none are recommended as edible worldwide.
A creamy white mushroom native to China, Japan, Korea, & Taiwan where ingestions have resulted in outbreaks of rhabdomyolysis associated with acute renal failure.
About 600 species, at least 7 known nephrotoxic, many are edible.
Diversity
mushroom meals. Many other Tricholoma species are edible.
Leaf & needle litter & decaying wood of coniferous & oak woodlands with chalky (limestone) soils Large, white caps that can flatten out from convex to plano-convex
Needle litter of coniferous woodlands with chalky (limestone) soils
Leaf litter of deciduous oak woodlands in mountainous regions
Needle litter of pine forests with sandy soils
Preferred habitat (US)
Large orange to rusty brown caps that flatten from convex to flat with age
Large dull creamy white caps that flatten from convex to flat to concave with age
Large yellow to yellow-green cap with yellow gills
Color of mature mushroom
Color of spore print
White
Brown
White
White
Smell has been described as unpleasant. Cap convex to flat with age; free gills; stem (stipe) is shaggy with an easily torn annulus (ring) & prominent volva (base). Amanita proxima has been mistaken for edible Amanita ovoidae . Amanita smithiana has been mistaken for edible Tricholoma magnivalere.
Slight radish smell & no strong taste Large flat orange to rusty brown caps with gills
Smell
Not distinctive
Not distinctive
Large dull creamy white caps that flatten from convex to flat to an everted umbrella shape with age; gills attached to thick, stems; no annulus. White flesh turns a pale red color when cut. Russula subnigricans has been mistaken for Russula nigricans , a less poisonous species that may be consumed. White flesh turns black when cut. Russula cantharellicola , a likely nephrotoxic species found in coastal oak woodland habitats in California.
Large yellow to yellow-green cap with yellow gills attached to an even diameter stem without a ring.
Distinctive mycological features
connected to stems without rings. Top of the cap may have a darker umbo (protuberance). Cortinarius species mushrooms have been mistaken for edible chanterelles. C. speciosissimus (synonym C. rubellus ) has been mistaken for edible Cratellus tubaeformis & Hygrophorus species.
Tricholoma equestre was formerly considered edible. It has been mistaken for other edible Tricholoma
Species commonly mistaken for which edible specices
species, such as T. aestuans , T. auratum , & T. sulphureum .
J La State Med Soc VOL 169 NOVEMBER/DECEMBER 2017 163
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