Mushroom and Fungal Poisoning | Symptoms and Treatment

Mushroom / Fungal Poisoning | Symptoms and Treatment

Fungal poisoning is always an acute medical emergency. Depending on the type of fungal poison that has been ingested, it is life-threatening – and should, therefore, be treated as soon as possible!

Fungal poisoning is caused by the consumption of poisonous fungi. Various fungal toxins provide for the symptoms of poisoning. In most cases, confusion or insufficient knowledge of mushroom collectors leads to accidental preparation and intake of harmful fungi. More rarely, fungal poisoning occurs through the conscious consumption of (allegedly) psychoactive fungi.

The number of severe fungal poisonings in Germany has increased significantly in the past year. In 2013, 34 cases were treated in the hospital, according to the health insurance company DAK-Gesundheit. This is about 41 percent more than in the previous year. Most of the cases were in Bavaria.

Forms of fungal poisoning depending on the hazard

Depending on how quickly the symptoms of poisoning begin, fungal poisoning scans with short latency (15 minutes to six hours) and long latency poisoning (over six hours to several days) are distinguished. If the symptoms occur shortly after the consumption of the fungi, the poisoning is usually not organ-damaging and therefore not life-threatening. However, the unpleasant discomfort can last several days.

Poisoning with a long latency period is far more dangerous, as the poison, in this case, had a lot of time to spread in the body and attack organs such as the liver and kidneys. These cases require intensive medical treatment in order to save the lives of those affected. Nevertheless, they often have to live with long-term consequences after overcoming fungal poisoning. As with all poisonings, the extent of symptoms and damage depends on the number of toxins taken.

Food poisoning by improperly stored and spoiled fungi

In addition to the real fungal poisoning, intolerances and allergic reactions occur in some people when eating actually harmless edible mushrooms. As a result of improper storage and preparation of fungi, bacterial infestation can also lead to the formation of toxins (toxins), which lead to symptoms of classic food poisoning. It is important to have boiled mushrooms

Anyone who suffers from nausea, diarrhea or vomiting after a mushroom meal should immediately call the emergency doctor (112) or contact the poison emergency call in their state. Under no circumstances should one experiment with medicines or home remedies on your own. These can possibly disguise or even aggravate the poisoning.

A quick medical diagnosis and therapy can save lives in case of poisoning. Therefore, if you suspect a fungal poisoning, you should immediately go to a hospital and point out their suspicion that they have eaten poisonous mushrooms at the reception of the emergency room.

Symptoms of fungal poisoning

Symptoms of fungal poisoning can manifest themselves quite differently. Because each poisonous fungus variety contains different and sometimes even several different toxins.

The list of fungal toxins is very long and the harmful substances are not yet fully clarified in their chemical structure and mode of action. For all symptoms that occur after a mushroom meal, therefore, one should always think of fungal poisoning – a quick medical treatment can then save lives.

Poisoning by tuber leaf fungi

Phyllodes syndrome is the most common. This type of fungal poisoning is responsible for 90 percent of all fatal fungal poisoning. The cause is the highly toxic so-called amatoxins, which occur in tuber leaf fungi, the coniferous wood heap, some other Galerina (Häublinbgs) species, as well as in various umbrellas. Especially the green tuber leaf mushroom looks like a tempting edible mushroom and is often confused with a meadow mushroom due to its external similarity.

Amatoxins (and especially the so-called amanitins) penetrate the body cell and inhibit their genetic apparatus so that no more proteins can be produced for the exchange of information and their own metabolism. The affected tissue dies. The cells of the liver are first damaged by the action of the toxins due to their high activity. For this reason, amanitin poisoning is usually perceived as liver disease. The toxicity of the amanitine is so high that even a green tuber leaf fungus can lead to fatal poisoning.

Symptoms often occur in several phases, in the meantime even the symptoms improve, which is particularly treacherous. The first phase after the mushroom meal usually lasts eight to twelve hours (sometimes 48 hours) in which the patients have no complaints (complaint-free latency). The first signs after this are

  • Sudden onset of nausea
  • Severe, colic-like abdominal pain
  • Vomit
  • Aqueous diarrhea

This gastrointestinal phase can last 12 to 24 hours. Due to the loss of water and electrolyte, it can lead to a shock. It is triggered by other toxins (so-called phallotoxins), which are also contained in the fungi in addition to the amatoxins.

Subsequently, the discomfort improves, which is often regarded by laymen as a recovery. In reality, however, the poisoning by the amatoxins progresses inexorably. These toxins mainly attack the liver, which is noticeable after a further latency of about one to two days due to symptoms of hepatic impairment. In addition to altered blood values, jaundice and pronounced sensitivity to the pressure of the liver may occur. In addition, there may be bleeding in the gastrointestinal tract, altered urinary behavior, and impaired consciousness.

If left untreated, the patient’s death from (multi-)organ failure often occurs after a few days.

Symptoms of muscarinic type

The toxin Muskarin was isolated from the toadstool for the first time, although it is found here only in small amounts and is hardly responsible for its toxicity. In larger quantities, however, it can be found in crack fungi and funnels. The poison is built up like a certain messenger substance of the human body, the so-called acetylcholine, and occupies its docking points (receptors). The result is permanent arousal of the affected cells – with unpleasant consequences in the event of fungal poisoning.

The symptoms of poisoning usually begin shortly after eating the mushrooms (a few minutes to a maximum of two hours). Complaints include:

  • Strong saliva and tear flow
  • Sweats
  • Nausea
  • Vomit
  • Visual impairment
  • Slowed pulse

The poison can also lead to a narrowing of the airways, leading to asthma-like discomfort with acute shortness of breath. If this is the case, doctors speak of an asthmatic reaction.

Even if the symptoms of poisoning are very threatening and unpleasant, they usually subside without permanent damage. In addition, the rabies poison atropine is an effective antidote, as it displaces the muscarine from the receptors. Only in very large quantities can untreated muscarinic poisoning lead to death due to circulatory failure.

Symptoms of toadstool and panther fungus poisoning

The group of the Pantherina-type mainly belong to the toadstool and its relative, the panther fungus. Their toxins cause noise-like conditions that were previously used for ritual purposes in some cultures. However, consuming larger amounts can be fatal.

Not all responsible ingredients have yet been identified. The main active ingredient is the so-called ibotenic acid, which breaks down into the even more effective substance muscimol in the dried fungus or during cooking. Muscimol can bind to certain cell structures in the human brain, causing various disorders. The panther fungus has a significantly higher toxicity (toxicity) than the toadstool.

The complaints of this fungal poisoning as pantherina poisoning are initially reminiscent of an alcohol rush. Typical are

  • Dizziness
  • Drowsiness
  • Balance problems
  • psychological symptoms such as mood swings
  • Sensory illusions
  • Patients lose their sense of time and space and their own personality.

The characteristics of the intoxication state are decisively dependent on the initial situation. In addition to euphoria, depression, tantrums and anxiety are also possible.

Especially when consuming large amounts, there is a risk of seizures and confusion (delirium). In most cases, patients end up falling into a deep sleep that can last ten to 15 hours. After awakening, there are often no memories of the events experienced in the state of intoxication.

If too many toxins are taken, a coma or even death from respiratory paralysis can occur.

Psilocybin type: symptoms of intoxication fungi

The toxins psilocybin and psilocin occur in the so-called magic mushrooms and cause perceptual disorders similar to those of the drug LSD. The effect of psilocybin and psilocin is due to their structural similarity with the body’s messenger substance serotonin. Serotonin usually filters the incoming flood of sensory stimuli in the brain. The toxins override this protective mechanism. As a result, the brain can no longer meaningfully classify the incoming sensory impressions, resulting in overstimulation and impaired perception.

Physical signs of fungal poisoning with intoxication mushrooms include:

  • Heartbreak
  • Hypertension
  • Overheating of the body
  • Strongly enlarged pupils

However, the focus is on the psychological symptoms, which can be determined depending on the mood of the patient. As a result, euphoric intoxication, as well as massive anxiety, depression, and aggression, are possible. Patients experience a changed sense of space, time and body with disturbed sensory perceptions (volume, sounds, the play of colors). There may be impaired consciousness and various forms of hallucinations. These can be heard, seen but also felt.

The perception of reality is still mostly present, but in some cases strongly distorted. Pseudo hallucinations are therefore also referred to. The noise state usually lasts six to ten hours.

If there is a certain susceptibility (disposition), the toxins can trigger or amplify psychosis. In addition, so-called flashbacks may occur at a later time. In doing so, the patients suddenly experience the intoxication experience again, but without having consumed the triggering substance again.

Discomfort of the gastrointestinal tract

A variety of fungi can lead to a so-called gastrointestinal syndrome when consumed. Here, the symptoms are limited to the gastrointestinal tract and usually disappear by themselves after two to three days at the latest. Patients suffer from severe nausea, abdominal pain, and refractive diarrhea. The causing toxins of this heterogeneous group are very diverse. The majority of poisoning mechanisms have therefore not yet been clarified in detail.

Although fungal poisoning with a short latency period is usually not life-threatening, it should not be underestimated. In addition, it should be borne in mind that often different types of mushrooms are cooked and eaten together, so that mixed poisoning is possible, in which only the fast-occurring symptoms of poisoning are initially taken into account. It is therefore essential that all suspected cases are investigated by the medical side.

Poisoning by spring lorn

The responsible toxin gyromitrin is mainly found in the spring ordeal (can easily be confused with the edible morsel) and some (rare) related fungal varieties. Gyromitrin is broken down by cooking or by the gastric juice to the substance monomethylhydrazine. This is actually heat-resistant and water-soluble, which is why the spring kernel was sufficiently cooked for a long time as an edible mushroom (and still applies in some countries).

In the meantime, however, despite the correct preparation, several serious and even fatal poisonings have occurred. Since monomethylhydrazine is very volatile with a boiling point of 87 degrees Celsius, the substance partially escapes directly during cooking. Inhalation of the boiling water vapor can lead to poisoning. In the body, the toxin damages the liver and central nervous system.

The symptoms of poisoning often occur in two stages. First, gastrointestinal ailments such as abdominal pain, nausea, vomiting, and diarrhea occur at the earliest six hours (up to a maximum of 25 hours) after ingestion. Patients feel dull and complain of headaches. The incipience of damage to the central nervous system and the resulting symptoms (CNS symptoms) are of varying degrees in this first phase. For example, there is restlessness, enlarged pupils and convulsions. Often the discomfort then subsides and deceives a recovery.

Insidiously, however, the poisoning progresses in the body. In the second phase, CNS symptoms intensify and liver damage is increasing. These are manifested by symptoms such as jaundice (icterus), an increase in the concentration of so-called transaminases in the blood and the dissolution of red blood cells (partial hemolysis).

In addition, non-functional hemoglobin, so-called methemoglobin, is increasingly formed, which can no longer release oxygen to the tissue. The excreted amount of urine can also be greatly reduced (anuria). Patients may fall into a coma. Death can occur due to circulatory collapse and respiratory arrest a few days after taking the fungi.

Treacherous: Orellanus type with very long latency

This type of fungal poisoning was observed after eating various types of roughhead. The main culprit seems to be the substance orellanine, which has a strong kidney-damaging effect. However, since Orellana is not detectable in all cases of poisoning of this type, other previously unknown toxins are probably involved.

Particularly treacherous about this poisoning syndrome is that the symptoms have a very long latency period of two to 16 days. This circumstance often makes it difficult to attribute the disease to the mushroom meal that has been going on for a long time.

The first signs are also quite nonspecific with general mattity and headaches. Nausea, vomiting, diarrhea and abdominal cramps often occur first. Symptoms of incipient renal dysfunction include pain in the lumbar region, strong thirst and a dry mouth with at the same time altered urinary behavior. In severe cases, there are pronounced renal dysfunctions up to renal failure with increasing nausea and nausea.

If left untreated, the diseases are therefore often fatal. However, if the poisoning is detected and treated in good time, permanent damage can be avoided in many cases.

Mushroom poisoning in combination with alcohol

Symptoms of this fungal poisoning only occur if alcohol is drunk after the mushroom meal (in the case of larger amounts of alcohol, even before the fungal consumption). Therefore, after consuming various types of tinglings, the consumption of alcohol within the next 24 hours, but in exceptional cases also two to five days later, is dangerous.

As a responsible poison in the Coprinus type, the substance coprin was isolated from various tinting species. The substance interferes with the breakdown of alcohol in the body, so that certain intermediates accumulate, which lead to symptoms. The latency period, therefore, varies with the time of alcohol consumption. It should be noted that hidden alcohols (e.g. in medications) can also lead to poisoning syndrome.

Shortly after taking alcohol (20 minutes to two hours later), hot flashes and characteristic redness occur in the face and neck area. Other symptoms may include headaches, metallic taste in the mouth, tingling in the arms and legs, as well as dizziness and palpitations. As a rule, symptoms reappear within one to six hours.

Poisoning is not usually life-threatening.

Causes: Only a few fungi are life-threateningly toxic

About 150 poisonous mushrooms are known in Europe, but few of them can cause life-threatening fungal poisoning. Many of the fungi contain toxins that are hazardous to health in the raw state but are destroyed by heating (cook for at least 15 minutes). Proper preparation is therefore of great importance. However, some fungal toxins have a very stable structure, which is not destroyed even by long cooking, so that despite cooking, fungal poisoning is possible. There are even fungal toxins that work by inhaling cooking water or only in combination with alcohol.

Each poisonous fungus contains different and sometimes even several different toxins. The list of fungal toxins and the symptoms they cause is therefore very long and the harmful substances have not yet been fully clarified in their chemical structure and mode of action.

Diagnosis of fungal poisoning: quick action important

If there is a suspicion of fungal poisoning, a hospital should be visited immediately. This also applies in the event that no symptoms have yet occurred.

The diagnosis of fungal poisoning is initially based on the present symptoms and the statements of the patients or their companions.

Mushroom residues for the analysis of the poison

It is particularly important to find out as quickly as possible which fungi may have caused the poisoning if suspected. If any residues of the mushroom meal or the fungal waste are still available, it is important to pass it on to the doctor for analysis. The patient’s vomit can also be used for this purpose.

Of great importance for the further diagnosis procedure and therapy is the time between the consumption of the fungi and the first onset of symptoms.

Short latency usually indicates that the poison has not yet attacked any organs. However, since there is the possibility, especially in mixed mushroom dishes, that additional fungi with organ-damaging toxins have been ingested, a blood test will be carried out in any case and liver and kidney function will be closely monitored. The same applies to long-latency poisoning, whether or not symptoms are present.

Patients have usually admitted inpatients for observation and therapy.

Mushroom poisoning: Rapid medical treatment can save lives

The therapy depends on the type of fungal poisoning. In principle, it is important to take the toxins out of the body and to alleviate the symptoms or to avoid serious consequential damage to poisoning.

Self-responsible therapy attempts with home remedies should, in any case, be avoided in the event of fungal poisoning. In the worst case, they can obscure or even aggravate the course of the disease. If, after eating mushroom meals, there is a suspicion of fungal poisoning, the affected persons should be treated quickly by a doctor. In order to quickly determine the fungal poison causing the cause, leftovers of the collected material, the mushroom meal and possibly vomit should be taken to the clinic.

If there is certainty about the cinsing toxins, the therapy is targeted at this. If the symptoms occur very quickly after eating the mushrooms, part of the meal is probably still in the stomach. In this case, it may be useful to empty the stomach by vomiting or pumping out to prevent further intake of the toxins into the blood. However, if the symptoms occur only after a long latency period, this measure no longer makes sense, as the substances have passed through the stomach long ago.

Treatment measures against fungal poisoning

Medical coal binds toxins in the body and thus removes them from the food cycle. In many types of poisoning, therefore, 20 to 60 grams of medical coal can be administered repeatedly.

Basically, it is important to stabilize the patient’s circulation and to control blood pressure and pulse rate and, if necessary, to support it with medication.

In case of severe vomiting and aqueous diarrhea, it is important to balance the fluid and electrolyte balance. This is done if necessary via an infusion (drip).

Even if there is no life-threatening fungal poisoning, patients usually stay in the hospital for a few days for observation.

Severe fungal poisoning can lead to organ failure

If there is poisoning that leads to liver or kidney damage, the therapy focuses on the protection and relief of the affected organ. In very severe cases, a transplant can be the last salvation. In the case of tuber leaf fungal poisoning, this measure is indicated in up to 30 percent of patients and life-saving. Due to the lack of donor organs and the acute danger to the patient, artificial liver replacement systems must then be used to bridge the time to the transplant.

Prevent fungal poisoning: Leave mushrooms in doubt!

In general, only mushrooms should be consumed, which can be clearly determined. During transport, storage and preparation, fungi can also spoil and produce toxins.

Even those who think they know mushrooms well can be mistaken. Therefore, if the doubt about the edibleness of the fungus is to remain in the forest. Depending on the region, soil conditions and weather conditions, mushrooms can look quite different than you are used to. Ideally, a qualified and certified mushroom expert should confirm the find as edible.

Golden Rule: Only collect what you know

Whoever collects mushrooms – whether regularly or only occasionally – should also be able to know the most important poisonous mushrooms and their edible doppelgängers and be able to determine them without any doubt. Thus, the deadly green tuber leaf fungus must be clearly distinguished from the mushroom. Other edible mushrooms such as pearl mushrooms, chanterelles or chestnut tubes also have poisonous relatives, which mushroom collectors should know absolutely.

It is reckless to read his mushroom knowledge only with internet forums or – partly outdated – mushroom books. If you want to get into mushroom picking, you should get information from certified mushroom experts and take part in guided mushroom walks. In addition, the “immigrant” of heat-loving poisonous fungi, which often look very similar to the native, edible, threatens new dangers.

Proper storage and preparation

Improper transport, storage, and preparation can cause toxins in edible mushrooms. Therefore, only flawless mushrooms belong in the cooking pot. Sime, old and mad specimens remain in the forest. The collection vessel should be airy as fungi spoil quickly. For the same reason, they should be prepared as quickly as possible. Any storage must always be kept cool and dry to prevent fungal poisoning.

Only a few varieties of mushrooms are raw and freshly edible. Before consumption, the mushrooms should, therefore, be heated for at least 15 minutes. The remains of a mushroom meal should also be cooled quickly, stored in a cool place for a maximum of one day and consumed well heated again.

If, after the meal, there is a suspicion that harmful or toxic fungi may have been eaten, it is necessary to keep calm and to visit a hospital as soon as possible. In the case of suspected fungal poisoning, a quick diagnosis and therapy is often life-saving. Therefore, residues of the collected mushrooms, cleaning waste, residues of the prepared meal and, if necessary, vomit should be taken to the clinic to determine the specific fungal poison.