Despite cultural changes over the past decades, mushroom ingestions, particularly toxic mushroom ingestions, are becoming more common.
According to the American Association of Poison Control Centers, there were 7,733 mushroom exposures in the United States in 2007, and nearly 35% of those exposures resulted in health care facility visits.1 A smaller 2-year study performed in Texas revealed an admission rate of 7.9% for intentional mushroom exposures.2 Luckily, the vast majority of these ingestions result in minimal symptomatology, with few fatalities.
However, even in intentional ingestions, it is often difficult for emergency physicians to differentiate between potentially life-threatening ingestions and those with more benign clinical courses.
Adding to the diagnostic confusion of mycotoxic exposures is the rarity with which patients or physicians are able to identify the species of mushroom that was ingested. Regional, and especially international, variation does occur, and knowledge of prior exposures or potential pathogens in your particular area is often helpful. Further aid can sometimes be garnered by patient characteristics and the history of the ingestion.
The overwhelming majority of pediatric patients present with accidental, also known as “backyard,” ingestions. In a review of Toxic Exposure Surveillance System (TESS) data, more than 82,000 accidental ingestions of mushrooms in pediatric patients were catalogued, and just 16 cases had major effects, with no fatalities.3 Adults, on the other hand, present mainly for intentional ingestions, most commonly because of culinary use of misidentified mushrooms, illicit use of hallucinogenic mushrooms, or, more rarely, deliberate self-injurious behavior.
Experts agree that, in terms of emergency department management, a syndromic classification scheme is needed to promote accurate diagnosis and risk stratification. Multiple iterations have been proposed over the past three decades (see sidebars, p. 13).4,5 It is also important to have knowledge of the most common mushroom species and their varied, and time-dependent, effects.
Please note that disposition recommendations are for known ingestions in the following sections, and that patients with persistent, uncontrolled symptoms following a mushroom ingestion should always be admitted.
Syndrome Classification: Germany
- Short lag time (< 4 hours): neurotoxic.
- Short lag time (< 4 hours): cholinergic.
- Delayed lag time (> 4 hours): gastroenteritis, plus autoimmune hemolytic anemia.
Source: Leber Magen Darm 1987;17:97-112