DOI: http://dx.doi.org/10.18203/2349-3933.ijam20201629

Prognosis and treatment options in cases of acute liver failure caused by mushroom poisoning due to Amanita phalloides

Anant Parasher, Akshay Aggrawal

Abstract


Poisoning due to mushroom ingestion is a relatively rare but deadly cause of acute liver failure (ALF). Consumption of the poisonous mushroom Amanita phalloides, also known as ‘death cap’, is one of the most common causes of mushroom poisoning worldwide, being involved in the majority of human fatalities caused due to mushroom ingestion. A major portion of the liver damage due to Amanita phalloides is related to powerful toxins known as amanitins, which cause impairment in protein synthesis and subsequent cell necrosis by the inhibition of RNA polymerase II. Initially the presentation is that of an asymptomatic lag phase, followed by gastrointestinal symptoms and hepato-renal involvement. Amatoxin poisoning may progress into fulminant hepatic failure and eventually death if liver transplantation is not performed. It is based on a careful assessment of history of type and duration of mushroom ingestion, as well as the clinical manifestations. Diagnosis can be confirmed by laboratory tests measuring urinary amatoxin levels and identification of the mushroom. Although N-Acetyl Cysteine and Penicillin-G have proven to be effective therapeutic agents, Orthotopic Liver Transplantation (OLT) or Auxiliary Partial Orthotopic Liver Transplantation (APOLT) is the only treatment option for most of the cases carrying a poor prognosis.


Keywords


Amanita phalloides, Amatoxin, Hepatic failure, Liver transplantation, Mushroom poisoning

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References


Garcia J, Costa V, Carvalho A, Baptista P, Pinho P, Bastos M, et al. Amanita phalloides poisoning: Mechanisms of toxicity and treatment. Food Chem Toxicol. 2015;86:41-55.

Santi L, Maggioli C, Mastroroberto M, Tufoni M, Napoli L, Caraceni P. Acute Liver Failure Caused by Amanita phalloides Poisoning. Int J Hepatol. 2012.

Karlson-Stiber C, Persson H. Cytotoxic fungi—an overview. Toxicon. 2003;42(4):339-49.

Enjalbert F, Rapior S, Nouguier-Soulé J, Guillon S, Amouroux N, Cabot C. Treatment of amatoxin poisoning: 20-Year retrospective analysis. J Toxicol. 2002;40(6):715-57.

Verma N, Bhalla A, Kumar S, Dhiman RK, Chawla YK. Wild mushroom poisoning in north India: case series with review of literature. J Clin Exp Hepatol. 2014;4(4):361-5.

Purkayastha RP, Chandra A. Manual of Indian Edible Mushrooms. New Delhi, India: Jagendra Book Agency; 1985.

Diaz JH. Syndromic diagnosis and management of confirmed mushroom poisonings. Crit Care Med. 2005;33:427-36.

Kumar M, Kaviyarasan V. Few common poisonous mushrooms of Kolli hills, south India. J Acad Indus. Res. 2012;1:19-22.

Sarma TC, Sarma I, Patiri BN. Wild edible mushrooms used by some ethnic tribe in western Assam. Bioscan. 2010;3:613-25.

Sharma SK, Aggarwal A, Pal LS. Mushroom (Amanita phalloides) poisoning with special reference to serum enzyme levels. J Indian Med Assoc. 1980;75:213-7.

Singh S, Singhi S, Sood NK. Changing pattern of childhood poisoning (1970–1989): experience of a large north Indian hospital. Indian Pediatr. 1995;32:331-6.

Broussard CN, Aggarwal A, Lacey SR, Post AB, Gramlich T, Henderson JM, et al. Mushroom poisoning—from diarrhea to liver transplantation. Am J Gastroenterol. 2001 Nov 1;96(11):3195-8.

Himmelmann A, Mang G, Schnorf-Huber S. Lethal ingestion of stored Amanita phalloides mushrooms. Swiss Med Wkly. 2001;131(41-42):616-7.

Horgen P, Vaisius A, Ammirati J. The insensitivity of mushroom nuclear RNA polymerase activity to inhibition by amatoxins. Arch Microbiol. 1978;118(3):317-9.

Berger K, Guss D. Mycotoxins revisited: part I. J Emerg Med. 2005;28(1):53-62.

Busi C, Fiume L, Costantino D. Amanita toxins in gastroduodenal fluid of patients poisoned by the mushroom, Amanita phalloides. New Engl J Med. 1979;300(14):800.

Faulstich H. New aspects of amanita poisoning. Klinische Wochenschrift. 1979;57(21):1143-52.

Piqueras J. Hepatotoxic mushroom poisoning: diagnosis and treatment. Mycopathol. 1989;105(2):99-110.

Vesconi S, Langer M, Iapichino G. Therapy of cytotoxic mushroom intoxication. Crit Care Med. 1985;13(5):402-6.

Jaeger A, Jehl F, Flesch F, Sauder P, Kopferschmitt J. Kinetics of amatoxins in human poisoning: therapeutic implications. J Toxicol. 1993;31(1):63-80.

Fiume L, Sperti S, Montanaro L, Busi C, Costantino D. Amanitins do not bind to serum albumin. Lancet. 1977;1(8021):1111.

Faulstich H, Talas A, Wellhoner H. Toxicokinetics of labeled amatoxins in the dog. Arch Toxicol. 1984;56(3):190-4.

Gibbons R. Mushroom poisoning. Compr Ther. 1982;8(12):33-9.

Manoguerra A. Amanita phalloides—type mushroom poisoning. Bulletin of San Diego Regional Poison Control Center. 1982;6:1.

Derenzini M, Betts C, Busi C, Fiume L. Ultrastructural changes in β-cells of pancreatic islets in α-amanitin-poisoned mice. Virchows Archiv B. 1978;28(1):13-20.

Leist M, Gantner F, Naumann H, Bluethmann H, Vogt K, Brigelius-Flohe R, et al. Tumor necrosis factor-induced apoptosis during the poisoning of mice with hepatotoxins. Gastroenterology. 1997 Mar 1;112(3):923-34.

Paaso B, Harrison D. A new look at an old problem: mushroom poisoning. Clinical presentations and new therapeutic approaches. Am J Med. 1975;58(4):505-9.

Sanz P, Reig R, Borras L, Martinez J, Manez R, Corbella J. Disseminated intravascular coagulation and mesenteric venous thrombosis in fatal amanita poisoning. Human Toxicol. 1988;7(2):199-201.

Mas A. Mushrooms, amatoxins and the liver. J Hepatol. 2005;42(2):166-9.

Butera R, Locatelli C, Coccini T, Manzo L. Diagnostic accuracy of urinary amanitin in suspected mushroom poisoning: a pilot study. J Toxicol. 2004;42(6):901-12.

Wittebole X, Hantson P. Use of the molecular adsorbent recirculating system (MARS) for the management of acute poisoning with or without liver failure. Clin Toxicol. 2011;49(9):782-93.

Mitzner S, Stange J, Klammt S, Peszynski P, Schmidt R, Nöldge-Schomburg G. Extracorporeal detoxification using the molecular adsorbent recirculating system for critically ill patients with liver failure. J Am Soc Nephrol. 2001;12(17):75-82.

Faybik P, Hetz H, Baker A, Bittermann C, Berlakovich G, Werba A, et al. Extracorporeal albumin dialysis in patients with Amanita phalloides poisoning. Liver Inter. 2003 Jun;23:28-33.

Sorodoc L, Lionte C, Sorodoc V, Petris O, Jaba I. Is MARS system enough for A. phalloides-induced liver failure treatment. Human and Exp Toxicol. 2010;29(10):823-32.

Hruby K, Csomos G, Fuhrmann M, Thaler H. Chemotherapy of Amanita phalloides poisoning with intravenous silibinin. Hum Toxicol. 1983;2(2):183-195.

Faulstich H, Jahn W, Wieland T. Silybin inhibition of amatoxin uptake in the perfused rat liver. Drug Res. 1980;30(3):452-4.

Sklar G, Subramaniam M. Acetylcysteine treatment for non-acetaminophen-induced acute liver failure. Ann Pharmacother. 2004;38(3):498-501.

Schmidt L, Dalhoff K. Risk factors in the development of adverse reactions to N-acetylcysteine in patients with paracetamol poisoning. Brit J Clin Pharmacol. 2001;51(1):87-91.

Chan T, Critchley J. Adverse reactions to intravenous N-acetylcysteine in Chinese patients with paracetamol (Acetaminophen) poisoning. Hum Exp Toxicol. 1994;13(8):542-4.

O'Grady J, Alexander G, Hayllar K, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterol. 1989;97(2):439-45.

Bernuau J. Selection for emergency liver transplantation. J Hepatol. 1993;19(3):486-7.

Ganzert M, Felgenhauer N, Zilker T. Indication of liver transplantation following amatoxin intoxication. J Hepatol. 2005;42(2):202-9.

Escudié L, Francoz C, Vinel JP, Moucari R, Cournot M, Paradis V, et al. Amanita phalloides poisoning: reassessment of prognostic factors and indications for emergency liver transplantation. J Hepatol. 2007 Mar 1;46(3):466-73.

Bernuau J. Acute liver failure: avoidance of deleterious cofactors and early specific medical therapy for the liver are better than late intensive care for the brain. J Hepatol. 2004;41(1):152-5.