Clinical profile of patients presenting with mushroom toxicity in a tertiary care setup in Northeast India: with special focus on model for end-stage liver disease score as a predictor of disease outcome

Authors

  • Aritra Saha Department of Medicine, Assam Medical College, Dibrugarh, Assam, India
  • Dipankar Das Department of Medicine, Assam Medical College, Dibrugarh, Assam, India
  • Anupam Dutta Department of Medicine, Assam Medical College, Dibrugarh, Assam, India
  • Ajit K. Pegu Department of Medicine, Assam Medical College, Dibrugarh, Assam, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20231452

Keywords:

Mushroom toxicity, MELD score, Acute liver failure

Abstract

Background: Ingestion of wild mushrooms leading to toxicity is a common phenomenon every year during the rainy season in Upper Assam, India. The model for end-stage liver disease (MELD) score was developed to predict mortality in a specific group of patients with decompensated chronic liver disease. It has also been used to predict mortality in patients with acute liver failure, which is also one of the dreaded complications of mushroom toxicity. There are only a couple of studies in the world that have studied MELD score as a predictor of outcomes in patients with mushroom toxicity and to the best of our knowledge, this is the first such study done in India.

Methods: In this hospital-based observational study, 35 patients aged >13 years with an alleged history of ingestion of wild mushrooms, but no other cause of hepatic dysfunction were included in this study. Disease outcome (discharged/expired) was correlated with both MELD score and day of presentation from symptom onset.

Results: The mean age was 32.54 years with a male-to-female sex ratio of 4:5 among the study participants. Gastrointestinal symptoms, including loose stool, vomiting, pain abdomen, and jaundice, were the most common. The MELD score was significantly higher in patients who succumbed to the toxin (p<0.05) and positively correlated with mortality (r=0.664, p<0.001) and a later day of presentation (r=0.226, p=0.123). A later-day presentation also positively correlated with mortality (r=0.227, p=0.189).

Conclusions: The MELD score can be used as a prognostic tool in patients with mushroom toxicity.

References

Valverde ME, Hernández-Pérez T, Paredes-López O. Edible Mushrooms: Improving Human Health and Promoting Quality Life. Int J Microbiol. 2015;2015:1-14.

Graeme KA. Mycetism: A Review of the Recent Literature. J Med Toxicol. 2014;10(2):173-89.

Pandita. Mushroom poisoning and outcome of patients admitted in a tertiary care hospital in North East India. Available at: https://www.jmed tropics.org/article.asp?issn=2276-7096;year=2021; volume=23;issue=1;spage=29;epage=34;aulast=Pandita. Accessed on 03 July 2023.

Lehmann PF, Khazan U. Mushroom poisoning by Chlorophyllum molybdites in the Midwest United States. Cases and a review of the syndrome. Mycopathologia. 1992;118(1):3-13.

Tran HH, Juergens AL. Mushroom Toxicity. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2022.

Diaz JH. Amatoxin-Containing Mushroom Poisonings: Species, Toxidromes, Treatments, and Outcomes. Wilderness Environ Med. 2018;29(1):111-8.

Dinis-Oliveira RJ, Soares M, Rocha-Pereira C, Carvalho F. Human and experimental toxicology of orellanine. Hum Exp Toxicol. 2016;35(9):1016-29.

Lheureux P, Penaloza A, Gris M. Pyridoxine in clinical toxicology: a review. Eur J Emerg Med. 2005;12(2):78-85.

Saliba F, Samuel D. Acute liver failure: Current trends. J Hepatol. 2013;59(1):6-8.

Chen L, Sun L, Zhang R, Liao N, Qi X, Chen J, et al. Epidemiological analysis of wild mushroom poisoning in Zhejiang province, China, 2016–2018. Food Sci Nutr. 2021;10(1):60-6.

Erden A, Esmeray K, Karagöz H, Karahan S, Gümüşçü HH, Başak M, et al. Acute liver failure caused by mushroom poisoning: a case report and review of the literature. Int Med Case Rep J. 2013;6:85-90.

Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31(4):864-71.

Singal AK, Kamath PS. Model for End-stage Liver Disease. J Clin Exp Hepatol. 2013;3(1):50-60.

Zaman MB, Hoti E, Qasim A, Maguire D, McCormick PA, Hegarty JE, et al. MELD Score as a Prognostic Model for Listing Acute Liver Failure Patients for Liver Transplantation. Transplantation Proceedings. 2006;38(7):2097-8.

Katoonizadeh A, Decaestecker J, Wilmer A, Aerts R, Verslype C, Vansteenbergen W, et al. MELD score to predict outcome in adult patients with non-acetaminophen-induced acute liver failure. Liver Int. 2007;27(3):329-34.

Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003;124(1):91-6.

Barthakur B. Mushroom poisoning, tea community and role of management in tea gardens of Assam. Two and a Bud. 2012;59(2):19-21.

Dutta A, Das A, Pegu AK, Kalita BC. Early Hydration Therapy in Mushroom Poisoning Improves Mortality and Morbidity. J Indian Soc Toxicol. 2018;14(1):22-7.

Eren SH, Demirel Y, Ugurlu S, Korkmaz I, Aktas C, Güven FMK. Mushroom poisoning: retrospective analysis of 294 cases. Clinics. 2010;65(5):491-6.

Schmutz M, Carron PN, Yersin B, Trueb L. Mushroom poisoning: a retrospective study concerning 11-years of admissions in a Swiss Emergency Department. Intern Emerg Med. 2018;13(1):59-67.

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.

Sharma J, Malakar M, Sandiguria E, Das J. An expressive study of Mushroom poisoning cases in Lakhimpur district of Assam. Int J Adv Res Technol. 2013;2:82-8.

Pajoumand A, Shadnia S, Efricheh H, Mandegary A, Hassanian-Moghadam H, Abdollahi M. A retrospective study of mushroom poisoning in Iran. Hum Exp Toxicol. 2005;24(12):609-13.

Bonacini M, Shetler K, Yu I, Osorio RC, Osorio RW. Features of Patients With Severe Hepatitis Due to Mushroom Poisoning and Factors Associated With Outcome. Clin Gastroenterol Hepatol. 2017;15(5):776-9.

Çelik F, Ünal NG, Şenkaya A, Aslanov S, Buyruk AM, Turan İ, et al. Outcomes of Patients with Acute Hepatotoxicity Caused by Mushroom-Induced Poisoning. Turk J Gastroenterol. 2021;32(8):678-84.

Cai Q, Jia Z, Liu T, Zhang C, Hui Z, Dong X, et al. Correlation between model for end-stage liver disease score and prognosis in mushroom poisoning patients: a multicenter clinical study. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018;30(1):67-71.

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Published

2023-05-25

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Original Research Articles