Overview of Fungal Intoxication

According to the mechanism of mycotoxins, several syndromes are described. Differentiation of fungi is possible only by microscopic mycological examination from food residues or from the contents of the stomach or stool.

Gastroenterodyspeptic Syndrome

Latency: < 2 hours
Symptoms: gastrointestinal symptoms
Toxins: unknown
Treatment: symptomatic care
Prognosis: good
Notes: -
Examples of fungi: Satan's bolete (Rubroboletus satanas), some members of the Agaricus genus and the Russula genus.

Muscarinic Syndrome

Latency: < 2 hours
Symptoms: sweating, salivation, lacrimation, miosis
Toxins: muscarine
Treatment: gastric irrigation, administration of atropine
Prognosis: depends on the amount ingested
Notes: -
Examples of fungi: some members of the Inocybe genus and the Clitocybe genus.

Psylocibin Syndrome (psychotropic)

Latency: < 2 hours
Symptoms: hallucinations
Toxins: psilocybin, psilocin
Treatments: sedation, administration of diazepam
Prognosis: good
Notes: do not administer antibiotics
Examples of fungi: fungi of Psilocybe genus

Mycoatropine-Neurotoxic Syndrome (muscarinic)

Latency: < 3 hours
Symptoms: muscarinic symptoms - sweating, lacrimation, miosis, convulsions, jaundice, diarrhea + other gastrointestinal symptoms → progress to anticholinergic symptoms - mental excitation, dryness of the skin, tachycardia, hallucinations, alternation between euphoria and depression...
Toxins: muscimol, ibotenic acid, muscazone
Treatment: gastric irrigation, oral administration of active charcoal, symptomatic care.
Prognosis: relatively good
Notes: do not administer diazepam, atropine, barbiturates
Examples of fungi: fly agaric (Amanita muscaria) and panther cap (Amanita pantherina)

Gyromitrin-Hepatotoxic Syndrome

Latency: 6–12 hours
Symptoms: headache, convulsions, jaundice, diarrhea + other gastrointestinal symptoms
Toxins: gyromitrin
Treatment: gastric irrigation, oral administration of active charcoal, adjustment of metabolic acidosis, intravenous administration of pyridoxine, symptomatic cares
Prognosis: uncertain
Notes: intoxication is possible by inhalation
Examples of fungi: Gyromitra esculenta

Phalloides-Hepatorenal Syndrome

Latency: 6–24 hours
Symptoms: gastrointestinal symptoms, hepatorenal failure
Toxins: the amatoxin (thermostable cyclic octapeptides) amanitin and phaloidin
Pathogenesis: toxins are taken up by the liver, and subsequently excreted inbile. The toxins are reabsorbed via the enterohepatic circulation. Once the toxins enter the cells, they bind to RNA polymerase, and inactivate it, causing a halt of proteosynthesis, → cell death
Treatment: vomiting to remove toxin, gastric irrigation, massive dose of active charcoal (1g/kg/2-4 hours), administration of silibinin (inhibits the cellular uptake of amatoxins), hemodialysis/hemoperfusion, complex supportive care (fluid reimbursement, substitution of coagulation factors, glucose with insulin); the last treatment option is a liver transplantation.
Prognosis: poor (death within a week from circulatory failure or septic shock), survival rate is 10-20%.
Notes: 85% of amatoxins are excreted unchanged by kidneys. The kidney damage is caused by dehydration (during therapy it is necessary to maintain water and electrolyte balance)
Examples of fungi: death caps (Amanita phalloides), fool's mushroom (Amanita verna, it is often confused with ones of Agaricus genus, parasol mushroom, St. George's mushroom)

Antabuse Syndrome

Latency: 6–24 hours
Symptoms: sweating, headache, tachycardia.
Toxins: coprine
Treatment: symptomatic care
Prognosis: good
Notes: symptoms occur only after the ingestion of alcohol
Examples of fungi: common ink cap (Coprinopsis atramentaria)

Orellanine-Nephrotoxic Syndrome

Latency: 36 hours –17 days
Symptoms: gastrointestinal symptoms, headache, convulsions, oliguria, acute renal failure
Toxins: orellanine
Treatment: hemodialysis
Prognosis: poor
Notes: long latency!
Examples of fungi: fool's webcap (Cortinarius orellanus)