Prognostic value of decision criteria for emergency liver transplantation in patients with wild mushroom induced acute liver injury

Background： The reported mortality rate of mushroom-induced acute liver failure with conventionaltreatment is 1.4%–16.9%. Emergency liver transplantation may be indicated and can be the only curativetreatment option. This study aimed to assess the prognostic value of criteria for emergency livertransplantation in predicting 28-day mortality in patients with mushroom-induced acute liver injury.Methods： A retrospective cohort study was performed between January 2005 and December 2015. Alladult patients aged≥18 years admitted with mushroom intoxication at our emergency department wereevaluated. All patients with acute liver injury, defined as elevation of serum liver enzymes （〉5 timesthe upper limit of normal, ULN） or moderate coagulopathy （INR 〉 2.0） were included. The ability of the King’s College, Ganzert’s, and Escudié’s criteria to predict 28-day mortality was evaluated.

The characteristics of liver injury induced by Amanita and clinical value of α-amanitin detection

Background:Amanita poisoning as a foodborne disease has raised concerning mortality issues.Reducing the interval between mushroom ingestion and medical intervention could greatly influence the outcomes of Amanita poisoning patients,while treatment is highly dependent on a confirmed diagnosis.To this end,we developed an early detection-guided intervention strategy by optimizing diagnostic process with performingα-amanitin detection,and further explored whether this strategy influenced the progression of Amanita poisoning.Methods:This study was a retrospective analysis of 25 Amanita poisoning patients.Thirteen patients in the detection group were diagnosed mainly based onα-amanitin detection,and 12 patients were diagnosed essentially on the basis of mushroom consumption history,typical clinical patterns and mushroom identification(conventional group).Amanita poisoning patients received uniform therapy,in which plasmapheresis was executed once confirming the diagnosis of Amanita poisoning.We compared the demographic baseline,clinical and laboratory data,treatment and outcomes between the two groups,and further explored the predictive value ofα-amanitin concentration in serum.Results:Liver injury induced by Amanita appeared worst at the fourth day and alanine aminotransferase(ALT)rose higher than aspartate aminotransferase(AST).The mortality rate was 7.7%(1/13)in the detection group and 50.0%(6/12)in the conventional group(P=0.030),since patients in the detection group arrived hospital much earlier and received plasmapheresis at the early stage of disease.The early detection-guided intervention helped alleviate liver impairment caused by Amanita and decreased the peak AST as well as ALT.However,the predictive value ofα-amanitin concentration in serum was still considered limited.Conclusions:In the management of mushroom poisoning,consideration should be given to the rapid detection ofα-amanitin in suspected Amanita poisoning patients and the immediate initiation of medical treatment upon a positive toxin screening result.

Analysis of the clinical features and risk factors of death in patients with mushroom poisoning

Background:Wild edible mushrooms are rich in nutrition and popular with people;however,few laboratory studies are available about the predictability of outcomes among patients with mushroom poisoning.Therefore,this study aimed to analyze the clinical features and death risk factors of patients with mushroom poisoning.Methods:Patients with mushroom poisoning admitted to the hospital from 2015 to 2021 were retrospectively evaluated.Results:A total of 197 patients with mushroom poisoning were enrolled in this study,of which 100(50.76%)were males,and the mortality was 10.66%(21/197).Patients who died were more likely to have demonstrated a long latency,high alanine aminotransferase,aspartate aminotransferase,direct bilirubin,total bilirubin(TB),activated partial thromboplastin time,prothrombin time,international normalized ratio,creatinine,and blood urea nitrogen.Multiple logistic regression analysis indicated that TB level greater than or equal to 34.2μmol/L had the greatest lethal risk and could increase the risk of death by 14.588 times(odds ratio:15.588;95%confidence interval:2.088-116.351),which indicated that TB was an independent risk factor of death in patients with acute mushroom poisoning.Conclusion:Bilirubin concentration was associated with the increased likelihood of mortality.Total bilirubin was the independent risk factor of mushroom poisoning.

Investigation and analysis of 102 mushroom poisoning cases in Southern China from 1994 to 2012

Mushroom poisoning is the main cause of mortality in food poisoning incidents in China.Although some responsible mushroom species have been identified,some were identified inaccuratly.This study investigated and analyzed 102 mushroom poisoning cases in southern China from 1994 to 2012,which involved 852 patients and 183 deaths,with an overall mortality of 21.48%.The results showed that 85.3%of poisoning cases occurred from June to September,and involved 16 species of poisonous mushroom:Amanita species(A.fuliginea,A.exitialis,A.subjunquillea var.alba,A.cf.pseudoporphyria,A.kotohiraensis,A.neoovoidea,A.gymnopus),Galerina sulciceps,Psilocybe samuiensis,Russula subnigricans,R.senecis,R.japonica,Chlorophyllum molybdites,Paxillus involutus,Leucocoprinus cepaestipes and Pulveroboletus ravenelii.Six species(A.subjunquillea var.alba,A.cf.pseudoporphyria,A.gymnopus,R.japonica,Psilocybe samuiensis and Paxillus involutus)are reported for the first time in poisoning reports from China.Psilocybe samuiensis is a newly recorded species in China.The genus Amanita was responsible for 70.49%of fatalities;the main lethal species were A.fuliginea and A.exitialis.Russula subnigricans caused 24.59%of fatalities,and five species showed mortality>20%(A.fuliginea,A.exitialis,A.subjunquillea var.alba,R.subnigricans and Paxillus involutus).Mushroom poisoning symptoms were classified from among the reported clinical symptoms.Seven types of mushroom poisoning symptoms were identified for clinical diagnosis and treatment in China,including gastroenteritis,acute liver failure,acute renal failure,psychoneurological disorder,hemolysis,rhabdomyolysis and photosensitive dermatitis.

Mycetismus:a review

Although rare,death from amanitin exposure poses a significant health risk and a diagnostic challenge to the clinician due to its rarity.This is one of the few conditions to be voluntarily reported by healthcare professionals.No antidote exists for this poisoning and,perhaps due to its rarity or lack of attention,the United States has lagged behind Europe for almost three decades in treatment,diagnostics and experimentation.This regrettable fact warrants the formation of a centralized agency for education,the advancement of research and the collection of data,to provide better treatment for the population.

Assessing global fungal threats to humans

Fungi are an integral part of the earth's biosphere.They are broadly distributed in all continents and ecosystems and play a diversity of roles.Here,I review our current understanding of fungal threats to humans and describe the major factors that contribute to various threats.Among the 140,000 or so known species out of the estimated six million fungal species on Earth,about 10%directly or indirectly threaten human health and welfare.Major threats include mushroom poisoning,fungal allergies,infections of crop plants,food contamination by mycotoxins,and mycoses in humans.A growing number of factors have been identified to impact various fungal threats,including human demographics,crop distributions,anthropogenic activities,pathogen dispersals,global climate change,and/or the applications of antifungal drugs and agricultural fungicides.However,while models have been developed for analyzing various processes of individual threats and threat managements,current data are primarily descriptive and incomplete,and there are significant obstacles to integration of the diverse factors into accurate quantitative assessments of fungal threats.With increasing technological advances and concerted efforts to track the spatial and temporal data on climate and environmental variables;mycotoxins in the feed and food supply chains;fungal population dynamics in crop fields,human and animal populations,and the environment;human population demographics;and the prevalence and severities of fungal allergies and diseases,our ability to accurately assess fungal threats will improve.Such improvements should help us develop holistic strategies to manage fungal threats in the future.