Table 1.
Categorization of primary systems affected by toxic mushrooms
| Section in text | Primary system affected | Syndrome (mushrooms) | Characteristic toxicity | Gastrointestinal distress | Symptom onset |
|---|---|---|---|---|---|
| Neurotoxins | Neurologic | Cholinergic–muscarine (Inocybe, Clitocybe, Boletus, and Robinoboletus species) | Cholinergic syndrome | Present | 15 min–5 h |
| Neurologic (also hepatic and hematologic) | Epileptogenic—Gyromitra (Gyromitra esculenta) | Ataxia, coma, seizures, moderate hepatotoxicity, hemolysis, methemoglobinemia (in springtime) | Present, but delayed (occasionally bloody) | 4–12 h (rarely, as early as 2 h) | |
| Neurologic | Epileptogenic—in renally compromised patients (Pleurocybella porrigens) | Convulsions, myoclonus, dysarthria, ataxia, paresis, paralysis | Not reported | Delayed 1–31 days | |
| Neurologic | Inebriating—glutaminergic/GABAminergic—Pantherina/Muscaria (Amantia muscaria, Amanita pantherina) | Alternating CNS excitation and depression | May occur | 30 min–3 h | |
| Neurologic | Inebriating—Morchella sp. | Ataxia, tremor, visual disorders, paresthesias, confusion | Often present | 5 h for GI; 12 h neuro | |
| Neurologic | Encephalopathic (Hapalopilus rutilans) | Encepahlopathy with hepatorenal insufficiency and purple urine | Present, but delayed | 12 h | |
| Neurologic | Hallucinogenic—psilocybin (Psilocybe and Panaeolus species) | Hallucinations | May occur | 15–30 min | |
| Neurovascular toxins | Neurologic and vascular | (Clitocybe acromelalga, Clitocybe amoenolens) | Erythromelalgia | Generally 6–24 h | |
| Cardiotoxins and sudden death | Cardiovascular | Sudden unexplained death—Trogia venenata | Sudden death—following recurrent syncope, palpitations; ventricular tachycardia and fibrillation; seizures | Present | Initially diarrhea; reports of 3–5 days of syncope or dizziness prior to sudden death |
| Cardiovascular | Sudden unexplained death—Amanita franchetii or Ramaria rufescens | Sudden death—following tremor, muscle spasms; tachycardia, hypotension, and EKG changes | Present | 2–15 h | |
| GI toxins | GI (without other systems) | Gastrointestinal (Chlorophyllum molybdites and Omphalotus illudens) | Nausea, vomiting, abdominal cramping, diarrhea | Mild to marked (occasionally bloody) | Generally < 6 h |
| GI (with flushing) | Disulfiram-like—Coprinus (Coprinus species) | Ethanol intolerance: flushing with nausea and vomiting after ethanol ingestion | Present | 15–30 min after ethanol ingestion | |
| Hepatotoxins | Hepatic, renal, MSOF | Amatoxin-induced hepatic failure—Phalloides (Amanita, Galerina, and Lepiota species) | Fulminant hepatic failure, coagulopathy, renal failure, pancreatitis (in autumn) | Severe, but delayed (occasionally bloody) | Generally 6–24 h (but may occur sooner) |
| Nephrotoxins | Renal | Renal Failure—Orellanus (Cortinarius species) | Weakness, flank pain and oligo-anuria | Generally mild; may be absent | 30 hours to 20 days |
| Renal (slight hepatic) | (Amanita proxima, A. smithiana) | Acute kidney injury with mild hepatitis | Present | Generally 20 min–24 h for GI; 1–6 days for nephrotoxicity | |
| Myotoxins | Musculoskeletal, Cardiopulmonary, MSOF | Rhabdomyolysis (Tricholoma equestre, Russula subnigricans) | Muscle weakness, myalgias, respiratory failure, renal failure, myocarditis, seizures | Present | GI in 30 min–2 h; systemic toxicity generally >1 day |
| Immune/heme toxins | Immunologic, Hematologic, MSOF | Allergic—Paxillus (Paxillus involutus) | Immunohemolytic anemia, followed by acute renal failure, multiple organ dysfunction | Present | 30 min–3 h |
| Immunologic, Hematologic, MSOF | Immunosuppressive (Podostroma cornu-damae) | Pancytopenia, purpura, desquamation of the palms and face, alopecia, DIC | Present | Early GI, followed by complications of fluid loss, MSOF, pancytopenia and DIC |
GI gastrointestinal, neuro neurological