Treatment of Amatoxin Poisoning: 20-Year Retrospective Analysis

  title={Treatment of Amatoxin Poisoning: 20-Year Retrospective Analysis},
  author={Françoise Enjalbert and Sylvie Rapior and Janine Nouguier-Soul{\'e} and S Guillon and No{\"e}l Amouroux and Claudine Cabot},
  journal={Journal of Toxicology: Clinical Toxicology},
  pages={715 - 757}
Background: Amatoxin poisoning is a medical emergency characterized by a long incubation time lag, gastrointestinal and hepatotoxic phases, coma, and death. This mushroom intoxication is ascribed to 35 amatoxin-containing species belonging to three genera: Amanita, Galerina, and Lepiota. The major amatoxins, the α-, β-, and γ-amanitins, are bicyclic octapeptide derivatives that damage the liver and kidney via irreversible binding to RNA polymerase II. Methods: The mycology and clinical syndrome… 

Amatoxin poisoning: A 15-year retrospective analysis and follow-up evaluation of 105 patients

The experience indicates that the protocol used in the Toxicologicy Unit is effective for amatoxin poisoning, and that all patients treated within 36 hours after mushroom ingestion were cured without sequelae.

N-acetylcysteine as a treatment for amatoxin poisoning: a systematic review

NAC treatment combined with other therapies appears to be beneficial and safe in patients with amatoxin poisoning, and until further data emerge, it is reasonable to use NAC in addition to other treatments for amat toxin poisoning.

Cyclosporine as a novel treatment for amatoxin-containing mushroom poisoning: a case series

IV cyclosporine, a drug readily available in most hospitals, may be useful to reduce hepatotoxicity from amatoxin poisoning, and in an in-vitro study of the role of cyclospora in cultured HEK293T cells and human hepatoma Huh7 cells, it is concluded.

Amanita phalloides poisoning: Mechanisms of toxicity and treatment.

  • Juliana GarciaV. M. Costa F. Carvalho
  • Medicine
    Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association
  • 2015

Acute Liver Failure Caused by Amanita phalloides Poisoning

The pathogenesis, clinical features, prognostic indicators, and therapeutic strategies of ALF secondary to ingestion of Amanita phalloides, which represents the most common and deadly cause of mushroom poisoning, are analyzed.

Legalon® SIL: The Antidote of Choice in Patients with Acute Hepatotoxicity from Amatoxin Poisoning

Silibinin, a proven antioxidative and anti-inflammatory acting flavonolignan isolated from milk thistle extracts, has been shown to interact with specific hepatic transport proteins blocking cellular amatoxin re-uptake and thus interrupting enterohepatic circulation of the toxin.

Toxic Effects of Amanitins: Repurposing Toxicities toward New Therapeutics

An overview of the knowledge on amanitins, including the latest advances that could allow the proposal of new innovative and effective therapeutics is presented, suggesting the predominant role of oxidative stress in the pathophysiology.

Poisoning due to ingestion of amatoxin-containing mushrooms in South Korea: a systematic review and meta-analysis

A systematic review and meta-analysis of the association between severe early-stage central nervous system symptoms and mortality in cases of amatoxin poisoning in South Korea found that Amanita mushrooms are often mistaken for edible mushrooms, and their ingestion is frequently fatal.

Amanitin intoxication: effects of therapies on clinical outcomes – a review of 40 years of reported cases

No statistical differences could be observed for the effects of N-acetylcysteine, PEN or SIL in proven poisonings with amanitin-containing mushrooms, however, monotherapy with SIL or PEN and combination therapy with NAC/SIL appear to be associated with higher survival rates compared to supportive care alone.

A Case Study: Rare Lepiota brunneoincarnata Poisoning.




Poisoning due to amatoxin-containing Lepiota species.

Twenty-seven consecutive mushroom poisoning cases were followed up over a period of 14 days and it appeared that therapeutic measures were ineffective and it also seemed that the amount of mushroom ingested was the determining factor for the prognosis.

Treatment of Amanita phalloides poisoning: I. Retrospective evaluation of plasmapheresis in 21 patients.

  • S. JanderJ. Bischoff
  • Medicine, Biology
    Therapeutic apheresis : official journal of the International Society for Apheresis and the Japanese Society for Apheresis
  • 2000
It is indicated that plasmapheresis is a safe and effective treatment for amanita phalloides poisoning but that further investigations are needed, especially involving measurements of efficacy and the efficiency of toxin removal.

Therapy of cytotoxic mushroom intoxication

Poisoning by cytotoxic mushrooms (Amanita phalloides and related species) is associated with severe morbidity and a high mortality rate. Due to the difficulty of performing controlled studies and to

Use of Acetylcysteine as the Life-saving Antidote in Amanita phalloides (Death Cap) Poisoning

High dosages of N-acetyl-cysteine (CAS 616-91-1, NAC), already used as antioxidant in paracetamol poisoning, were successfully used in the Intensive Care Unit (ICU) in the treatment of Amanita phalloides poisoning, and all the patients recovered successfully but one needed liver transplantation.

Amanita phalloides intoxications in a family of russian immigrants. Case reports and review of the literature with a focus on orthotopic liver transplantation.

In 3/4 patients, severe hepatic failure developed as assessed by a decrease of all coagulation factors, mainly Quick's test and factor V, whereas in all other patients liver function improved spontaneously and all patients survived their intoxication.

Kinetics of amatoxins in human poisoning: therapeutic implications.

The rapid clearance of circulating amatoxins by day 4 spares the transplanted liver and indicates that enhanced elimination of amat oxins requires early treatment.

[The wrong mushroom. Diagnosis and therapy of mushroom poisoning, especially of Amanita phalloides poisoning].

  • J. Beer
  • Medicine
    Schweizerische medizinische Wochenschrift
  • 1993
By far the most frequent deadly intoxication with mushrooms is caused by Amanita phalloides, while the other important types of mushroom intoxications are summarized in Table 1.

Treatment of Human Amatoxin Mushroom Poisoning

The aim of this article is to steer a course between the distressing and unjustified resignation and the reports of some case histories, where survival is surmised but not proven to be related to the variety of treatment employed.

Amanita poisoning: treatment and the role of liver transplantation.

Amanita poisoning during the second trimester of pregnancy

Maternal Amanita poisoning is not necessarily an indication for induced abortion from the second trimester on, as sonographic and obstetric controls failed to show any fetal abnormalities in the acute phase of poisoning.