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The diversity of mushroom species is evident in our grocery stores, our restaurant menus, and our environment. The diversity of the American population has led to experimentation by young and old—old citizens and our newest immigrants as well as our young children reaching for what might become an innocuous or a serious ingestion. Rigor in analyzing the possible ingestion is indispensable for poison center staff and emergency physicians treating a patient who has ingested a mushroom of concern. This chapter offers general information of the most consequential toxicologic groups of mushrooms.

Unintentional exposures to mushrooms represent a small but relatively constant percentage of consultations requested from poison centers (see citations for American Association of Poison Control Centers [AAPCC] data in Chap. 135). A summary of a quarter century of AAPCC data reveals that mushrooms represent far less than 0.5% of the reported human exposures. Combined data accumulated by the AAPCC and the Mushroom Poisoning Registry of the North American Mycological Association indicates that approximately five patient exposures to toxic mushrooms per 100,000 population occur per year. Some variations result from geographic and climatic conditions and mycologic habitats.109 Although the methods of analysis of patients with mushroom exposures have changed over the past quarter century, cumulative AAPCC data consistently demonstrate the relative benignity of the vast majority of exposures. The inability of most healthcare providers to correctly identify the ingested mushroom and the rarity of lethal ingestions are demonstrated by the accumulated data. In 85% to 95% of cases, the exact species was unidentified.109 More than 50% of exposed individuals had no symptoms. Most patients were treated at home and rarely had major toxicity. During the quarter century covered by the AAPCC data, fewer than 100 patients died of their ingestions. Of the mushrooms associated with a death, most were Amanita spp, and several were hallucinogens, Boletus spp, gyromitrin- containing mushroom, while others remained unidentified. All reported deaths occurred in adults. Hallucinogens and gastrointestinal (GI) toxins were the most common exposures yet they accounted for less than 10% of exposures. All other presumed exposures represented less than 2% of the total number of identified. Because 85% to 95% of mushrooms involved in exposures are never identified, a strategy for making significant decisions with incomplete data is essential.

This chapter does not address molds, mildews, and yeasts, which in addition to mushrooms are all categorized as fungi. The unifying principle for fungi is the lack of the photosynthetic capacity to produce nutrition. Survival is achieved by the enyzymatic capacity of these organisms to integrate into living materials and digest them. Molds are ubiquitous and often associated with varied adverse health effects such as rhinitis, rashes, headaches, and asthma.19 An example of a mold-related mycotoxin is discussed in Chap. 132 on biological weapons. All other molds are not associated with toxicologic emergencies and are not addressed in this chapter.

Because mushroom species vary widely with regard to ...

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