The Phalloides Syndrome is produced by Amanita phalloides and related mushrooms that produce a toxin that can result in multi-organ failure and death.
Mushroom species involved:
(1) Amanita phalloides ("death cap")
(2) Amanita verna ("destroying angel")
(3) Amanita virosa
(4) other Amanita species
(5) Galerina species
(6) Imocybe species
(7) Omphalotus olearius
(8) Clitocybe dealbata and other species
(9) Lepiota species
Toxin: amanitins, also called amatoxins (cyclic oligopeptides designated alpha, beta, gamma and delta). The toxin inhibits RNA polymerase 2, with failure to transcribe mRNA. Symptoms occur when protein stores are exhausted.
Features of the toxin: thermostable
History: ingestion of wild mushrooms during the summer or autumn
Stage |
Descriptor |
Features |
1 |
incubation period |
Asymptomatic for the first 8 to 12 hours (range 6 to 16 hours) after ingestion |
2 |
gastrointestinal stage |
Recurring episodes of abdominal pain with vomiting and severe watery diarrhea. Gastrointestinal hemorrhage may occur. Severe electrolyte imbalances and dehydration may occur. The patient may develop shock with or without acute renal failure. |
|
temporary lull |
Clinical improvement with resolution of GI symptoms (false recovery) |
3 |
cytotoxic stage |
Onset of hepatocellular damage which may be rapidly progressive 24 to 48 hours after ingestion |
4 |
comatose stage |
Multi-organ failure with coma, coagulopathy and liver failure |
Late clinical findings:
(1) jaundice and hepatomegaly
(2) hemorrhage with petechiae
(3) oligouria or anuria
(4) cerebral involvement with coma
(5) pulmonary congestion
Laboratory findings:
(1) markedly elevated liver transaminase levels
(2) aminoacidemia
(3) markedly prolonged PT and PTT
(4) elevated BUN and creatinine
(5) demonstration of amanitin (multiple types) or other toxins (phallotoxins, viroisin, viroidin)
(6) usually negative tests for viral hepatitis
Histologic findings:
(1) liver – massive centrolobular hepatocellular necrosis
(2) kidneys – acute tubular necrosis
Clinical outcomes:
(1) slow resolution of symptoms with recovery
(2) death from progressive multi-organ failure
(3) liver transplantation
Specialty: Toxicology, Emergency Medicine, Critical Care
ICD-10: ,