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Toxic Fungi of Western North America

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Toxic Fungi of Western North America Toxic Fungi of Western North America by Thomas J. Duffy, MD Published by MykoWeb (www.mykoweb.com) March, 2008 (Web) August, 2008 (PDF) 2 Toxic Fungi of Western North America Copyright © 2008 by Thomas J. Duffy & Michael G. Wood Toxic Fungi of Western North America 3 Contents Introductory Material ........................................................................................... 7 Dedication ............................................................................................................... 7 Preface .................................................................................................................... 7 Acknowledgements ................................................................................................. 7 An Introduction to Mushrooms & Mushroom Poisoning .............................. 9 Introduction and collection of specimens .............................................................. 9 General overview of mushroom poisonings ......................................................... 10 Ecology and general anatomy of fungi ................................................................ 11 Description and habitat of Amanita phalloides and Amanita ocreata .............. 14 History of Amanita ocreata and Amanita phalloides in the West ..................... 18 The classical history of Amanita phalloides and related species ....................... 20 Mushroom poisoning case registry ...................................................................... 21 “Look-Alike” mushrooms ...................................................................................... 21 Identification aids ................................................................................................ 24 Guidelines for pot-hunters ................................................................................... 25 Insecticides and other toxic sprays ...................................................................... 26 Guide to the identification of mushroom poisoning by symptoms ..................... 27 Onset of symptoms less than 4 hours after ingestion: .................................... 27 Onset of symptoms after 4 hours from time of ingestion: ............................... 28 Group I toxins: Amatoxins ................................................................................. 30 4 Toxic Fungi of Western North America The amatoxic group .............................................................................................. 30 General description and occurrence ................................................................. 30 The Amanitas .................................................................................................... 30 The Lepiotas ...................................................................................................... 32 The Galerinas .................................................................................................... 35 Conocybe filaris ................................................................................................. 37 Ethnicity and amanitin poisoning ....................................................................... 39 Toxins of Amanita phalloides, other amatoxic Amanita and amatoxic species in the genera Lepiota, Galerina and Conocybe ........................................................ 41 The Wieland-Meixner qualitative test for amatoxins ......................................... 43 The pathologic picture of amanitins .................................................................... 44 Pregnancy and amanitin poisoning ..................................................................... 48 Fatality rates from selected studies published since 1970 ................................. 48 Evaluation of amanitin treatment ....................................................................... 49 Prognostic indicators for likely fatality ............................................................... 50 The clinical course of amanitin poisoning ........................................................... 51 Detailed treatment of amanitin poisoning .......................................................... 53 Outline and summary of treatment for poisoning by amatoxins ....................... 58 Group II toxins: Ibotenic Acid/Muscimol ........................................................ 60 Isoxazole poisoning from Amanita muscaria & Amanita pantherina (pantherine syndrome) ............................................................................................................. 60 Toxins of the ibotenic acid/muscimol group (pantherine poisoning) .................. 64 Toxic Fungi of Western North America 5 Symptoms of ibotenic/muscimol poisoning (isoxazol poisoning) ........................ 67 Treatment of ibotenic acid/muscimole poisoning ................................................ 69 Group III toxins: Amanita smithiana .............................................................. 71 Amanita smithiana poisoning & unclassified renal/hepatic toxicity ................. 71 Clinical picture, presumed toxin and treatment ................................................ 72 Group IV toxins: Orellanine .............................................................................. 75 Delayed renal failure with Cortinarius species .................................................. 75 The genus Cortinarius in general ........................................................................ 77 Toxins of Cortinarius orellanus ........................................................................... 77 Clinical course and treatment ............................................................................. 79 Group V toxins: Gyromitrin ............................................................................... 80 Gyromitrin group ................................................................................................. 80 Gyromitrin toxins ................................................................................................. 82 The clinical picture of gyromitrin poisoning ....................................................... 83 Treatment of gyromitrin toxicity ......................................................................... 84 Group VI toxins: Paxillus involutus ................................................................ 86 Autoimmune hemolysis with Paxillus involutus ................................................ 86 Group VII toxins: Muscarine ............................................................................. 89 The muscarine group toxins ................................................................................ 89 General description and occurrence .................................................................... 90 The clinical picture of muscarine poisoning ........................................................ 94 6 Toxic Fungi of Western North America Treatment of muscarine poisoning ...................................................................... 94 Group VIII toxins: Hallucinogenic indoles (psilocybin) .............................. 96 The "New World" history of psilocybin containing mushrooms ......................... 96 Taxonomic and legal problems ............................................................................. 97 General description and occurrence .................................................................... 98 Psilocybin and psilocin toxins ............................................................................ 105 The clinical picture of psilocybin toxicity .......................................................... 105 Treatment of psilocybin toxicity ........................................................................ 106 Group IX toxins: Coprine .................................................................................. 108 Disulfiram-like reactions to alcohol ................................................................... 108 Group X toxins: Gastrointestinal irritants, toxins and idiosyncrasies .. 111 GI reactions due to fungi usually considered edible ......................................... 111 Mushrooms known for their GI toxins or irritants ........................................... 115 Group XI toxins: Miscellaena ........................................................................... 123 Miscellaneous toxins .......................................................................................... 123 Addendums, Glossary, & References ............................................................. 128 Addendum 1: Scientific names and the conventions used in the text .............. 128 Addendum 2: Fungal nomenclature, fungal taxonomy, and effect on fungal names .................................................................................................................. 132 Glossary .............................................................................................................. 136 References ........................................................................................................... 148 Toxic Fungi of Western North America 7 Introductory Material Dedication Dedicated to my wife Ellen and my 4 children—Carolyn, Linda, Susan and John. Also in remembrance of Paul Vergeer. Preface For cases in which Amanita phalloides or other deadly amatoxic fungi are suspected, go at once to the section titled Guide to the identification of mushroom poisoning by symptoms and, if appropriate, The amatoxic group. For a thumbnail guide to the treatment
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