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Mushroom Poisoning in Thailand: Incidence and Intoxication To Tawatsin A. et al. Medical Research Archives, vol. 6, issue 9, September 2018 Page 1 of 12 RESEARCH ARTICLE Mushroom Poisoning in Thailand: Incidence and Intoxication to Human Health Apiwat Tawatsin1*, Sittiporn Parnmen1, Usavadee Thavara1, Padet Siriyasatien2, Pornpimol Kongtip3 Authors’ affiliations: 1 National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi 11000 Thailand 2 Faculty of Medicine, Chulalongkorn University, Bangkok 10330 Thailand 3 Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, Bangkok 10400 Thailand * Corresponding author: Apiwat Tawatsin, E-mail: [email protected] ABSTRACT Mushroom poisoning is one of the public health issues related to food-borne diseases in Thailand and worldwide. This paper revealed the incidence of mushroom poisoning in Thailand between 2008 and 2017 and discussed relevant information involved. About 1,200 to 2,000 reported cases were reported each year with morbidity rates from 1.86 to 3.34 per 100,000 population and mortali- ty rates from 0.12 to 1.12%. Overall, 15,680 patients of mushroom poisoning were reported in Thailand during the 10-year period from 2008 to 2017 with an average of 1,568 patients annually. The cases were reported mainly from northeast and north Thailand. Actually, the incidence of mu- shroom poisoning increased during rainy season between May and September. The highest risk was found among patients aged between 55 and 64 years and over 65 years followed by the group of 45- 54 years. The poison risk to women was always greater than to men with ratios varying between 1.13:1 and 1.70:1 and the incidence was found mainly among farmers and general workers. Four groups of toxins have been found in Thailand including protoplasmic poisons, neurotoxins, ga- strointestinal irritants and disulfiram-like toxins. The protoplasmic poisons are a major cause of death in most cases and are found among some mushrooms, such as Amanita exitialis, A. fuliginea, A. fuligineoides and A. gleocystidiosa. Gastrointestinal irritants are the most common toxins found in all regions of Thailand and found among some mushrooms, such as Chlorophyllum molybdites, Russula sp., Cantharocybe virosa, Entoloma sp., Lactarius sp.and Tricholoma sp. Commonly, con- sumption of poisonous mushrooms is usually a result from misidentification of some poisonous ones, closely similar to those of the commonly edible mushrooms. Therefore, educating the public to recognize poisonous mushrooms to avoid to harvesting them for consumption or sale is urgently needed. Keywords: Mushroom, Poisoning, Toxin, Consumption, Health, Thailand Copyright 2018 KEI Journals. All Rights Reserved http://journals.ke-i.org/index.php/mra Tawatsin A. et al. Medical Research Archives, vol. 6, issue 9, September 2018 Page 2 of 12 INTRODUCTION tion of mushrooms included DNA extraction, PCR amplification, DNA sequencing, fungal Mushrooms are commonly found throughout identification using BLAST and BOLD-IDS, the world and are an important source of sequence alignments and phylogenetic ana- food for humans. About 140,000 species of lyses while the liquid chromatography mass 1 mushrooms have already been identified. spectrometry (LC-MS) method was used to Among these, approximately 2,000 species detect toxins in the mushrooms.15 All data are recognized as edible mushrooms while were statistically calculated and presented as about 700 species are considered as medicin- proper figures. al ones.1 Thailand is located in a tropical area in Southeast Asia with a high degree of bio- diversity; and as a result, many species of RESULTS AND DISCUSSION mushroom can be found in forest The annual incidence of mushroom poison- areas. Almost 2,000 species of edible and ing in Thailand from 2008 to 2017 is shown inedible mushrooms are distributed around 2 in Figure 1. As can be seen, about 1,200 to the country. Mushrooms have been com- 2,000 cases were reported each year with a monly consumed by Thais. However, mu- morbidity rate between 1.86 and 3.34 per shroom poisoning is also one of the major 100,000 population during that period. The public health issues related to food-borne lowest incidence of mushroom poisoning was diseases in Thailand. Mushroom poisoning found in 2016 with 1,220 reported cases resulting in death is reported by the Ministry while the highest in 2012 reported 2,148 cas- of Public Health yearly and remains a signif- es. Overall, 15,680 mushroom poisoning icant cause of poisoning-related mortality in 3 patients were reported in Thailand during the the country. This study intended to investi- 10-year period between 2008 and 2017 with gate the epidemiology of mushroom poison- an average of 1,568 patients/year. This inci- ing in Thailand during the past decade. In- dence is dramatically high as compared with formation about poisonous mushrooms and other countries, such as Japan (192 pa- their toxins found in Thailand were revealed tients/year),16 Switzerland (79 pa- and discussed.Some attempts to minimize the tients/year),17 Hong Kong (67 patients/year)18 incidence were also investigated and solu- and Korea (21 patients/year).19 Therefore, tions suggested. minimizing the incidence of mushroom poi- soning in Thailand is urgent needed as much MATERIALS AND METHODS as possible using various strategies. Howev- er, the number of people reporting mushroom The data on the incidence of mushroom poi- poisoning in Thailand yearly should be high- soning in Thailand between 2008 and 2017 er than those reported in the Figure 1 because was obtained using online published annual people presenting only mild symptoms after reports of the Bureau of Epidemiology, De- ingesting the mushrooms do not want to visit partment of Disease Control, Ministry of hospitals, especially those living in remote 4-13 Public Health, Thailand. The information areas with poor access to health services. about mushroom species identification using Normally, the number of reported mushroom molecular techniques and laboratory detec- poisoning cases increases during the rainy tion of toxins in mushroom samples was ob- season between May and September. In fact, tained from the Toxicology Center, National this is the best period for mushroom growing Institute of Health (Thai NIH) and the pub- in Thailand, especially for those residing in lished annual reports of the National Institute forests. Thais collect many mushrooms from of Health, Department of Medical Sciences, the forests nearby their homes for consump- 14 Ministry of Public Health, Thailand. The tion in their families as well as for local sale. molecular techniques for species identifica- Copyright 2018 KEI Journals. All Rights Reserved http://journals.ke-i.org/index.php/mra Tawatsin A. et al. Medical Research Archives, vol. 6, issue 9, September 2018 Page 3 of 12 Some commonly edible mushrooms, such as Therefore, many Thais are active in harvest- Termitomyces fuliginosus, Termitomyces ing edible mushrooms in the forests during globulus and Astraeus hygrometricus have rainy season yearly to supplement their in- relatively high prices in the market, approx- come. imately 600-1,000 THB/kg (USD 20-35/kg). 2 400 5,0 2 200 2 000 Reported cases 4,0 1 800 Morbidity rates 1 600 1 400 3,0 1 200 Reported Reported cases 1 000 2,0 800 600 1,0 Mortbidity rates (per 100,000population) 400 200 0 0,0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year Figure 1. Reported cases and morbidity rates of mushroom poisoning in Thailand, from 2008 - 2017. The number of reported deaths because of methods, such as boiling, grilling or stir- poisonous mushrooms and mortality rates frying cannot affect the toxicity of some mu- (%) between 2008 and 2017 are presented in shrooms because the toxins are heat stable. Figure 2. The lowest incidence (2 deaths) As for the individual response, the elderly was found in 2009 with 0.12% mortality and children are at higher risk for the serious whereas the highest (24 deaths) was found in effects from mushroom poisoning than 2012 with a 1.12% mortality rate. Overall, 79 healthy young adults.20 In this study, the patients died by mushroom poisoning in highest risk was usually found among the Thailand from 2008 to 2017 with an average patients aged between 55 and 64 years and of about 8 deaths annually. Most cases were over 65 years, followed by the group 45-54 caused by consuming poisonous mushrooms years. As can be seen, most cases of mu- from the genus Amanita. Actually, the severi- shroom poisoning in Thailand commonly ty of mushroom poisoning depends mainly occurred among adults with ages at least 45 on the species poisonous mushrooms in- years old. Additionally, the poison risk to gested, the amount of toxins received, the women was always greater than men from cooking process and individual response to 2008 to 2017, with ratios varying between the toxins. Many toxins produced by poison- 1.13:1 (in 2011) and 1.70:1 (in 2017) and ous mushrooms can affect the organs, vary- was found mainly among farmers and gener- ing from mild to severe symptoms. Cooking al workers. Copyright 2018 KEI Journals. All Rights Reserved http://journals.ke-i.org/index.php/mra Tawatsin A. et al. Medical Research Archives, vol. 6, issue 9, September 2018 Page 4 of 12 25 1,4 20 Reported deaths 1,2 Mortality rates 1,0 15 0,8 Mortbidity Mortbidity rates (%) Reported Reported deaths 10 0,6 0,4 5 0,2 0 0,0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year Figure 2. Reported deaths and mortality rates of mushroom poisoning in Thailand, from 2008 - 2017. Mushroom poisoning can be classified in without presenting any symptoms could last four groups by the physiological effects: pro- about 6-24 hours after mushroom ingestion.
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