Fungal Diversity (2014) 64:123–131 DOI 10.1007/s13225-013-0260-7 Investigation and analysis of 102 mushroom poisoning cases in Southern China from 1994 to 2012 Zuohong Chen & Ping Zhang & Zhiguang Zhang Received: 17 June 2013 /Accepted: 31 July 2013 /Published online: 15 August 2013 # Mushroom Research Foundation 2013 Abstract Mushroom poisoning is the main cause of mortality Keywords Mushroom poisoning . Amanita . Syndrome . in food poisoning incidents in China. Although some respon- Psilocybe samuiensis . Rhabdomyolysis sible mushroom species have been identified, some were identified inaccuratly. This study investigated and analyzed 102 mushroom poisoning cases in southern China from 1994 Introduction to 2012, which involved 852 patients and 183 deaths, with an overall mortality of 21.48 %. The results showed that 85.3 % Approximately 3,800 species of mushrooms have been of poisoning cases occurred from June to September, and catalogued in China, and about 421 species are considered involved 16 species of poisonous mushroom: Amanita species as poisonous (Mao 2000, 2006). Collecting wild mushrooms (A. fuliginea, A. exitialis, A. subjunquillea var. alba, A. cf. for human consumption has been a long-standing tradition in pseudoporphyria, A. kotohiraensis, A. neoovoidea, A. many areas in southern China. However, edible and poisonous gymnopus), Galerina sulciceps, Psilocybe samuiensis, mushrooms may be frequently confused, or their identities Russula subnigricans, R. senecis, R. japonica, Chlorophyllum mistaken, leading to an annual toll of mushroom poisoning molybdites, Paxillus involutus, Leucocoprinus cepaestipes incidents. The statistical data of the national food poisoning and Pulveroboletus ravenelii. Six species (A. subjunquillea report from the Chinese Center for Disease Control and Pre- var. alba, A. cf. pseudoporphyria, A. gymnopus, R. japonica, vention (CDC) showed that 311 mushroom poisoning events Psilocybe samuiensis and Paxillus involutus) are reported for were reported, with 1,954 poisoning cases and 409 deaths. the first time in poisoning reports from China. Psilocybe The mortality was 20.93 % where mushroom poisoning was samuiensis is a newly recorded species in China. The genus the main cause of death (Niu et al. 2011; Jin and Li 2009). Amanita was responsible for 70.49 % of fatalities; the main However, most of the investigations and reports from the lethal species were A. fuliginea and A. exitialis. Russula CDC focused on epidemiology, and the reports from hospitals subnigricans caused 24.59 % of fatalities, and five species mainly emphasized the syndromes (Niu et al. 2011; Jin and Li showed mortality >20 % (A. fuliginea, A. exitialis, A. 2009;Yuetal.2012;Zhouetal.2009;Chenetal.1991). subjunquillea var. alba, R. subnigricans and Paxillus Identification of which mushrooms were responsible for the involutus). Mushroom poisoning symptoms were classified poisoning events is often inaccurate. For example, before from among the reported clinical symptoms. Seven types of 2005, most of the lethal species belonging to Amanita genus mushroom poisoning symptoms were identified for clinical were identified as A. phalloides, A. verna and A. virosa (Li diagnosis and treatment in China, including gastroenteritis, et al. 2002;Chenetal.1991). In recent years, mycology acute liver failure, acute renal failure, psychoneurological experts in China investigated mushroom poisoning cases or disorder, hemolysis, rhabdomyolysis and photosensitive identified the mushrooms responsible for the incidents. The dermatitis. results indicated that some poisonous mushrooms (especially in the genus Amanita) did not occur in Europe or in North America, and some are new species or belong exclusively to East Asian taxa (Yang 2000a, 2005). For example, A. exitialis, * : : Z. Chen ( ) P. Zhang Z. Zhang which caused 52 poisoning cases including 20 fatalities during College of Life Sciences, Hunan Normal University, – Changsha 410081, China 2000 2010 (Deng et al. 2011), has only been reported in e-mail: [email protected] Guangdong Province (Yang 2005). Amanita fuliginea, which 124 Fungal Diversity (2014) 64:123–131 caused many fatal poisoning cases in Hunan and Jiangxi and collected from the field and eaten at home in the Provinces (Zhang et al. 2002; Huang et al. 2002), occurs only remaining 101 cases; therefore, the data should reflect the in China and Japan (Yang 2005). A “little white mushroom” natural occurrence of the mushrooms over time. Table 1 which caused about 400 sudden unexplained deaths in Yun- shows that 85.30 % of the poisoning cases, 91.31 % of nan Province during summers over the last 35 years has been poisoned patients and 84.70 % of deaths occurred from June identified as a new species, Trogia venenata (Yang et al. to September. These periods are hot and rainy in southern 2012). In this paper, we report the investigation and analysis China, which are suitable conditions for the rapid growth of of 102 mushroom poisoning cases in southern China from wild mushrooms. The seven cases that occurred in March and 1994 to 2012, clarifying the mushroom species responsible April were in Guangdong Province, where the climate is and their clinical symptoms. warmer and wetter than other parts of southern China. Materials and methods Poisonous mushroom species Sourcesofmaterials Sixteen species of poisonous mushrooms were identified by morphological, anatomical and molecular studies. The results We collected the mushroom poisoning specimens from the are shown in Table 2, and some of them are displayed in field and clinical symptoms data from the hospital records of Fig. 1. Among them, seven species belong to the genus the poisoned patients in southern China, including Hunan, Amanita: A. fuliginea Hongo, A. exitialis Zhu L. Yang & T. Hubei, Guangdong, Jiangxi, Guizhou, Chongqing and Si- H. Li, A. subjunquillea var. alba Zhu L. Yang, A. cf. chuan Provinces, from 1994 to 2012. pseudoporphyria Hongo, A. kotohiraensis Nagas. & Mitani, A. neoovoidea Hongo and A. gymnopus Corner & Bas. Three Mushroom identification species of the genus Russula were identified: R. subnigricans Hongo, R. senecis S. Imai and R. japonica Hongo. The other The mushroom specimens were collected from the scene of six species were Galerina sulciceps (Berk.) Boedijn, the poisoning accidents and confirmed by the patients or their Chlorophyllum molybdites (G. Mey.) Massee, Leucocoprinus family members. The mushrooms were identified by morpho- cepaestipes (Sow.: Fr.) Pat., Pulveroboletus ravenelii (Berk. & logical and anatomical studies, and molecularly by internal M.A. Curtis) Murrill, Psilocybe samuiensis Guzmán, Bandala transcribed spacer sequence analysis. All specimen vouchers & J.W. Allen and Paxillus involutus (Batsch) Fr. For six were deposited at the Herbarium of College of Life Sciences, species (A. subjunquillea var. alba, A. cf. pseudoporphyria, Hunan Normal University (MHHNU). A. gymnopus, R. japonica, Psilocybe samuiensis and Paxillus involutus), this is the first report of their involvement in Data analysis poisoning in China. Psilocybe samuiensis is a newly recorded EXCEL 2003 was used to establish a database for statistical analysis. Table 1 Monthly distribution of mushroom poisoning Month No. of Percent No. of Percent No. of Percent cases (%) patients (%) deaths (%) Results Jan. 0 0 0 0 0 0 Overview of mushroom poisoning Feb. 0 0 0 0 0 0 Mar.5 4.90273.17147.65 One hundred and two mushroom poisoning cases were inves- Apr.2 1.96131.5384.37 tigated in southern China from 1994 to 2012. Seventy-eight May 2 1.96 6 0.70 3 1.64 cases occurred in Hunan Province, and 24 in Chongqing, June 45 44.12 316 37.09 83 45.35 Guangdong, Guizhou, Hubei, Jiangxi, and Sichuan Provinces, July 14 13.73 85 9.98 21 11.48 which involved 852 poisoned patients with 183 patient deaths, Aug. 18 17.65 136 15.96 37 20.22 giving a mortality of 21.48 %. Sept. 10 9.80 241 28.28 14 7.65 Oct. 2 1.96 4 0.47 2 1.09 Monthly distribution of mushroom poisoning Nov.3 2.94172.0010.55 Dec. 1 0.98 7 0.82 0 0 Except for one incident where the patients ate dried mush- total 102 100 852 100 183 100 rooms at a restaurant, the poisonous mushrooms were fresh Fungal Diversity (2014) 64:123–131 125 Fig. 1 Poisonous mushrooms found in southern China. A. Amanita fuliginea;B.A. exitialis; C. A. subjunquillea var. alba;D. A. cf. pseudoporphyria;E.A. kotohiraensis;F.A. gymnopus;G. Galerina sulciceps;H.Russula subnigricans;I.Russula japonica;J.Chlorophyllum molybdites;K.Pulveroboletus ravenelii;L.Psilocybe samuiensis species in China, and this is the first report of R. japonica in Paxillus involutus was caused by the ingestion of a single mainland China. species. However, in the poisoning cases induced by A. Table 2 shows that 64.70 % of poisoning cases, 78.05 % of fuliginea and A. subjunquillea var. alba, most of the cases poisoned patients and 70.49 % of deaths were caused by the were caused by the ingestion of miscellaneous mushroom species of the genus Amanita. Among the genus Amanita,the species, most of which could be edible; however, because of main lethal species were A. fuliginea and A. exitialis.In carelessness, the collection and ingestion of A. fuliginea or A. addition, 13.73 % of the poisoning cases, 10.33 % of poisoned subjunquillea var. alba caused the poisoning. In eight of the patients and 24.59 % of deaths were caused by R. 33 cases caused by A. fuliginea, where the poisoning was subnigricans. The combined poisoning cases, patients and caused by ingestion of A. fuliginea only, mortality was 60– deaths caused by these three fatal mushrooms were 51.96 %, 100 %. 55.63 % and 78.69 %, respectively. Table 2 also shows that eight of the mushroom species Monthly distribution of poisoning cases caused by different could cause fatalities. Among them, five species had a mor- mushrooms tality >20 %: A. fuliginea, A. exitialis, A. subjunquillea var. alba, R. subnigricans and Paxillus involutus. The mortality Different mushroom species grow during different seasons, data should be explained here. In our investigation, we found and understanding the periods when the poisoning occurred that the poisoning induced by A.