Wennig Robert, Eyer Florian, Schaper Andreas, Zilker Thomas, Andresen-Streichert Hilke
Luxembourg: Prof. Dr. Robert Wennig (formerly Laboratoire National de Santé- Toxicologie, Université du Luxembourg-Campus Limpertsberg); Department of Clinical Toxicology & Poison Control Center Munich, Klinikum rechts der Isar, School of Medicine, Technical University of Munich; GIZ-Nord Poisons Centre,Göttingen University Hospital Faculty of Medicine and University Hospital Cologne and Department of Forensic Toxicology,University Hospital Cologne.
Dtsch Arztebl Int. 2020 Oct 16;117(42):701-708. doi: 10.3238/arztebl.2020.0701.
Poisonous mushrooms are eaten by mushroom hunters out of ignorance, after misidentification as edible mushrooms, or as a psychoactive drug. Mushroom poisoning commonly leads to consultation with a poison information center and to hospitalization.
This review is based on pertinent publications about the syndromes, toxins, and diagnostic modalities that are presented here, which were retrieved by a selective search in PubMed. It is additionally based on the authors' longstanding experience in the diagnosis and treatment of mushroom intoxication, expert consultation in suspected cases, macroscopic identification of wild mushrooms, and analytic techniques.
A distinction is usually drawn between mushroom poisoning with a short latency of less than six hours, presenting with a gastrointestinal syndrome whose course is usually relatively harmless, and cases with a longer latency of six to 24 hours or more, whose course can be life-threatening (e.g., phalloides, gyromitra, orellanus, and rhabdomyolysis syndrome). The DRG diagnosis data for Germany over the period 2000-2018 include a total of 4412 hospitalizations and 22 deaths due to the toxic effects of mushroom consumption. 90% of the fatalities were due to the death cap mushroom (amatoxins). Gastrointestinal syndromes due to mushroom consumption can be caused not only by poisonous mushrooms, but also by the eating of microbially spoiled, raw, or inadequately cooked mushrooms, or by excessively copious or frequent mushroom consumption.
There are few analytic techniques available other than the qualitative demonstration of amatoxins. Thus, the diagnosis is generally made on the basis of the clinical manifestations and their latency, along with meticulous history-taking, assisted by a mushroom expert, about the type(s) of mushroom that were consumed and the manner of their preparation.
采食毒蘑菇的原因包括蘑菇采集者出于无知、误将毒蘑菇认作可食用蘑菇或当作精神活性药物。蘑菇中毒通常会导致向毒物信息中心咨询并住院治疗。
本综述基于此处呈现的有关综合征、毒素和诊断方法的相关出版物，这些出版物通过在PubMed中进行选择性检索获得。此外，它还基于作者在蘑菇中毒诊断和治疗方面的长期经验、疑似病例的专家咨询、野生蘑菇的宏观鉴定以及分析技术。
通常将潜伏期短于6小时的蘑菇中毒与潜伏期为6至24小时或更长时间的病例区分开来。前者表现为胃肠道综合征，病程通常相对无害；后者的病程可能危及生命（如毒鹅膏、鹿花菌、赭盖牛肝菌和横纹肌溶解综合征）。2000 - 2018年德国的疾病诊断相关分组（DRG）诊断数据显示，因食用蘑菇的毒性作用而住院的病例共有441例，死亡22例。90%的死亡病例是由毒鹅膏（鹅膏毒素）导致的。食用蘑菇引起的胃肠道综合征不仅可能由毒蘑菇引起，还可能由食用微生物污染的、生的或未煮熟的蘑菇，或过量或频繁食用蘑菇所致。
除了对鹅膏毒素进行定性检测外，可用的分析技术很少。因此，诊断通常基于临床表现及其潜伏期，并在蘑菇专家的协助下，通过仔细询问食用蘑菇的种类及其烹饪方式的详细病史来做出。
