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 19 October 2017

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News

Factors associated with severe hepatitis due to mushroom poisoning

The most recent issue of the Clinical Gastroenterology & Hepatology examines features of patients with severe hepatitis due to mushroom poisoning and factors associated with outcome.

News image

Acute liver failure after ingestion of toxic mushrooms is a significant medical problem. 

Most exposures to toxic mushrooms produce no symptoms or only mild gastroenteritis, but some lead to severe hepatic necrosis and fulminant hepatic failure requiring liver transplantation. 

Dr Maurizio Bonacini and colleagues from California, USA assessed mortality from mushroom poisoning, and identified variables associated with survival and liver transplantation.

The researchers collected information from 27 patients admitted to the emergency department within 24 hours of ingesting wild mushrooms. 

The team developed severe liver injury, and were treated with activated charcoal and N-acetylcysteine at a tertiary medical center in San Francisco, California from 1997 through 2014. 

26% to 50% of patients could have avoided transfer to a transplant center
Clinical Gastroenterology & Hepatology
Viral hepatitis, autoimmune liver disease, acetaminophen, salicylate toxicity, and chronic liver diseases were ruled out for all patients. 

The researchers analyzed patient demographics, time since ingestion, presenting symptoms, laboratory values, and therapies administered. 

A good outcome was defined as survival without need for liver transplant. 

The team defined a poor outcome as death or liver transplant. 

The researchers observed that liver injury was attributed to ingestion of Amanita phalloides in 24 patients and Amanita ocreata in 3 patients. 

The team found that 24 of the patients ingested mushrooms with meals, and 3 patients for hallucinogenic purpose. 

At 24–48 hours after ingestion, all patients had serum levels of alanine aminotransferase ranging from 554 to 4546 IU/L. 

The researchers observed that acute renal impairment developed in 5 patients. 

There were 23 patients that survived without liver transplantation, and 4 patients had poor outcomes. 

Of the 23 patients with peak levels of total bilirubin of 2 mg/dL or more during hospitalization, only 4 had a poor outcome. 

Peak serum level of aspartate aminotransferase less than 4000 IU/L, peak international normalized ratio less than 2, and a value of serum factor V greater than 30% identified patients with good outcomes with 100% positive predictive value.

The team observed that if these peak values were used as a cutoff, 26% to 50% of patients could have avoided transfer to a transplant center.

Dr Bonacini's team comments, "In an analysis of 27 patients with hepatocellular damage due to mushroom (Amanita) poisoning and peak levels of total bilirubin greater than 2 mg/dL, the probability of liver transplantation or death is 17%, fulfilling Hy’s law."

"Patients with peak levels of aspartate aminotransferase less than 4000 IU/L can be monitored in a local hospital, whereas patients with higher levels should be transferred to liver transplant centers."

"Women and older patients were more likely to have a poor outcome than men and younger patients."

Clin Gastroenterol Hepatol 2017: 15(5): 776–779
04 May 2017

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