Bay Area Shocked by Amanita phalloides Poisonings

by Bill Freedman


For a full week, members of the MSSF were besieged by the news media for opinions and explanations about Amanita phalloides and its toxic human effects. You may have seen Bill Freedman and Larry Stickney on TV and in newspaper reports. Bob Mackler instructed doctors at Mount Diablo Hospital on how to identify the “Death Cap’. Dr. Bob West tracked down the coroner following a Mexican man’s death. After conferring with U.C.S.F. doctors, Bill was invited to take part in the Pediatric Department’s clinical rounds reporting the unusual case of the 13 year old who needed a new liver.

On February 5th, a Taiwanese mother, her 13 year old daughter and two sons, in the U.S.A. for only two years, were seen briefly at the Alta Bates Hospital Emergency Room complaining of Stomach Distress, Nausea, vomiting and diarrhea. They brought mushrooms of the sort they had cooked with spaghetti and sauce and eaten on Feb. 4th. Given Compazine to control symptoms diagnosed as viral gastro-enteritis, they were returned home.

A well-respected elder and friend of the family from Los Angeles, considered knowledgeable about wild mushrooms was visiting the Orinda family. On Feb. 3rd they gathered mushrooms at the Lafayette Reservoir at a time when fungi were abundant. The fungi were prepared for lunch on Feb. 4th. The daughter hungrily ate her own portion as well as her brothers’ leftovers. The family enjoyed them so much that they served them for the evening meal. It was after the second exposure that they began to have gastro-intestinal symptoms.

On Feb. 6th they returned to the E.R. The daughter still had diarrhea. Her liver was enlarged and tender. MSSF member, Mike Wood, identified the specimen as Amanita phalloides. They were transferred to the U.C.S.F. Hospital where the daughter was immediately placed with possible liver failure in the Intensive Care Unit and the Liver Transplant Team was alerted.

On the second hospital day, her condition had deteriorated and she was fortunate to obtain a suitable liver available for transplantation. The surgeons elected to perform a partial transplant, removing the left lobe of the liver and attaching the donor left lobe, with suitable transplantation of arteries and the biliary drainage system. This is a very new approach for this condition. Since the liver re-grows rapidly after the toxic injury of amanitin, and since the majority of the poison has presumably passed from the body through the kidneys, the new liver was used to temporarily provide the patient’s body with good liver function until the old liver recovered. And this is just what happened.

On the 11th hospital day at U.C., the new liver had been damaged by a blood clot and appeared to be failing, so it was removed. Special, very modern visualization methods demonstrated that the patient’s liver had resumed more normal functioning. Therefore, there was little risk in this maneuver. She was discharged from the hospital on Feb. 24th.

The other members of the family had recovered with simple supportive treatment and had been returned home.

I was contacted by the Petaluma Valley Hospital after Arturo Leyba-Sanchez, a migrant Mexican field worker in the U.S.A. for 1 year had been admitted in semi-comatose condition with hepatic failure after eating an unknown amount of mushrooms, later identified by a woman as A. phalloides. He ate them on Feb. 3rd. Gastro-intestinal symptoms are reputed to have followed within an hour, suggesting that he had eaten another mildly toxic fungus. He died the day following admission, on Feb. 6. The coroner’s report concluded that liver damage causing his death was consistent with fulminant amanitin poisoning.

As I was completing this report, David Arora called to request I contact the attending physicians at the Dominican Hospital in Santa Cruz. They reported that a 13 year old young man of Mexican parentage had eaten part of a raw mushroom to “get high” at 6:00 P.M. last night. He experienced nausea, vomiting and diarrhea this morning. An initial liver enzyme test was within normal limits. It was recommended that tubal duodenal drainage be initiated at once if the blood clotting time level is adequate.

BE CAREFUL OUT THERE! Amanita phalloides is fruiting late. It is more widely distributed and more abundant than it was in the seventies, when the first epidemic of this fungus was experienced on the West Coast. Experienced gatherers are not going to expect to find it now.

Examine every single mushroom you collect for the table with diligence. Soon Amanita ocreata will arise. It is equally deadly. All white, with a sprinkling of brown cinnamon over the apex of the cap, it prefers oak woodlands. All all-white mushrooms should be suspect.

A poster for distribution to North American Emergency Rooms, immigrant access points, Asian Agencies and Community Centers is being prepared. It will warn newcomers to this country or Canada of the lethal dangers of eating wild mushrooms. We will try to use pictures to avoid having to send our message in a myriad of dialects. The National Poison Control Center is providing contact with the State Department and, with NAMA, some seed money. We will need outside funding to complete this task.

Please report all cases of mushroom reactions to me so that they can be reported to the national Poison Control Center. It is important that we accumulate as much knowledge as possible to prevent events such as the above in America.

P.S.: At the March 26th meeting of the Study Group at the Randall Museum, we will discuss in detail the medical aspects of these cases of ingestion of Amanita phalloides. If you have specific questions about these reports, and there are many ‘puzzlements’ yet unexplained, you are invited to attend.