Interest in the recent poisonings from Amanita phalloides continues. I have talked with Mrs. Chang, mother of the 13 year old who received a temporary partial liver transplant. She clarified several of the questions we had about what happened. She will attempt to find out specifically the name of the mushroom which they thought they had eaten. So for, this is the single fact in all of these cases which eludes us. What do Asian immigrants think they are picking?
The visiting family member who thought he had picked mushrooms like this in Taiwan returned to L.A. and became moderately ill. He and the rest of the family are now well, with improved chemical tests and taking no medicines. It is predicted that they will be troubled no more with this experience.
The young man we reported from Santa Cruz, who nibbled on a A. phalloides cap to ôget highö, was observed at the Dominican Hospital. Lab tests alarmed his doctors who transferred him to the U.C.S.F. Hospital. There, he rapidly improved and returned home the following day. I believe he was treated with Penicillin.
The Rochester Area Mycological AssÆn has shared with us their experience last October when 4 Laotians were hospitalized with A. phalloides poisoning. All recovered after treatment with Penicillin and Tagamet. A flyer was written in Laotian and distributed in the area. From Japan, we have heard of a family succumbing to a meal of A. phalloides. So the risk of this happening is widespread.
Why Penicillin? Perhaps doctors feel comfortable with a drug they are accustomed to using. It is given in Italy, France and occasionally in Germany. If adequate doses are applied and the sodium salt is used, there is proven risk of allergic reactions, convulsions and cardiac congestion. Its use is based on the theory that Penicillin competes with amanitin poison for binding sites on transport proteins. If it actually works, the exact mode of action is at this time not well understood. It seems safer and more rational to pass a nasoduodenal tube into the intestine to remove the bile which contains amanitin after it courses through the liver. This prevents recycling of the poison and additional harm to the liver cells. It must be done within the first 48 hours after ingestion.
Our Toxicology Committee will recommend later to the FDA that doctors in the USA give the drug, Silybinin, a trial. This is a promising extract used in Germany after animal experiments demonstrated that dogs given measured toxic doses of a-amanitin suffered little harm when protected early enough with the drug. Silybinin is extracted from the seeds of the spilt milk thistle, Sylybum marianum, a common weed in the West. It blocks the uptake of poison at the liver cell membrane, has no known side-effects and no drug interactions to contend with.
A prototype for a poster is being prepared by Earl Gee, a S.F. graphics designer, for use in obtaining donation money. The National Poison Control Center will distribute the final poster in the USA and Canada. NAMA has established a ôToxic Poster Fundö to manage finances. We hope to have a pictorial, rather than a narrative message, to avoid the multi-dialect problem in warning people from many countries.
A student at the San Jose State College is preparing a paper on the subject. She has promised to submit a copy for our library reference. In addition, on May 30th, at 9:00 P.M., a program discussing mushroom poisoning entitled ôThe Most Dangerous...ö is planned for CBS (KPIX). The springtime Amanitas are fruiting now. A. ocreata in the West, and A. virosa and A. verna in the East are mostly white species as poisonous as phalloides. Familiarize yourselves with these species. Do yourself a favor ù avoid all white mushrooms, especially those with a partial veil, a volva and white gills.