2014 NAMA Toxicology Committee Report

In addition to the four documented deaths, Marilyn Shaw reported a mysterious death of a teenager attempting to get high. The youth had gone out and returned well after midnight, “thrashing around, apparently hallucinating.” The father could not get through to his son, so he left him, only to find his son dead four hours later. While no cause of death could be determined and drug panels turned up negative, a plastic bag of dried mushroom material was found and brought to Denver, Colorado, by an assistant in a Colorado coroner’s office. Marilyn Shaw and Vera Evenson could make out small pieces that appeared to be Amanita muscaria in the bag. There is no evidence that mushrooms were consumed in the fatal incident, but it is possible. However, even if mushrooms had been consumed, the toxins muscimol and ibotenic acid are not lethal toxins (unless consumed in extraordinarily large amount). Even then, they would not cause death so rapidly except in a case of shock (because of an allergic reaction).

In a Washington state case, a teen presented at the hospital with severe gastrointestinal symptoms. It was presumed that he had eaten Galerina marginata, a deadly species containing amatoxins. Brandon Matheny later sequenced the mushrooms and found that they were Gymnopilus penetrans (Joe Ammirati, personal communication). Several Gymnopilus species do contain enough psilocybin and psilocin to be hallucinogenic. They do not contain amatoxins but may very well contain other uncharacterized toxins.

In a New Mexico case, a 1-year-old ate a fair amount of what was clearly a species of Inocybe. She appeared to be hallucinating, was agitated, and required intubation. She had a fever in excess of 104°F, went into a coma, and had a seizure. She did not have any symptoms of muscarinic poisoning. The child’s mother sampled the same mushrooms and felt strange as a result. While most species of Inocybe contain high levels of the toxin muscarine, a few Inocybe species are high in the indoles psilocybin and psilocin. These indoles, present in many species in the genus Psilocybe, have previously caused death in very young children. Given the child’s temperature, we can assume that this was a narrow escape on death. It is worth noting that wild mushrooms of any kind are not advisable for children under the age of 5 or 6. Their immune systems are not yet fully developed, and they are both more severely affected by toxic mushrooms than healthy adults are and can be sickened by mushrooms that are edible for adults.

We have reports regarding six young men who wound up in the hospital while attempting to get high on what was presumed by Poison Center personnel to be Psilocybe species. Such events are far more common than indicated by the six reports that we received; neither hospitals nor Poison Centers release information due to privacy issues or time constraints. In two other cases—one in South Carolina and the other in Washington state—20- to 30-year-old men who knew nothing about mushrooms had picked little brown mushrooms in the woods hoping to get high. Both men suffered adverse effects for weeks, writing repeatedly to several different NAMA toxicology identifiers and fearing that they had eaten something that was going to kill them days or weeks later. The Washington state man had eaten Gymnopus peronatus. We could not tell with any certainty what the South Carolina man had eaten. In both cases, the ongoing symptoms were possibly the result of fear and panic, rather than any toxin inherent to the mushrooms. Marilyn Shaw also had a case where she concluded that ongoing symptoms described by a caller were probably panic attacks after a person consumed mushrooms as food without carefully identifying them first.

Chlorophyllum molybdites was behind more of the poisoning reports than any other species. It is common in warm, humid areas (or well-watered lawns in warm climates). It is the most common poisonous lawn mushroom and is frequently sampled raw, an unwise practice with any mushroom, wild or cultivated. The taste is great, but it can cause vomiting, diarrhea, and intestinal cramps lasting for many hours, and its ingestion may lead to bloody diarrhea and bloody sputum.

Another group of tasty but poisonous mushrooms is Amanita subgenus Amanita section Amanita. This includes the Amanita muscaria group and the Amanita pantherina group. In six reports involving nine individuals, people consumed mushrooms containing the isoxazole compounds found in members of Amanita section Amanita. All but one of four people who consumed Amanita pantherina as food wound up hospitalized and in a coma. One case involved a 91-year-old female who became comatose after consuming a large meal of Amanita pantherina. Another involved a couple who consumed about one-half pound of Amanita pantherina.

We have three reports involving six individuals who became sick after consuming Leccinum species. Four of those individuals from two 2014 cases consumed raw or only lightly cooked mushrooms. It is increasingly clear that if you do choose to eat a Leccinum, you should cook it thoroughly. In addition, it is unwise to eat a very large meal of Leccinum, as one couple learned after they consumed 12 to 15 cooked buttons.

Shiitake mushrooms were involved in several cases of both GI upset and severe rash. Lentinula edodes, shiitake, must be thoroughly cooked. It is important to note that in May 2014 researchers reported finding high inorganic arsenic levels in shiitake products, including fresh mushrooms, food supplements, and canned and dried shiitake. Moderate consumption of shiitake is not a concern, but regular consumption could pose a threat of arsenic poisoning.

In one case, a chef purchased “ceps” and Lepista nuda “blewits” from a forager. Even though the forager warned the chef to cook the blewits, the chef consumed one raw, a fact that he did not initially own up to since he was so embarrassed over his poor judgment. The price the chef paid was initial flushing, sweating, vomiting, nausea, and blurred vision followed by a return bout of vomiting 14 hours later. On follow-up, he was very chastened and resolved to be much more conservative in his future consumption of mushrooms (Greg Marley personal communication).

It is also clear that raw or undercooked morels can cause vomiting and diarrhea, as at least one person rediscovered last year. Two other people suffered extreme drowsiness immediately after consuming cooked yellow morels, followed by vertigo when they awoke hours later. One of the two also began vomiting on awakening. It is not clear how well-cooked those morels were.

Gyromitra esculenta, sometimes known as “beefsteaks,” continues to be widely consumed, especially in Michigan. Even well-cooked Gyromitra esculenta can cause severe, even life-threatening poisoning. One man from British Columbia, a lifelong forager who was not in great health, was hospitalized for one month after a meal of Gyromitra esculenta. Rapid hepatic and renal failure and then a colonic ischemia followed his initial nausea and vomiting. Doctors had presumed it was a case of amatoxin poisoning. In a Michigan case, a 75-year-old man in poor initial health who had eaten a large meal of beefsteaks for two days in a row, presented at the ER with elevated transaminases and bilirubin as well as diarrhea, dizziness, intestinal cramps, vomiting, nausea, and headache. Four days later, he was still very jaundiced and his urine was dark red. In another case, three teenagers out camping picked a five-gallon bucket of Gyromitra esculenta, cooked up a big pot of the mushrooms, and “ate a lot.” For two, diarrhea and vomiting followed. The third suffered chills, flushing, and headache in addition to nausea and vomiting. The next morning their dog found the pot of cooked mushrooms and, like many a dog, pigged out. After suffering vomiting and diarrhea for two days, the dog became dehydrated and its temperature climbed to 102.4°F. A veterinarian treated the dog for two days, and the dog died on day four.

In the past year, two different women—in two separate instances—cooked and consumed Clitocybe dealbata, a mushroom that contains significant levels of muscarine. They suffered excessive salivation, sweating, chills, and vomiting. One woman had mistaken her collection for blewits, which she had eaten for years. The other woman had mistaken her mushrooms for “box elder” mushrooms, which she had eaten for years. Both swore that they would be more careful in the future.

Even with edible mushrooms, moderation can be important. If you have a somewhat adverse reaction to a species and you continue to eat it, your next reaction can be worse. One couple consumed Verpa bohemica several days in a row. The woman eventually developed diarrhea, and the man became woozy. Another man reported that chanterelles normally increased his visual acuity, nightmares, and sensitivity to cold. However, in that man’s most recent experience, in addition to his usual reactions, he had extreme hypertension (300-plus/180). He does not plan to eat chanterelles again. Another woman had felt unwell after her first meal of chanterelles. Her second meal was much worse, resulting in vomiting and diarrhea.

Cats are considered obligate carnivores, and it is very rare to get a report of even one cat poisoned by mushrooms. However, this year three individuals reported four cats who fell sick after consuming wild mushrooms. A California case involved a sick cat that died at the veterinarian’s office. The owner found a partially eaten Amanita ocreata under the dining room table. The cat had brought its prize into the house, as cats tend to do. A second case involved a cat from semiarid eastern Washington. After periods of heavy rain, what appeared from photos to be Coprinopsis atramentaria variety crassivelata would start to form underground where a huge poplar tree had once grown. The cat would dig out the mushrooms, eat them, act crazy, and vomit. Even though the owner tried to preemptively remove the mushrooms, the cat would detect them before they broke the soil surface.

The third cat poisoning case involved two sick feral cats from Nova Scotia. The person who submitted the report engaged an animal communicator, who relayed to the owner that the cats said that they loved to eat mushrooms but this time the mushrooms had made them ill. The reported symptoms were reminiscent of Amanita muscaria poisoning. The person who submitted the report hesitated for fear of being considered a bit crazy. I will leave any conclusion to your judgment.

It is also unusual, but not unheard of, to get a report of a horse eating mushrooms. This year’s case involved a horse that appeared to be hallucinating in a Montana pasture. On the sescond day of its strange behavior, the horse was lying down and could not get up for quite a while. The owner would not let the veterinarian euthanize the horse. The owner, a medical doctor, had observed an abundance of little brown mushrooms in the grass and on manure, with blue staining on some mushrooms, so she suspected they were hallucinogenic mushrooms (the species involved may have been in the genus Panaeolus). She consulted with Marilyn Shaw who confirmed the suspicions. The horse recovered with no lasting problems.

Many more veterinarians are now aware of NAMA, and we are getting better information about animal poisonings. As usual, dogs dominated the animal poisoning cases. In many cases dogs died after consuming wild mushrooms. For the first time ever, there was a report of a dog that died after consuming what very much appeared to be Amanita cokeri. Amanita cokeri was once suspected of containing the toxin allenic norleucine, but it actually contains other toxins yet to be described. Another dog was acting “stoned” and had diarrhea, then became lethargic and soon died. The mushroom found in the yard was a white Xerula species. However, there is no direct evidence linking the presence of the Xerula to the dog poisoning. Indeed, we simply do not know whether some Xerula species are toxic.

Amanita phalloides and Amanita ocreata dominated the dog death reports, with six reports of eight dogs dead in California from ingesting these mushrooms. Newspaper reports, mainly in the Marin Independent Journal repeatedly warned dog owners to look out for Amanita phalloides and Amanita ocreata, which mainly grow under oaks, though both species have been found under other hardwoods and Amanita phalloides has been found under conifers.  

The news articles caution owners to remove the mushrooms as soon as they are spotted because they seem irresistible to some dogs. One article told owners to pick the mushrooms without being seen by the dogs since seeing owners picking the mushrooms can pique the dogs’ interest. That is good advice. The articles also made it clear to us that the six reports we received represented only a small fraction of the dogs that died in California last year. Reporters also pointed out that larger dogs could sometimes be saved by prompt and aggressive treatment focusing on rehydration. However, with small dogs, even prompt treatment could not save many animals. While the cause of a dog’s death often remains a mystery, we learned that the University of California, Davis, is now testing dog urine for amatoxins as well as doing tissue postmortems. Thus, at least for California, veterinarians now can confirm whether amatoxins were present.

Ingestion of a Scleroderma species claimed the lives of two Yorkies in California. Scleroderma species are involved in human and animal poisonings nearly every year. While no human deaths have been recorded from Scleroderma species, they have killed both dogs and pigs. Inocybe species are also known to be potentially lethal to dogs, but so far not to humans. In 2014, at least one dog died from ingesting an Inocybe. The picture of the Inocybe looked somewhat similar to Inocybe lanuginosa, but the spores were smooth, not nodulose, so we do not know what the actual species was. In another incident, two dogs died from amatoxin-like symptoms, but no Amanita species were found in the yard. However, the pictures included what appeared to be Lepiota subincarnata, a species known to contain amatoxins. With dogs, it is always a challenge figuring out what they actually consumed unless the mushrooms are found in the stomach contents or vomitus or mushrooms are found partially eaten.