Advanced Search

Preplanned Studies: Mushroom Poisoning Outbreaks — China, 2020

View author affiliation
  • Summary

    What is already known about this topic?

    Acute liver failure, rhabdomyolysis, acute renal failure, and hemolysis caused by poisonous mushrooms are the most important mushroom poisoning threats to the Chinese population. The most notorious lethal mushrooms are the species from genera Amanita, Lepiota, and Galerina that cause acute liver failure, and Russula subnigricans that leads to rhabdomyolysis.

    What is added by this report?

    In 2020, the total number of investigations reached 676, involving an estimated 102 species of poisonous mushrooms, 24 of which were newly recorded in China. Gyromitra venenata was newly discovered in incidents in Yunnan and Guizhou provinces and were the first reported poisonings due to gyromitrins in China since 2000. The rare poisoning Shiitake mushroom dermatitis was recorded in China. Hemolysis poisoning caused by Paxillus involutus was recorded for the second time since the beginning of the new century, resulting in one death in Inner Mongolia Autonomous Region.

    What are the implications for public health practice?

    Promoting knowledge about safe consumption of mushrooms is essential to reduce mushroom poisonings. It is not wise to collect and eat wild mushrooms. For southwestern provinces such as Yunnan, especially, caution must be exercised with unfamiliar mushroom species.

  • loading...
  • The median number of cases per incident was two.
  • [1] Li HJ, Zhang HS, Zhang YZ, Zhang KP, Zhou J, Yin Y, et al. Mushroom poisoning outbreaks — China, 2019. China CDC Weekly 2020;2(2):19 − 24. http://dx.doi.org/10.46234/ccdcw2020.005CrossRef
    [2] Wu F, Zhou LW, Yang ZL, Bau T, Li TH, Dai YC. Resource diversity of Chinese macrofungi: edible, medicinal and poisonous species. Fungal Divers 2019;98:1 − 76. http://dx.doi.org/10.1007/s13225-019-00432-7CrossRef
    [3] White J, Weinstein SA, De Haro L, Bédry R, Schaper A, Rumack BH, et al. Mushroom poisoning: a proposed new clinical classification. Toxicon 2019;157:53 − 65. http://dx.doi.org/10.1016/j.toxicon.2018.11.007CrossRef
    [4] Wang XH. Taxonomic comments on edible species of Russulaceae. Mycosystema 2020;39(9):1617 − 39. http://dx.doi.org/10.13346/j.mycosystema.200209 (In Chinese). CrossRef
    [5] Ge ZW, Jacobs A, Vellinga EC, Sysouphanthong P, Van Der Walt R, Lavorato C, et al. A multi-gene phylogeny of Chlorophyllum (Agaricaceae, Basidiomycota): new species, new combination and infrageneric classification. MycoKeys 2018;32:65 − 90. http://dx.doi.org/10.3897/mycokeys.32.23831CrossRef
    [6] Kanokmedhakul S, Lekphrom R, Kanokmedhakul K, Hahnvajanawong C, Bua-Art S, Saksirirat W, et al. Cytotoxic sesquiterpenes from luminescent mushroom Neonothopanus nambi. Tetrahedron 2012;68(39):8261 − 6. http://dx.doi.org/10.1016/j.tet.2012.07.057CrossRef
    [7] Li HJ, Chen ZH, Cai Q, Zhou MH, Chen GJ, Sun CY, et al. Gyromitra venenata, a new poisonous species discovered from China. Mycosystema 2020;39(9):1706 − 18. http://dx.doi.org/10.13346/j.mycosystema.200146CrossRef
    [8] Fan YG, Bau T. Taxonomy in Inocybe subgen. Mallocybe from China. J Fungal Res 2016;14(3):129 − 32, 141. http://dx.doi.org/10.13341/j.jfr.2014.1124CrossRef
    [9] Fan YG, Bau T. Taxonomy and phylogeny ofInocybe subgen. Inosperma from China. J Fungal Res 2018;16(1):17 − 27. http://dx.doi.org/10.13341/j.jfr.2018.1204CrossRef
    [10] Nguyen AH, Gonzaga MI, Lim VM, Adler MJ, Mitkov MV, Cappel MA. Clinical features of shiitake dermatitis: a systematic review. Int J Dermatol 2017;56(6):610 − 6. http://dx.doi.org/10.1111/ijd.13433CrossRef
    [11] Zhou J, Yuan Y, Lang N, Yin Y, Sun CY. Analysis of hazard in mushroom poisoning incidents in China mainland. Chin J Emerg Med 2016;25(6):724 − 8. http://dx.doi.org/10.3760/cma.j.issn.1671-0282.2016.06.008 (In Chinese). CrossRef
  • FIGURE 1.  Monthly distribution of mushroom poisonings in China, 2020.

    TABLE 1.  Geographical distribution of mushroom poisoning incidents, cases, deaths, and case fatality in China, 2020.

    PLADsNumber of incidentsNumber of patientsDeathsCase fatality (%)
    Hunan30266630.45
    Yunnan8124472.87
    Guizhou4314874.73
    Zhejiang437800
    Sichuan4012310.81
    Chongqing358800
    Fujian184200
    Guangxi158733.45
    Anhui123000
    Ningxia122913.45
    Hubei122414.16
    Guangdong112100
    Jiangxi91700
    Jiangsu9900
    Beijing82300
    Hainan73800
    Hebei73300
    Shandong38112.50
    Henan3300
    Inner Mongolia22150.00
    Liaoning1200
    Shanxi1200
    Gansu1100
    Xizang (Tibet)1100
    Total6761,719251.45
    Abbreviation: PLADs=provincial-level administrative divisions.
    Download: CSV

Citation:

通讯作者: 陈斌, bchen63@163.com
  • 1. 

    沈阳化工大学材料科学与工程学院 沈阳 110142

  1. 本站搜索
  2. 百度学术搜索
  3. 万方数据库搜索
  4. CNKI搜索
Turn off MathJax
Article Contents

Article Metrics

Article views(3890) PDF downloads(277) Cited by()

Share

Related

Mushroom Poisoning Outbreaks — China, 2020

View author affiliation

Summary

What is already known about this topic?

Acute liver failure, rhabdomyolysis, acute renal failure, and hemolysis caused by poisonous mushrooms are the most important mushroom poisoning threats to the Chinese population. The most notorious lethal mushrooms are the species from genera Amanita, Lepiota, and Galerina that cause acute liver failure, and Russula subnigricans that leads to rhabdomyolysis.

What is added by this report?

In 2020, the total number of investigations reached 676, involving an estimated 102 species of poisonous mushrooms, 24 of which were newly recorded in China. Gyromitra venenata was newly discovered in incidents in Yunnan and Guizhou provinces and were the first reported poisonings due to gyromitrins in China since 2000. The rare poisoning Shiitake mushroom dermatitis was recorded in China. Hemolysis poisoning caused by Paxillus involutus was recorded for the second time since the beginning of the new century, resulting in one death in Inner Mongolia Autonomous Region.

What are the implications for public health practice?

Promoting knowledge about safe consumption of mushrooms is essential to reduce mushroom poisonings. It is not wise to collect and eat wild mushrooms. For southwestern provinces such as Yunnan, especially, caution must be exercised with unfamiliar mushroom species.

  • 1. National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
  • Corresponding author:

    Chengye Sun, suncy@chinacdc.cn

    Online Date: January 15 2021
    doi: 10.46234/ccdcw2021.014
  • Preventing mushroom poisonings depends on cooperation between clinical doctors, CDC experts, and mycologists as well as the application of internet technology tools (1). Systematic epidemiological investigations, timely and accurate species identification, toxin detection, and appropriate diagnosis and treatment are key to properly controlling mushroom poisoning events.

    In 2020, a total of 676 independent mushroom poisoning incidents from 24 provincial-level administrative divisions (PLADs) involving 1,719 patients and 25 deaths were investigated and the overall mortality was 1.45%. The number of cases ranged from 1 to 27, and 14 outbreaks involved more than 10 patients. Of these cases, 93 patients from 24 incidents had eaten poisonous mushrooms purchased from market or given by friends; 51 patients from 12 incidents had been poisoned after eating dried mushrooms; 404 patients from 131 incidents with 7 deaths ate mixed mushrooms. Three rare clinical syndromes were recorded: Gamma-Aminobutyric Acid (GABA)-blocking mushroom poisoning caused by Gyromitra venenata, Hemolysis poisoning caused by Paxillus involutus, and Shiitake mushroom dermatitis caused by Lentinula edodes. Similar to 2019, mushroom poisonings occurred in every month but were centered from June to October (1). There were 2 peaks appearing in June and September involving 160 and 193 incidents, 428 and 412 patients, and 8 and 3 deaths, respectively (Figure 1).

    Figure 1.  Monthly distribution of mushroom poisonings in China, 2020.

    In terms of geographical distribution, Southwest China [Yunnan, Guizhou, Sichuan, Chongqing, and Xizang (Tibet)] were the most severely affected region with 200 incidents, 604 patients, and 15 deaths. Central China (Hunan, Hubei, and Jiangxi) had more incidents (323 incidents), more patients (707 patients), but less deaths (4 deaths). East China (Anhui, Fujian, Jiangsu, and Zhejiang) had 82 incidents, 159 patients, and 0 deaths and were followed by the other regions: South China (Guangdong, Guangxi, and Hainan) had 33 incidents, 146 patients, and 3 deaths; North China (Beijing, Hebei, Henan, Shandong, and Shanxi) had 22 incidents, 69 patients, and 1 death; Northwest China (Ningxia and Gansu) had 13 incidents, 30 patients, and 1 death; and Northeast China (Inner Mongolia and Liaoning) had 3 incidents, 4 patients, and 1 death. In addition, 3 Burmese workers in Yunnan had gastroenteritis after eating Chlorophyllum molybdites. Detailed information for each PLAD was displayed in Table 1.

    PLADsNumber of incidentsNumber of patientsDeathsCase fatality (%)
    Hunan30266630.45
    Yunnan8124472.87
    Guizhou4314874.73
    Zhejiang437800
    Sichuan4012310.81
    Chongqing358800
    Fujian184200
    Guangxi158733.45
    Anhui123000
    Ningxia122913.45
    Hubei122414.16
    Guangdong112100
    Jiangxi91700
    Jiangsu9900
    Beijing82300
    Hainan73800
    Hebei73300
    Shandong38112.50
    Henan3300
    Inner Mongolia22150.00
    Liaoning1200
    Shanxi1200
    Gansu1100
    Xizang (Tibet)1100
    Total6761,719251.45
    Abbreviation: PLADs=provincial-level administrative divisions.

    Table 1.  Geographical distribution of mushroom poisoning incidents, cases, deaths, and case fatality in China, 2020.

    Approximately 102 species of poisonous mushroom causing seven different clinical syndromes (acute liver failure, acute renal failure, rhabdomyolysis, hemolysis, gastroenteritis, psycho-neurological disorder, and Shiitake mushroom dermatitis) (23) were successfully identified. In 2020, 24 species were newly recorded as poisonous mushrooms and were added to the Chinese poisonous mushroom list. The most lethal 3 mushroom species were Lepiota brunneoincarnata, Russula subnigricans, and Amanita subpallidorosea killing 5, 4, and 4 people, respectively ( Supplementary Table S1). Chlorophyllum molybdites caused the most poisonings (appearing in 154 incidents, 304 patients), were the most widely distributed mushroom (discovered in 15 PLADs) and had the longest active period (from late March to late October) in China, 2020 (Supplementary Table S1).

    Mushroom speciesNumber of incidentsNumber of patientsDeathsCase fatality (%)Spatial and temporal distribution
    Acute liver failure
    Amanita exitialis113625.56Feb 24 to Mar 30, Guangdong;
    June 22 to July 22, Yunnan
    Amanita fuliginea92300June 1 to July 18, Hunan and Guizhou
    Amanita fuliginea and A. neoovoideaARF1200June 28, Zhejiang
    Amanita fuliginea and A. pseudoporphyriaARF2300June 2 to 9, Hunan
    Amanita fuliginea and A. subjunquilleaALF14375.00July 18, Guizhou
    Amanita fuliginea and A. oberwinkleranaARF1200June 23, Hunan
    Amanita fuliginea and A. fritillariaG/P3900June 5 to 15, Hunan
    Amanita cf. fuliginea2900June 18 to June 19, Guizhou and Chongqing
    Amanita pallidorosea4700June 16 to July 8, Guizhou
    Amanita pallidiorosea and A. sinocitrinaP1100June 30, Guizhou
    Amanita pallidorosea and A. fritillariaG/P1200June 30, Chongqing
    Amanita rimosa41000June 6 to 27, Hunan, Hubei, and Chongqing
    Amanita rimosa and Lepiota brunneoincarnataALF1400June 12, Hunan
    Amanita subjunquillea62800June 18 to 28, Guizhou; Aug 20 to Sept 2, Hebei and Beijing
    Amanita subpallidorosea48450.00Sept 16 to Oct 15, Yunnan and Guizhou
    Amanita subpallidiorosea, A. citrinaP and Lactifluus puberulusG1300Oct 20, Guizhou
    Amanita sp., Psathyrella candolleanaG/P, Russula sp.U and Agaricus sp.U12150.00July 13, Sichuan
    Galerina sulciceps612216.67Oct 8 to 16, Yunnan, Sichuan, and Guizhou
    Lepiota brunneoincarnata1428517.86May 13 to July 3, Hubei, Hunan, and Jiangsu; Aug 19 to 30, Ningxia, Gansu, Shandong, Hebei and Liaoning
    Lepiota brunneoincarnata and Gymnopus dryophilusG1100Sept 14, Guizhou
    Rhabdomyolysis
    Russula subnigricans1026415.38June 26 to Oct 4, Yunnan, Zhejiang, and Hunan
    Russula subnigricans and R. japonicaG 1400July 5, Yunnan
    Russula subnigricans and Entoloma prismaticumU1200Aug 8, Sichuan
    Acute renal failure
    Amanita gymnopus3400June 14 to July 7, Hunan and Yunnan; Oct 10, Zhejiang
    Amanita neoovoidea4400Sept 24 to Oct 19, Hunan and Sichuan
    Amanita oberwinklerana143600June 6 to July 5, Guizhou, Chongqing, Hunan, and Jiangsu; July 26 to Sept 25, Henan, Shanxi, Beijing, Hebei and Hunan
    Amanita oberwinklerana and A. cf. ibotengutakeP1100Sept 5, Beijing
    Amanita oberwinklerana and A. pseudoporphyriaARF2300June 3 to Sept 30, Hunan
    Amanita pseudoporphyria144936.12June 6 to Oct 14, Hunan, Guangxi, and Yunnan
    Amanita aff. pseudoporphyria31000June 6 to Oct 5, Hunan
    Amanita pseudoporphyria and Suillus placidusG (dried mushrooms)1300Dec 16, Hunan
    Hemolysis
    Paxillus involutus22150.00Sept 12 to 13, Inner Mongolia
    Gastroenteritis
    Baorangia major1400May 25, Fujian
    Baorangia major and B. pseudocalopusG1700July 19, Yunnan
    Baorangia sp.1500July 23, Yunnan
    Boletellus cf. emodensis1100Aug 12, Yunnan
    Chlorophyllum demangei and Scleroderma aurantiacumG1200July 31, Sichuan
    Chlorophyllum globosum31400June 3 to Aug 20, Sichuan
    Chlorophyllum hortense and Clitocybe sp.P1100Oct 26, Sichuan
    Chlorophyllum molybdites15230200Mar 28 to Oct 20, Hunan, Guangxi, Zhejiang, Anhui, Sichuan, Hubei, Yunnan, Chongqing, Jiangxi, Hainan, Henan, Guangdong, Fujian, Guizhou, and Jiangsu
    Chlorophyllum molybdites and Ch. hortenseG1100Sept 13, Hunan
    Chlorophyllum molybdites and Entoloma omienseG1100Sept 28, Hunan
    Chlorophyllum spp.3900July 31 to Dec 14, Sichuan, Hunan, and Guangdong
    Cortinarius sinensis.E and C. fulminoidesU (bought from market)1400Sept 8, Ningxia
    Entoloma caespitosum1100Sept 20, Hunan
    Entoloma omiense284900June 28 to Oct 9, Hunan, Zhejiang, Hainan, and Fujian
    Entoloma omiense, Entoloma spU and Psathyrella candolleanaG/P1100July 8, Hunan
    Entoloma omiense and Micropsalliota spU1300Sept 10, Fujian
    Entoloma omiense and Suillus placidusG1400Sept 17, Guizhou
    Entoloma cf. rhodopolium1500Aug 4, Yunnan
    Entoloma cf. sinuatum 2400Sept 14 to 21, Guizhou
    Entoloma spp.175100June 5 to Oct 18, Guangxi, Guizhou, Hunan, and Yunnan
    Gerhardtia sinensis41300Oct 7 to 11, Hunan
    Gymnopus densilamellatus31900Feb 12 to May 31, Hunan and Guizhou
    Hygrophorus cf. whiteiU, Lycoperdon caudatumU and Megacollybia marginataU1500Oct 9, Sichuan
    Hypholoma fasciculare3900July 8 to Dec 4, Sichuan and Yunnan
    Lactarius subhirtipes3900May 31 to July 26, Hunan, Guizhou, and Anhui
    Lactifluus deceptivus, Lf. pilosusG, Lf. aff. piperatusG and Lf. puberulusG (dried mushrooms)1200Feb 9, Hunan
    Lactifluus pseudoluteopusU1500Aug 23, Yunnan
    Leucocoprinus cretaceous and Lc. cepistipesG1200Sept 13, Hunan
    Marasmius maximusE and Mycena sp.U1100July 18, Hubei
    Melanoleuca griseobrunneaU1200May 12, Zhejiang
    Micropsalliota furfuracea1200Sept 14, Hunan
    Micropsalliota sp.U, Hortiboletus rubellusE and Russula pectinatoidesE1200Sept 24, Hunan
    Neoboletus venenatus (patients of two incidents ate dried mushrooms, bought from market)4900Aug 13 to Sept 24, Xizang, Guangdong, Hunan, and Sichuan
    Neoboletus venenatus and Scleroderma bovistaG (dried mushrooms, bought from market)1200June 18, Hunan
    Neonothopanus aff. nambi2400May 13 to July 13, Yunnan
    Omphalotus guepiniformis21000May 28, Guangxi; Oct 4, Hunan
    Omphalotus olearius21600Sept 9 to Nov 16, Yunnan
    Pholiota multicingulata2900Sept 22 to Oct 5, Hunan
    Pulveroboletus subrufus, Russula punctipesG, Chiua virensG and Suillus pinetorumG1200Dec 6, Guizhou
    Rubroboletus sinicus and Neoboletus cf. multipunctatusU1400July 28, Guizhou
    Rubroboletus sinicus and Retiboletus fuscusE1300June 18, Yunnan
    Rubroboletus sp.U1200July 25, Hunan
    Russula viridicinnamomeaE, Agaricus sp.U, Termitomyces microcarpusE and Lactarius vividusE1500Aug 2, Sichuan
    Russula rufobasalis1100June 10, Hunan
    Russula rufobasalis, Lactarius atromarginatusG, Amanita fritillariaG/P and Russula citrinaU1200June 11, Hunan
    Russula rufobasalis, Amanita fritillariaG/P, Russula compactaE, R. nigricansE, R. subatropurpureaE, R. cf. fragrantissimaU, and Cortinarius purpurascensU1200June 11, Hunan
    Russula grata, R. cf. subfoetensG, Lactifluus aff. glaucescensG, R. fragrantissimaU, R. pseudoamoenicolorU, R. sarnariiU, R. cyanoxanthaE, R. variataE, R. vescaE, R. virescensE and Entoloma cf. undatumU (dried mushrooms, bought from market)1300Feb 5, Hunan
    Russula japonica5815100May 31 to Oct 15, Hunan, Zhejiang, Chongqing, Anhui, Yunnan, Guizhou, Fujian, and Hubei
    Russula japonica, Entoloma omienseG and Agaricus sp.U1300Oct 5, Hunan
    Russula japonica, R. cerolensE, Leotia lubricaU and Phylloporus dimorphusE1200July 11, Guizhou
    Russula japonica and R. foetensG1100June 15, Hunan
    Russula japonica and R. sanguineaG1300June 10, Hunan
    Russula japonica and R. puncitpesG1300Oct 3, Hunan
    Scleroderma areolatum11200Aug 12, Beijing
    Scleroderma cepa41100July 7 to Sept 27, Yunnan, Sichuan, Hunan, and Chongqing
    Scleroderma citrinum1100Oct 13, Hunan
    Suillus granulatus (dried mushrooms, bought from market)1200Mar 23, Ningxia
    Suillus granulatus, Amanita sinocitrinaP, A. griseofoliaG/P, Russula spp.U, Lycoperdon sp.U and Gymnopus sp.U1100Sept 24, Hunan
    Suillus pinetorum1800July 21, Yunnan
    Thicholoma highlandense1200Nov 13, Yunnan
    Tricholoma sinopardinum, T. sinoportentosumE, Lactarius deterrimusE and Agaricus sp.U1300July 21, Sichuan
    Tricholoma stans1600Nov 14, Yunnan
    Tylopilus neofelleus1100Aug 9 to Sept 27, Yunnan and Chongqing
    Psycho-neurological disorder
    Amanita griseopantherina and Russula foetensG11200July 21, Sichuan
    Amanita melleiceps52000May 30 to Sept 15, Hunan and Guangxi
    Amanita orientigemmata1100Sept 23, Hunan
    Amanita orsonii, A. pseudovaginataU and Entoloma cf. subcorvinumU1200June 28, Guizhou
    Amanita rufoferruginea61800June 6 to Aug 6, Hunan, Chongqing, and Sichuan
    Amanita cf. subfrostiana 1200July 21, Yunnan
    Amanita subglobosa174900June 19 to Sept 24, Guizhou, Anhui, Chongqing, Sichuan, Yunnan, and Hunan
    Amanita sychnopyramis f. subannulata44200Apr 26 to June 10, Hainan, Guangxi, and Hunan
    Butyriboletus roseoflavus (bought from market, maybe from Yunnan)1900Nov 5, Hainan
    Clitocybe dealbata1200July 15, Yunnan
    Clitocybe subditopoda1300Oct 5, Guizhou
    Gymnopilus dilepis61300June 21 to Sept 23, Sichuan, Yunnan, and Guizhou
    Gymnopilus spp.5800May 9 to Oct 3, Jiangxi, Hubei, Hunan, and Yunnan
    Gyromitra venenata2400Mar 13 to 21, Guizhou, Yunnan
    Inocybe aff. ericetorum and Russula insignisG1100May 26, Hunan
    Inocybe serotina1200Sept 19, Ningxia
    Inocybe serotina and Mallocybe fulvipesP1100Sept 2, Ningxia
    Inocybe serotina and Pseudosperma umbrinellumP = Inocybe umbrinella1400Aug 28, Ningxia
    Inocybe splendentoides 1100Oct 7, Beijing
    Inosperma aff. virosum21600Sept 9 to 16, Yunnan
    Inosperma cf. virosum1500May 9, Hainan
    Lanmaoa asiatica1400July 19, Yunnan
    Lanmaoa asiatica, Rubroboletus latisporusG, Suillus granulatusG, Caloboletus xiangtoushanensisU and Imperator sp.U (dried mushrooms, from Chongqing)1300Aug 27, Guangdong
    Lanmaoa asiatica, Rubroboletus latisporusG, Tylopilus neofelleusG, Neoboletus sp.U and Sutorius aff. eximiusG (dried mushrooms, from Chongqing)1300Oct 13, Zhejiang
    Panaeolus fimicola1200June 30, Shandong
    Pseudosperma cf. bulbosissimum1400Oct 5, Ningxia
    Pseudosperma umbrinellum, Mallocybe sicilianaP = Inocybe siciliana, Hebeloma dunenseU and Psathyrella candolleanaG/P1400Sept 4, Hebei
    Pseudosperma yunnanense1100July 10, Yunnan
    Psilocybe cubensis1200Nov 27, Hunan
    Shiitake mushroom dermatitis
    Lentinula edodesE1100Jan 5, Jiangxi
    Unclassified
    Agaricus blazeiE1200Aug 25, Yunnan
    Amanita cf. constricta and Entoloma cf. piceinumU1500Aug 7, Sichuan
    Amanita griseofolia1400June 27, Guizhou
    Butyriboletus yicibusE (from Yunnan)1400July 26, Hunan
    Coprinopsis niveaE1300June 29, Hunan
    Coprinus comatusE2300Early August to Oct 25, Beijing and Ningxia
    Cortinarius sinensis.E (bought from market)1200Sept 24, Ningxia
    Lactarius cinnamomeusE1200Mar 14, Hunan
    Lactifluus tenuicystidiatusE1200Aug 25, Yunnan
    Panus gigianteusE1400Sept 20, Hunan
    Panus tigrinusE1100May 16, Yunnan
    Pleurotus ostreatusE1100Oct 31, Ningxia
    Retiboletus fuscusE (dried mushrooms, from Yunnan)1200Mar 6, Fujian
    Russula cf. viridicinnamomeaE1400July 29, Fujian
    Scleroderma yunnanenseE3700June 25 to Sept 15, Hunan, Yunnan, and Fujian
    Stropharia rugosoannulataE1100Jan 31, Guizhou
    Xerocomus parvulusE1400Sept 28, Hunan
    Abbreviations: ALF=Acute liver failure, ARF=Acute renal failure, G= Gastroenteritis, P= Psycho to neurological disorder, U=Unclassified, E=edible.
    Note: Species newly recorded as poisonous mushrooms in China are in bold.

    Table S1.  Mushroom species involved in poisoning incidents and their spatial and temporal distribution in China, 2020.

    Similar to 2019, the same 9 species causing acute liver failure were identified in China, 2020 (1). Lepiota brunneoincarnata was found to be the most dangerous species in 2020, being responsible for 15 incidents, 29 patients, and 5 deaths as the lone cause or in combination with other species. Lepiota brunneoincarnata was discovered under coniferous trees, but in 2 incidents occurring in 2020, it was found in hardwood forest dominated by fagaceous trees in Guizhou and under Ziziphus jujube in Mengcun County, Hebei Province. The incident in Hebei Province on August 29 involved 6 patients. Amanita exitialis also appeared in Guangdong in late February, which was earlier than in 2019 but resulted in less deaths (1). There were also more incidents of patients consuming a combination of poisonous mushrooms, which can cause greater difficulties and risks for diagnosis and treatment due to species resulting in different symptoms (Supplementary Table S1).

    Amanita gymnopus was a species discovered from poisoning investigations causing acute renal failure that was not found in 2019 (1). Due to delayed diagnosis and treatment, 3 people were killed by A. pseudoporphyria in early June in Guangxi. Amanita oberwinklerana was discovered in 18 incidents from 8 PLADs. Amanita oberwinklerana, a species occurring in southern China, also caused 6 incidents including 11 patients in North China for the first time from late July to late September. More deaths were caused by Russula subnigricans, which leads to rhabdomyolysis, when compared to 2019 (1, Supplementary Table S1).

    On September 12–13, 2 incidents involving 2 patients and 1 death caused by Paxillus involutus resulting hemolysis occurred in Chifeng and Tongliao, Inner Mongolia Autonomous Region. Clinically, this type of poisoning stimulates an autoimmune reaction, with a short incubation period (usually 30 min–3 h), followed by gastrointestinal tract effects (GIT) including nausea, vomiting, abdominal pain, and/or diarrhea. Intravascular haemolysis, anaemia, with potential secondary renal failure, shock, disseminated intravascular coagulopathy, and acute respiratory failure developed on the following few days and even caused death (3).

    A total of 56 species causing gastroenteritis were identified from mushroom poisoning incidents in China in 2020 (Supplementary Table S1). Among them, Baorangia major, Chlorophyllum demangei, Entoloma caespitosum, Gymnopus densilamellatus, Lactarius atromarginatus, Lactifluus deceptivus, Lf. puberulus, Leucocoprinus cretaceous, Micropsalliota furfuracea, Neonothopanus nambi, Pholiota multicingulata, Pulveroboletus subrufus, Russula rufobasalis, and Tricholoma stans were species newly discovered as poisonous mushrooms and subsequently added to the Chinese poisonous mushroom list (12, 46). This was the first report of Baorangia major in China. The top 3 species were Chlorophyllum molybdites, Russula japonica, and Entoloma omiense, which was the same as 2019, but these 3 species caused more incidents and had wider geographical distribution (1).

    About 28 species causing psycho-neurological disorders were identified from mushroom poisoning incidents in China in 2020, including Clitocybe subditopoda, Gyromitra venenata, Inocybe aff. ericetorum, Mallocybe fulvipes, Inosperma aff. virosum, Inosperma cf. virosum, Pseudosperma cf. bulbosissimum, and Pseudosperma yunnanense, which were species newly discovered as poisonous mushrooms and thus added to Chinese poisonous mushroom list (12, 79). The top five species are Amanita subglobose, A. rufoferruginea, Gymnopilus dilepis, A. melleiceps, and A. sychnopyramis f. subannulata (Supplementary Table S1). Among them, Gyromitra venenata is a new species discovered from Yunnan and Guizhou resulting 4 patients poisoned as containing gyromitrins (7). Inosperma aff. virosum and Inosperma cf. virosum were potentially two new independent species resulting in typical muscarinic syndrome post ingestion.

    Lentinula edodes, commonly known as Shiitake mushroom, is one of the most famous edible mushrooms worldwide (2). Shiitake mushroom dermatitis was also reported, though its pathophysiology is unclear at present (3,10). Clinically, this type of mushroom poisoning presents 1–2 days post ingestion of raw or cooked mushrooms with sudden onset of whiplike (flagellate) linear wheals on limbs, trunk, and/or face/neck, and its toxin was assumed to be the thermolabile polysaccharide, lentinan (3,10). On January 5, an individual showed typical Shiitake mushroom dermatitis after eating L. edodes from Jiangxi. However, two other people who also consumed L. edodes were asymptomatic.

    About 33 edible species were also identified from mushroom poisoning incidents in 2020 (Supplementary Table S1). These poisoning incidents may be attributed to consumption of mixed mushrooms with poisonous mushrooms, contaminated mushrooms, or some species potentially poisonous to certain people.

  • When comparing incidents in 2019 to 2020, more mushroom poisoning incidents occurred (276 in 2019 vs. 676 in 2020) involving more patients (769 vs. 1719) and deaths (22 vs. 25) (1). As in 2019, monthly distribution analysis showed that mushroom poisonings occurred every month and were centered from June to October; however, 1 peak appeared in July in 2019 (1), while 2 peaks (June and September) appeared in 2020. Geographical distribution analysis showed that mushroom poisoning incidents were reported in 24 PLADs in 2020—among which, 16 PLADs also reported cases in 2019 with the new PLADs being Anhui, Jiangxi, Beijing, Hebei, Inner Mongolia, Liaoning, Gansu, and Xizang (Tibet) (Supplementary Table S1). The PLADs with the highest number of mushroom poisonings were Hunan, Yunnan, Guizhou, Zhejiang, and Sichuan in 2020 (Supplementary Table S1), and Hunan, Yunnan, Zhejiang, Guizhou, and Chongqing in 2019 (1). Yunnan and Guizhou had the most deaths (7) in 2020, but in 2019, Yunnan had 14 deaths (1). Approximately 102 species of poisonous mushrooms were identified in incidents in 2020, among which 35 species were also identified in 2019, and the total number reached approximately 130 species.

    In Spring 2020, 4 people were poisoned by “false morels” resulting in typical metabolic-based pathology secondary to blocking of GABA synthesis in multiple organs. Clinically, the incubation period is 5–12 hours or longer, followed by gastrointestinal system effects, ataxia, hypoglycaemia, haemolysis, methaemoglobinaemia, or even hepatic damage (3). Another study showed that this species was different from Gyromitra esculenta and represented a new species described as G. venenata (7).

    Paxillus involutus was used as medicine for treating lumbago, skelalgia, and limb numbness in China and was considered edible in some areas of Northeast China, and recent studies also showed it was a good source of antioxidant (2). However, Paxillus involutus was reported as causing hemolysis after repeated exposure, and its toxins and poisoning mechanism are still unclear (3). The 2 incidents in 2020 involving 6 people but only 2 persons were poisoned with 1 death and the other developing renal failure. For safety, we strongly advise not to collect and eat this species although it seems safe to many people.

    Gerhardtia sinensis was identified in 2 incidents involving 6 patients and treated as a highly suspected poisonous species in 2019 (1). In 2020, this species caused 4 incidents involving 13 patients and was confirmed as poisonous although its toxicology was still unclear (Supplementary Table S1). Another mushroom causing 5 people GIT on August 23 from Dehong, Yunnan, was identified as Lactifluus pseudoluteopus. As no toxicological knowledge is available, this mushroom is highly suspected as poisonous presently although several closely related species are edible (4).

    Patients from many mushroom poisoning incidents consumed mixed wild mushrooms (Supplementary Table S1), and these poisonous mushrooms often caused different clinical syndromes, which put them at high risk. For example, patients consuming together Amanita fuliginea and A. neoovoidea, A. fuliginea and A. pseudoporphyria, or A. fuliginea and A. oberwinklerana could cause acute liver failure and acute renal failure at the same time (Supplementary Table S1). Coprinus comatus is a widely consumed mushroom, but as it is matures, coprine accumulates and may lead GIT, especially when combined with alcohol. Therefore, we strongly advise not combining consumption of mixed wild mushrooms and alcohol.

    Over 1,000 edible mushrooms and approximately 500 poisonous species were reported in China (12,4). Morphologically, many poisonous species are similar to edible ones, e.g. the lethal Russula subnigricans causing rhabdomyolysis is similar to the edible R. nigricans, making it hard to differentiate and repeatedly causing poisoning incidents. Educated individuals with the ability to recognize poisonous mushrooms and people aware of the risk of eating wild mushrooms are the basis for mushroom poisoning prevention and control. Therefore, science education is of great importance for reducing mushroom poisoning. In the last few years, many educational science materials for mushroom poisonings in China were produced with cooperation from governments, CDCs, doctors, and mycologists.

    Accurate and timely species identification is of pivotal importance in mushroom poisoning incidents, and progress has been made as more incidents were properly identified, which could better guide the diagnosis and treatments for patients. The number of incidents with satisfactory mushroom identification grew from only 2 during 2010–2014 (11) to over 200 in 2019 (1) and over 600 in 2020. The growing number of poisonous mushroom identifications suggests that what we know only a portion of the variety of poisonous mushrooms. Many species need to be formally described and their edibility is not clear. More effort and closer cooperation are still needed urgently from local and national governments, CDC staff, doctors, and mycologists to properly control mushroom poisoning events.

    Acknowledgements: Profs. Zuohong Chen, Ping Zhang (Hunan Normal University), Prof. Zhuliang Yang, Gang Wu, Hong Luo, Zaiwei Ge, Yanchun Li (Kunming Institute of Botany, Chinese Academy of Sciences), Profs. Taihui Li, Wangqiu Deng, Dr. Ming Zhang (Guangdong Institute of Microbiology), Prof. Tolgor Bau (Jilin Agricultural University), Dr. Yuguang Fan (Hainan Medical University), Prof. Junfeng Liang, Dr. Jie Song (Research Institute of Tropical Forestry, Chinese Academy of Forestry), Profs. Yucheng Dai, Baokai Cui, Shuanghui He, Dr. Jing Si (Beijing Forestry University, China), Dr. Chuanhua Li (Shanghai Academy of Agricultural Sciences), Prof. Haisheng Yuan (Institute of Applied Ecology, Chinese Academy of Sciences) and Dr. Tiezheng Wei (Institute of Microbiology, Chinese Academy of Sciences); involved CDCs and hospitals.

  • The median number of cases per incident was two.
  • Reference (11)

    Citation:

    Catalog

      /

      DownLoad:  Full-Size Img  PowerPoint
      Return
      Return