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Preplanned Studies: Mushroom Poisoning Outbreaks — China, 2021

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  • Summary

    What is already known about this topic?

    Mushroom poisoning is one of the most serious food safety issues in China. Most poisoning incidents resulted from eating mushrooms causing gastroenteritis and psycho-neurological disorder from which patients usually could fully recover. Most deaths resulted from species causing acute liver failure and rhabdomyolysis, and the remaining deaths were attributed to acute renal failure and hemolysis.

    What is added by this report?

    In 2021, the total number of investigations was 327 from 25 provincial-level administrative divisions, involving 923 patients and 20 deaths, and the overall mortality was 2.17%. Overall, 74 poisonous mushrooms causing 6 different clinical syndromes were successfully identified, 15 of which were newly recorded in China as poisonous mushrooms.

    What are the implications for public health practice?

    Considering the potential huge risks for collecting and eating wild mushrooms, we strongly advise not collecting and eating unfamiliar wild mushrooms. Promoting knowledge about poisonous mushrooms is essential and urgent to reduce mushroom poisonings. Precise species identification timely after mushroom poisoning is important for appropriate diagnosis and treatment. Many deaths were ascribed to delayed hospitalization.

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  • [1] Li HJ, Zhang HS, Zhang YZ, Zhang KP, Zhou J, Yin Y, et al. Mushroom poisoning outbreaks — China, 2019. China CDC Wkly 2020;2(2):19 − 24. http://dx.doi.org/10.46234/ccdcw2020.005CrossRef
    [2] Li HJ, Zhang HS, Zhang YZ, Zhou J, Yin Y, He Q, et al. Mushroom poisoning outbreaks — China, 2020. China CDC Wkly 2021;3(3):41 − 5. http://dx.doi.org/10.46234/ccdcw2021.014CrossRef
    [3] 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):1 − 76. http://dx.doi.org/10.1007/s13225-019-00432-7CrossRef
    [4] Zhang P, Chen ZH, Xiao B, Tolgor B, Bao HY, Yang ZL. Lethal amanitas of East Asia characterized by morphological and molecular data. Fungal Divers 2010;42(1):119 − 33. http://dx.doi.org/10.1007/s13225-010-0018-4CrossRef
    [5] Cui YY, Cai Q, Tang LP, Liu JW, Yang ZL. The family Amanitaceae: molecular phylogeny, higher-rank taxonomy and the species in China. Fungal Divers 2018;91(1):5 − 230. http://dx.doi.org/10.1007/s13225-018-0405-9CrossRef
    [6] Wang CQ, Zhang M, Li HJ, Huang H, Deng WQ, Li T, et al. Hygrocybe rimosa (Hygrophoraceae, Agaricales), a new poisonous species from southern China. Phytotaxa 2021;527(4):293 − 300. http://dx.doi.org/10.11646/phytotaxa.527.4.7CrossRef
    [7] Ariyawansa HA, Hyde KD, Jayasiri SC, Buyck B, Chethana KWT, Dai YC, et al. Fungal diversity notes 111−252-taxonomic and phylogenetic contributions to fungal taxa. Fungal Divers 2015;75(1):27 − 274. http://dx.doi.org/10.1007/s13225-015-0346-5CrossRef
    [8] Zeng NK, Jiang S. Atlas of macrofungi from yinggeling of Hainan, China. Haikou: Nanhai Publishing Company. 2020. (In Chinese)
    [9] Deng LS, Kang R, Zeng NK, Yu WJ, Chang C, Xu F, et al. Two new Inosperma (Inocybaceae) species with unexpected muscarine contents from tropical China. MycoKeys 2021;85(3):87 − 108. http://dx.doi.org/10.3897/mycokeys.85.71957CrossRef
    [10] Wang XH, Verbeken A. Three new species of Lactarius subgenus Lactiflui (Russulaceae, Russulales) in southwestern China. Nova Hedwigia 2006;83(1 − 2):167 − 76. http://dx.doi.org/10.1127/0029-5035/2006/0083-0167CrossRef
    [11] 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
    [12] Wu G, Zhao K, Li YC, Zeng NK, Feng B, Halling RE, et al. Four new genera of the fungal family Boletaceae. Fungal Divers 2016;81(1):1 − 24. http://dx.doi.org/10.1007/s13225-015-0322-0CrossRef
  • FIGURE 1.  Monthly distribution of mushroom poisonings in China, 2021

    TABLE 1.  Geographical distribution of mushroom poisoning incidents in China, 2021.

    LocationNumber of incidentsNumber of patientsDeathsCase fatality
    rate (%)
    Hunan6415910.63
    Yunnan5920042.00
    Sichuan349822.04
    Fujian328200
    Guizhou266945.80
    Zhejiang215000
    Chongqing175300
    Guangdong1633412.12
    Ningxia132600
    Guangxi124212.38
    Jiangsu42400
    Hainan41100
    Jiangxi4400
    Shandong32000
    Hubei3700
    Beijing21417.14
    Anhui2700
    Shaanxi2400
    Hebei2300
    Xizang22150.00
    Inner Mongolia1500
    Xinjiang1400
    Shanxi13266.67
    Tianjin1200
    Jilin1100
    Total327923202.17
    Download: CSV

    TABLE S1.  Mushroom species involved in poisoning incidents and their spatial and temporal distribution in China, 2021.

    Clinical syndromes or mushroom speciesNumber of incidentsNumber of patientsDeathsCase fatality (%)Spatial and temporal distribution
    Acute liver failure
    Amanita exitialis38112.50March 3, Guangdong; June 24 to 26, Yunnan
    Amanita exitialis and A. fuligineoides1400July 2, Yunnan
    Amanita fuliginea and A. oberwinklerana ARF1500July 5, Hunan
    Amanita fuligineoides29111.11June 25 and July 2, Fujian, and Yunnan
    Amanita pallidorosea1200June 19, Hunan
    Amanita rimosa1300June 2, Hunan
    Amanita subjunquillea1200September 17, Sichuan
    Amanita spp.719315.79June 22 to July 26, Yunnan, Hunan, Chongqing, and Zhejiang
    Galerina sulciceps1439512.82April 16, Hunan; November 3 to 30, Sichuan, Chongqing, Hubei, Guizhou, and Hunan
    Galerina sp.11800December 28, Sichuan
    Lepiota brunneoincarnata154536.67July 4 to September 28, Yunnan, Hebei, Shanxi, Xinjiang, Shandong, Inner Mongolia, Ningxia, Shaanxi, Jilin, Beijing, and Tianjin
    Rhabdomyolysis
    Russula subnigricans1650612.00May 10 to September 9, Yunnan, Zhejiang, Hunan, Jiangsu, Fujian, Jiangxi, Guizhou, Guangdong, and Guangxi
    Acute renal failure
    Amanita kotohiraensis1200August 19, Fujian
    Amanita oberwinklerana6900mid-March, Guangdong; July 20 to August 29, Hubei, Sichuan, and Guizhou
    Amanita aff. pseudoporphyria2200August 22 and 23, Hunan
    Hemolysis
    Paxillus involutus22150.00July 31 and August 7, Xizang
    Gastroenteritis
    Agaricus atrodiscus1600July 28, Yunnan
    Agaricus xanthodermus1100April 29, Hunan
    Agaricus sp.1200August 20, Hunan
    Baorangia major1500May 28, Fujian
    Baorangia pseudocalopus2800June 23, Yunnan; September 17, Hunan
    Boletellus indistinctus1600August 3, Yunnan
    Chlorophyllum aff. globosum2800August 30 and September 5, Sichuan
    Chlorophyllum hortense2300August 12 to September 29, Hunan, and Guangxi
    Chlorophyllum molybdites6512000April 15 to December 27, Zhejiang, Guizhou, Hunan, Hainan, Fujian, Guangdong, Guangxi, Yunnan, Sichuan, Chongqing, Jiangsu, Hubei and Jiangxi
    Chlorophyllum molybdites and Cordyceps gunnii M1300August 21, Guizhou
    Coprinellus micaceus1100September 29, Beijing
    Coprinellus micaceus and Panaeolus bisporus P1300September 20, Ningxia
    Coprinopsis atramentaria1100April 19, Shandong
    Coprinus comatus1100October 19, Sichuan
    Cryptoporus volvatus M1100February 28, Guangxi
    Entoloma caespitosum1400May 24, Fujian
    Entoloma omiense72200June 6 to August 30, Fujian, Guangdong, Yunnan, Zhejiang, and Guizhou
    Entoloma aff. strictius1300April 12, Hunan
    Entoloma aff. sinuatum1900August 8, Yunnan
    Gymnopus densilamellatus, G. dryophilus G and
    Ripartites tricholoma U
    1200August 6, Hebei
    Gymnopus indoctus U, Leucoagaricus sinicus U, Panaeolus papilionaceus P, Ileodictyon gracileU and Agaricus sp. U1400October 14, Guangdong
    Heimioporus gaojiaocong3500January 12, Yunnan (dried boletes bought from market); June 3 to July 20, Yunnan
    Heimioporus japonicus2900August 26 and September 7, Fujian
    Hygrocybe rimosa1200July 1, Guizhou
    Lactarius purpureus1100August 29, Hunan
    Lactarius rubrocorrugatus2700July 11 and 27, Sichuan
    Lactifluus pseudoluteopus1100June 4, Yunnan
    Melanoleuca humilis1200September 15, Ningxia
    Neoboletus brunneissimus E,M, Butyriboletus yicibus E, Catathelasma subalpinum E and Cortinarius similis U1300August 16, Sichuan (dried boletes from Yunnan)
    Neoboletus venenatus31200March 10 and July 2, Hunan and Sichuan (dried boletes, bought from market); September 19, Yunnan
    Omphalotus guepiniformis1300May 1, Guizhou
    Omphalotus olearius2400July 28 and October 18, Yunnan
    Omphalotus sp.44400July 11 and October 18, Yunnan
    Pholiota multicingulata1400September 13, Chongqing
    Ramaria gracilis1100August 28, Yunnan
    Rubroboletus sinicus and Retiboletus fuscus E12000January 11, Jiangsu (dried boletes bought from market)
    Rubroboletus sp.1100August 19, Fujian
    Russula foetens1100August 26, Fujian
    Russula japonica247000May 25 to August 26, Guangxi, Hunan, Sichuan, Guizhou, Yunnan, Chongqing, Fujian, and Zhejiang
    Russula japonica and R. punctipes G1200May 31, Hunan
    Russula leucocarpa U and Russula sp.1400September 4, Fujian
    Russula punctipes1600August 23, Hunan
    Scleroderma aff. albidum2900March 7 and July 9, Guangxi and Sichuan
    Scleroderma cepa4700July 5 to August 25, Yunnan; October 27 to November 15, Hunan
    Suillus pinetorum, Amanita javanica E, Boletus bainiugan E and Phlebopus portentosus E1800April 15, Yunnan
    Thicholoma highlandense1100November 20, Guizhou
    Trametes hirsuta M, Irpex lacteus M and Schizophyllum commune E,M1100February 28, Guangdong (dried mushrooms from Sichuan)
    Tricholoma stans1200November 3, Yunnan
    Tricholoma aff. stans2500November 2 and December 1, Guizhou and Yunnan
    Psycho-neurological disorder
    Amanita ibotengutake11700September 5, Shandong
    Amanita melleialba1100August 10, Yunnan
    Amanita orientigemmata1200August 10, Yunnan
    Amanita pseudopantherina1100August 9, Yunnan
    Amanita pseudosychnopyramis21100April 6 and 15, Fujian and Zhejiang
    Amanita orsonii and Amanita sp. U1300June 29, Chongqing
    Amanita rufoferruginea1600July 6, Sichuan
    Amanita subglobosa41300June 29 to August 19, Sichuan and Hunan
    Amanita sychnopyramis f. subannulata1500May 28, Guangxi
    Clitocybe subditopoda1300October 26, Guizhou
    Clitocybe sp.1200October 18, Hainan
    Gymnopilus dilepis3500May 1 to July 2, Sichuan and Guizhou
    Inocybe aff. glabrodisca1400November 26, Guizhou
    Inosperma muscarium2700May 30 and June 5, Guangxi and Fujian
    Lanmaoa asiatica1100July 2, Yunnan
    Lanmaoa asiatica, Heimioporus japonicus G and Tylopilus neofelleus G1400January 27, Chongqing (dried boletes bought from market)
    Panaeolus bisporus1200August 14, Guizhou
    Pseudosperma arenarium nom. prov.2300September 22 and 30, Ningxia and Shaanxi
    Pseudosperma umbrinellum and Mallocybe fulvoumbonata P1200September 21, Ningxia
    Psilocybe ovoideocystidiata1200March 26, Guizhou
    Psilocybe papuana1200April 30, Hunan
    Unclassified
    Cortinarius cupreorufus U1300September 3, Ningxia
    Laccaria vinaceoavellanea E1200August 1, Yunnan
    Leucoagaricus barssii E1200September 6, Ningxia
    Porphyrellus nigropurpureus U1400August 1, Fujian
    Russula densifolia E1200August 13, Yunnan
    Scleroderma yunnanense E1400July 2, Yunnan
    Stropharia rugosoannulata E2200April 29 and May 16, Hunan and Chongqing
    Tricholoma myomyces E1200March 16, Hunan
    Note: Species newly recorded as poisonous mushrooms in China are in italic bold.
    Abbreviations used for mushroom poisoning incidents with more than two species: ARF=Acute renal failure, G=Gastroenteritis, P=Psycho to neurological disorder, M=Medicinal, U=Unclassified, E=Edible.
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Mushroom Poisoning Outbreaks — China, 2021

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Summary

What is already known about this topic?

Mushroom poisoning is one of the most serious food safety issues in China. Most poisoning incidents resulted from eating mushrooms causing gastroenteritis and psycho-neurological disorder from which patients usually could fully recover. Most deaths resulted from species causing acute liver failure and rhabdomyolysis, and the remaining deaths were attributed to acute renal failure and hemolysis.

What is added by this report?

In 2021, the total number of investigations was 327 from 25 provincial-level administrative divisions, involving 923 patients and 20 deaths, and the overall mortality was 2.17%. Overall, 74 poisonous mushrooms causing 6 different clinical syndromes were successfully identified, 15 of which were newly recorded in China as poisonous mushrooms.

What are the implications for public health practice?

Considering the potential huge risks for collecting and eating wild mushrooms, we strongly advise not collecting and eating unfamiliar wild mushrooms. Promoting knowledge about poisonous mushrooms is essential and urgent to reduce mushroom poisonings. Precise species identification timely after mushroom poisoning is important for appropriate diagnosis and treatment. Many deaths were ascribed to delayed hospitalization.

  • 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 21 2022
    doi: 10.46234/ccdcw2022.010
  • In recent years, an efficient mushroom poisoning control and prevention working system involving governments, clinical doctors, CDC experts, and mycologists has been established in China (1-2). Based on the technical support network, mushroom poisoning information was systematically collected by WeChat, telephone calls, and E-mails. Mushroom samples were collected by CDC staff or hospital professionals. Species identification depending on morphological observations and DNA data was carried out by mycologists from China CDC, universities, and research institutes nationwide. Related clinical symptoms data were summarized from the hospital records (1-2). In 2021, 327 independent mushroom poisoning incidents from 25 provincial-level administrative divisions (PLADs) involving 923 patients and 20 deaths were investigated. About 74 poisonous mushrooms resulting in 6 different clinical syndromes were successfully identified. Among the 74 species, 15 species were newly recorded in China. Hygrocybe rimosa, Inosperma muscarium, and Pseudosperma arenarium nom. prov. were three new species discovered in China. Mallocybe fulvoumbonata, Psilocybe ovoideocystidiata, and P. papuana were 3 records new to China, and the 9 remaining previously edibility unclear species were confirmed to be poisonous from poisoning incidents.

    In 2021, a total of 327 mushroom poisoning incidents involving 923 patients and 20 deaths were investigated and the overall mortality was 2.17%. The number of cases ranged from 1 to 20, the average number of cases per incident was 2, and 6 incidents involved more than 10 patients. Of these cases, 68 patients from 14 incidents ate poisonous mushrooms purchased from a market or given by friends; 46 patients from 10 incidents were poisoned after eating dried mushrooms and 113 patients from 28 incidents ate mixed mushrooms.

    Monthly distribution analysis showed that mushroom poisonings occurred every month, centered from May to November involving 294 incidents, 796 patients, and 18 deaths, and reached its peak in August (Figure 1). The first death appeared in early March from Guangdong. The top 3 months for deaths caused by poisonous mushrooms were September, July, and November with 7, 5, and 4 deaths, respectively.

    Figure 1. 

    Monthly distribution of mushroom poisonings in China, 2021

    In terms of geographical distribution, mushroom poisoning incidents were reported in 25 PLADs. Overall, 10 PLADs had over 10 incidents, and Hunan, Yunnan, Sichuan, Fujian, and Guizhou were the top 5 PLADs; 12 PLADs had over 20 patients and Yunnan, Hunan and Sichuan were the top 3 PLADs. Yunnan, Guizhou, and Guangdong had 4 deaths, Sichuan and Shanxi had 2 deaths, followed by Hunan, Guangxi, Beijing, and Xizang (Tibet) with 1 death each, and the remaining 16 PLADs had no deaths. Southwest China [Yunnan, Sichuan, Guizhou, Chongqing, and Xizang (Tibet)] was the most severely affected region with 138 incidents, 426 patients, and 11 deaths. Detailed information for each PLAD was shown in Table 1.

    LocationNumber of incidentsNumber of patientsDeathsCase fatality
    rate (%)
    Hunan6415910.63
    Yunnan5920042.00
    Sichuan349822.04
    Fujian328200
    Guizhou266945.80
    Zhejiang215000
    Chongqing175300
    Guangdong1633412.12
    Ningxia132600
    Guangxi124212.38
    Jiangsu42400
    Hainan41100
    Jiangxi4400
    Shandong32000
    Hubei3700
    Beijing21417.14
    Anhui2700
    Shaanxi2400
    Hebei2300
    Xizang22150.00
    Inner Mongolia1500
    Xinjiang1400
    Shanxi13266.67
    Tianjin1200
    Jilin1100
    Total327923202.17

    Table 1.  Geographical distribution of mushroom poisoning incidents in China, 2021.

    In 2021, 74 species of poisonous mushrooms caused 6 different clinical syndromes; acute liver failure, acute renal failure, rhabdomyolysis, hemolysis, gastroenteritis, and psycho-neurological disorder were successfully identified (Supplementary Table S1). A total of 15 species were newly recorded as poisonous mushrooms and were added to the Chinese poisonous mushroom list. Hygrocybe rimosa, which causes gastroenteritis, Inosperma muscarium and Pseudosperma arenarium nom. prov., which stimulated parasympathetic nervous system, were three new species discovered in China. Mallocybe fulvoumbonata, Psilocybe ovoideocystidiata, and P. papuana resulted in psycho-neurological disorders were three records new to China. Agaricus atrodiscus, Boletellus indistinctus, Lactarius purpureus, L. rubrocorrugatus, Lactifluus pseudoluteopus, Melanoleuca humilis, Ramaria gracilis, and Scleroderma aff. albidum cause gastroenteritis, and Inocybe aff. glabrodisca stimulates the parasympathetic nervous system; these species were confirmed to be poisonous from poisoning incidents.

    The top three lethal mushroom species were Russula subnigricans, Galerina sulciceps, and Lepiota brunneoincarnata, which caused 6, 5, and 3 deaths, respectively. Chlorophyllum molybdites, the most widely distributed mushroom (discovered in 13 PLADs), caused the most poisonings incidents (appearing in 66 incidents affecting 123 patients) and had distinct long active period (from middle April to late December).

    In 2021, 8 species (6 Amanita spp., 1 Galerina sp., and 1 Lepiota sp.) causing acute liver failure were identified in China (Supplementary Table S1). Galerina sulciceps killed 5 persons in 14 incidents involving 39 patients turned out to be the most dangerous species causing acute liver failure. Lepiota brunneoincarnata was responsible for 3 deaths in 15 incidents involving 45 patients, and this is the first report for its distribution in Yunnan Province (1-3). Amanita fuligineoides was originally described from Hunan and known from Yunnan as well (4-5). In late June, 2021, 5 people from Fujian were poisoned by this lethal species, which is indicative of a wider distribution of A. fuligineoides.

    Three species causing acute renal failure were identified from mushroom poisoning incidents (Supplementary Table S1). Amanita oberwinklerana caused the most incidents. It grew in March in Guangdong, then appeared from July to August in Central and Southwest China. Amanita kotohiraensis was responsible for poisoning 2 patients on August 19.

    Exposure to Russula subnigricans led to rhabdomyolysis causing 6 deaths; this species was found in 9 PLADs and appeared from May 10 to September 9. A total of 2 incidents involving 2 patients and 1 death caused by Paxillus involutus resulting in hemolysis occurred in Lasa, Xizang (Tibet).

    A total of 39 species causing gastroenteritis were identified from mushroom poisoning incidents in China in 2021 (Supplementary Table S1). Among them, Agaricus atrodiscus, Boletellus indistinctus, Hygrocybe rimosa, Lactarius purpureus, L. rubrocorrugatus, Lactifluus pseudoluteopus, Melanoleuca humilis, Ramaria gracilis, and Scleroderma aff. albidum were species newly discovered as poisonous mushrooms and subsequently added to the Chinese poisonous mushroom list (1-3). Hygrocybe rimosa was a new species discovered in 2021 (6). Notably, A. atrodiscus poisoning was reported for the first time from Yunnan since it was originally described from Thailand in 2015 (7) and discovered in Hainan Province, China, in 2020 (8). The top three species in this category were C. molybdites, R. japonica and Entoloma omiense.

    About 22 species causing psycho-neurological disorders were identified from mushroom poisoning incidents in China in 2021 (Supplementary Table S1). Among them, 6 species (Inocybe aff. glabrodisca, Inosperma muscarium, Pseudosperma arenarium nom. prov., Mallocybe fulvoumbonata, Psilocybe ovoideocystidiata, and P. papuana) were newly discovered as poisonous mushrooms (1-3). Inosperma muscarium and Pseudosperma arenarium were two new species. The former species was described in 2021 (9) and the latter was identified as P. cf. bulbosissimum in 2020 (2). Further study showed that P. cf. bulbosissimum was a new species. Mallocybe fulvoumbonata, P. ovoideocystidiata, and P. papuana were Chinese new records. The top five species were Amanita subglobosa, Gymnopilus dilepis, A. pseudosychnopyramis, Inosperma muscarium, and Pseudosperma arenarium.

    Nine boletes (Baorangia major, B. pseudocalopus, Boletellus indistinctus, Heimioporus gaojiaocong, H. japonicus, Neoboletus venenatus, Rubroboletus sinicus, Suillus pinetorum, and Tylopilus neofelleus) causing gastroenteritis and one (Lanmaoa asiatica) causing psycho-neurological disorder were identified from poisoning incidents.

    Interestingly, 2 incidents caused by polypores occurred in 2021. On February 28, 2021, one person from Guangxi had slight gastrointestinal symptoms after consumption of Cryptoporus volvatus, a recorded medicinal polypore (3). On the same date, one person from Guangdong also suffered from gastroenteritis after drinking boiled water using dried “medicinal mushrooms.” This mixture was confirmed as medicinal or edible mushrooms, Trametes hirsuta, Irpex lacteus, and Schizophyllum commune (3). Their toxicity and safe usage need to be further studied.

    About 6 edible mushrooms were also identified from mushroom poisoning incidents in 2021, which could be attributed to the consumption of mixed mushrooms with poisonous mushrooms, contaminated mushrooms, or some species potentially poisonous to certain people.

    • In 2021, mushroom poisoning incidents and patients were more than 2019 but less than 2020 as deaths slightly decreased (20 vs. 22 and 25) (1-2). Shaanxi, Xinjiang, Tianjin, and Jilin were four PLADs with newly recorded incidents (1-2). Approximately 74 poisonous mushrooms were successfully identified, among which 46 species were already recorded in 2019 and 2020 (1-2), raising the total species number from incidents reached over 150 in China by the end of 2021. The most dangerous mushroom was Russula subnigricans, killing 6 people in 2021, differing from Amanita exitialis that killed 13 people in 2019 and Lepiota brunneoincarnata that killed 5 people in 2020 (1-2).

      Monthly distribution analysis showed that mushroom poisonings in 2021 centered from May to November, longer than 2019 and 2020, peaking in August, which was later than the July peak in 2019, and different from 2020 that had 2 peaks in June and September (1-2).

      The top two PLADs with the most incidents were Hunan and Yunnan in 2021, identical to 2019 and 2020, and Southwest China remained the most severely affected area (1-2). Yunnan had the most deaths in the last three years, but declined markedly (1-2). Mushroom poisoning incidents decreased sharply in Zhejiang from 50 in 2019 to 43 in 2020 and to 21 in 2021 (1-2).

      Mushroom poisoning resulting in acute liver failure caused by Amanita spp. dropped sharply from 32 incidents, 80 patients, and 19 deaths in 2019 (1), to 53 incidents, 153 patients and 10 deaths in 2020 (2), and to 17 incidents, 52 patients and 5 deaths in 2021. This great progress mainly contributed to the continuous science popularization and health education on Amanita spp. Galerina sulciceps poisoning increased from 4 incidents, 9 patients, and 1 death in 2019 (1), to 6 incidents, 12 patients, and 2 deaths in 2020 (2), and to 14 incidents, 39 patients, and 5 deaths in 2021. Except appearing in autumn and winter, G. sulciceps also resulted in 1 death in April in Hunan. Attention must also be paid to Lepiota brunneoincarnata that caused 3 incidents in 2019 and 15 incidents in 2020 and 2021. Continuous and extensive science popularization about these lethal species was necessary and urgent in future.

      Similar to 2019 and 2020, Amanita oberwinklerana caused the most incidents, but resulted in relatively less incidents and patients than the last two years (1-2). Amanita kotohiraensis was discovered from one mushroom poisoning incident and expanded its distribution to Fujian (5).

      Compared to 2019 and 2020, Russula subnigricans leading to rhabdomyolysis caused more deaths (6 vs. 1 and 4), was discovered in more PLADs (9 vs. 5 and 4), and appeared earlier (1-2). Paxillus involutus resulting in hemolysis appeared earlier in Xizang (Tibet) than in Inner Mongolia, 2020 (2). On account of the huge risk of eating this mushroom, we strongly advise not collecting and eating this species although it was previously accepted as edible and medicinal fungus in China and seems safe to many people (2).

      Overall, 39 species causing gastroenteritis were successfully identified in 2021, which was more than 2019 (30 species) and less than 2020 (56 species), and the top three species were Chlorophyllum molybdites, Russula japonica, and Entoloma omiense, the same as 2019 and 2020 (1-2).

      Lactifluus pseudoluteopus was a species originally described from tropical Yunnan and was considered edible (10). In 2020, 5 people experienced gastroenteritis after eating Lf. pseudoluteopus, and we suspected the species might be poisonous (2). Subsequently, on June 4, 2021, another person also developed gastroenteritis after eating Lf. pseudoluteopus and we now could confirm that this species is toxic (10).

      Many species from Agaricus section Xanthodermatei were considered poisonous as they resulted in gastroenteritis, and 7 species were discovered in China by 2019 (3). In 2021, Agaricus atrodiscus and A. xanthodermus were identified from mushroom poisoning incidents. This was the first poisoning incident report caused by A. atrodiscus worldwide and supplemented poisoning information of A. xanthodermus (3,7).

      Omphalotus guepiniformis caused poisoning incidents in East, Central, South, and Southwest China in the recent years, whereas O. olearius poisoning only occurred in Yunnan Province (1-2). On July 11 and October 3, 2021, 22 persons were poisoned by a white, wood-rotting fungus which was similar to Pleurotus spp. Further studies showed that it might be an undescribed species of Omphalotus species, and we temporarily recorded it as Omphalotus sp. in the present investigation.

      Coprinellus micaceus, Coprinopsis atramentaria, and Coprinus comatus were three common and widely distributed mushrooms resulted in several poisoning incidents in 2021. They could produce coprine, especially when mature, and thus resulted in disulfiram-like mushroom poisoning when consumed with alcohol (11). In China, Cp. atramentaria and C. comatus were also considered edible, and C. comatus has been widely cultured commercially. Coprinellus micaceus was also considered as medicinal fungus (3). For the sake of safety, we strongly advise not eating these three species collected from the field or drinking alcohol when consuming cultured C. comatus.

      Baorangia major was firstly discovered in Fujian and Yunnan and resulted in 2 poisoning incidents either individually or in conjunction with B. pseudocalopus consumption in 2020 (2), and caused another incident in Fujian, 2021. Previously, Neoboletus venenatus was often discovered from incidents in which dried boletes were consumed (1-2). On September 19, 2021, 7 people from Yunnan were poisoned after eating fresh basidiomata. On August 19, 2021, 1 person from Fujian suffered from gastroenteritis after eating a red bolete. Our study indicated that it might be a new species and temporarily recorded as Rubroboletus sp.

      About 22 species causing psycho-neurological disorders were identified in 2021, which was more than 2019 (18 species) but less than 2020 (28 species), and Amanita subglobosa occupied the first for the last three years (1-2). Except the 6 newly added poisonous species, the previously convincible poisonous species A. ibotengutake, A. melleialba, A. pseudopantherina, A. pseudosychnopyramis, and Panaeolus bisporus appeared in poisoning incidents in 2021 (15).

      Amanita is the most famous genus worldwide since it includes many notorious poisonous mushrooms which could cause acute liver failure, acute renal failure, and psycho-neurological disorder (13, 5, 11). In China, many species are China-specific, 9 lethal species leading to acute liver failure and 10 species leading to psycho-neurological disorder were originally described from China (4-5), and their toxicity of many species had been confirmed from poisoning incidents (1-2). Although dozens of species of this genus are edible, on account of the high phenotypic similarity between edible and lethal species, we strongly advise not eating Amanita spp. unless the identity is fully determined.

      Lanmaoa asiatica, commonly known as “red bolete with onion smell,” is a delicious bolete that needs properly cooking, which was originally described from China (12). When causing poisoning, this species could cause hallucinations. Different from species containing psilocybin, its toxicity is still unclear and needs further studies.

      The incidents reported in this study only represent a portion of actual mushroom poisonings. In some poisoning incidents, some specimens cannot be given a satisfactory species name. More taxonomic work is needed and more new species will be hopefully discovered (1-3, 5-10, 12). The low level of awareness of mushroom poisoning, in contrast to the high species diversity in China is a huge challenge for mushroom poisoning control and prevention. The practice demonstrates that more efforts and closer cooperation are still urgently needed from governments, CDC staff, doctors, and mycologists to properly control mushroom poisoning events in the future.

    • Profs. Zuohong Chen, Ping Zhang (Hunan Normal University), Prof. Zhuliang Yang, Drs. Xianghua Wang, Gang Wu, Hong Luo, Zaiwei Ge, Yanchun Li (Kunming Institute of Botany, Chinese Academy of Sciences), Profs. Taihui Li, Wangqiu Deng, Drs. Ming Zhang, Chaoqun Wang (Institute of Microbiology, Guangdong Academy of Scicences), Prof. Tolgor Bau (Jilin Agricultural University), Drs. Niankai Zeng, 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), Dr. Chuanhua Li (Shanghai Academy of Agricultural Sciences), Prof. Haisheng Yuan (Institute of Applied Ecology, Chinese Academy of Sciences), Dr. Xiaolan He (Institute of Agricultural Resources and Environment, Sichuan Academy of Agricultural Science) and Profs. Ruilin Zhao, Xiaoyong Liu, Tiezheng Wei (Institute of Microbiology, Chinese Academy of Sciences); involved CDCs and hospitals.

      Clinical syndromes or mushroom speciesNumber of incidentsNumber of patientsDeathsCase fatality (%)Spatial and temporal distribution
      Acute liver failure
      Amanita exitialis38112.50March 3, Guangdong; June 24 to 26, Yunnan
      Amanita exitialis and A. fuligineoides1400July 2, Yunnan
      Amanita fuliginea and A. oberwinklerana ARF1500July 5, Hunan
      Amanita fuligineoides29111.11June 25 and July 2, Fujian, and Yunnan
      Amanita pallidorosea1200June 19, Hunan
      Amanita rimosa1300June 2, Hunan
      Amanita subjunquillea1200September 17, Sichuan
      Amanita spp.719315.79June 22 to July 26, Yunnan, Hunan, Chongqing, and Zhejiang
      Galerina sulciceps1439512.82April 16, Hunan; November 3 to 30, Sichuan, Chongqing, Hubei, Guizhou, and Hunan
      Galerina sp.11800December 28, Sichuan
      Lepiota brunneoincarnata154536.67July 4 to September 28, Yunnan, Hebei, Shanxi, Xinjiang, Shandong, Inner Mongolia, Ningxia, Shaanxi, Jilin, Beijing, and Tianjin
      Rhabdomyolysis
      Russula subnigricans1650612.00May 10 to September 9, Yunnan, Zhejiang, Hunan, Jiangsu, Fujian, Jiangxi, Guizhou, Guangdong, and Guangxi
      Acute renal failure
      Amanita kotohiraensis1200August 19, Fujian
      Amanita oberwinklerana6900mid-March, Guangdong; July 20 to August 29, Hubei, Sichuan, and Guizhou
      Amanita aff. pseudoporphyria2200August 22 and 23, Hunan
      Hemolysis
      Paxillus involutus22150.00July 31 and August 7, Xizang
      Gastroenteritis
      Agaricus atrodiscus1600July 28, Yunnan
      Agaricus xanthodermus1100April 29, Hunan
      Agaricus sp.1200August 20, Hunan
      Baorangia major1500May 28, Fujian
      Baorangia pseudocalopus2800June 23, Yunnan; September 17, Hunan
      Boletellus indistinctus1600August 3, Yunnan
      Chlorophyllum aff. globosum2800August 30 and September 5, Sichuan
      Chlorophyllum hortense2300August 12 to September 29, Hunan, and Guangxi
      Chlorophyllum molybdites6512000April 15 to December 27, Zhejiang, Guizhou, Hunan, Hainan, Fujian, Guangdong, Guangxi, Yunnan, Sichuan, Chongqing, Jiangsu, Hubei and Jiangxi
      Chlorophyllum molybdites and Cordyceps gunnii M1300August 21, Guizhou
      Coprinellus micaceus1100September 29, Beijing
      Coprinellus micaceus and Panaeolus bisporus P1300September 20, Ningxia
      Coprinopsis atramentaria1100April 19, Shandong
      Coprinus comatus1100October 19, Sichuan
      Cryptoporus volvatus M1100February 28, Guangxi
      Entoloma caespitosum1400May 24, Fujian
      Entoloma omiense72200June 6 to August 30, Fujian, Guangdong, Yunnan, Zhejiang, and Guizhou
      Entoloma aff. strictius1300April 12, Hunan
      Entoloma aff. sinuatum1900August 8, Yunnan
      Gymnopus densilamellatus, G. dryophilus G and
      Ripartites tricholoma U
      1200August 6, Hebei
      Gymnopus indoctus U, Leucoagaricus sinicus U, Panaeolus papilionaceus P, Ileodictyon gracileU and Agaricus sp. U1400October 14, Guangdong
      Heimioporus gaojiaocong3500January 12, Yunnan (dried boletes bought from market); June 3 to July 20, Yunnan
      Heimioporus japonicus2900August 26 and September 7, Fujian
      Hygrocybe rimosa1200July 1, Guizhou
      Lactarius purpureus1100August 29, Hunan
      Lactarius rubrocorrugatus2700July 11 and 27, Sichuan
      Lactifluus pseudoluteopus1100June 4, Yunnan
      Melanoleuca humilis1200September 15, Ningxia
      Neoboletus brunneissimus E,M, Butyriboletus yicibus E, Catathelasma subalpinum E and Cortinarius similis U1300August 16, Sichuan (dried boletes from Yunnan)
      Neoboletus venenatus31200March 10 and July 2, Hunan and Sichuan (dried boletes, bought from market); September 19, Yunnan
      Omphalotus guepiniformis1300May 1, Guizhou
      Omphalotus olearius2400July 28 and October 18, Yunnan
      Omphalotus sp.44400July 11 and October 18, Yunnan
      Pholiota multicingulata1400September 13, Chongqing
      Ramaria gracilis1100August 28, Yunnan
      Rubroboletus sinicus and Retiboletus fuscus E12000January 11, Jiangsu (dried boletes bought from market)
      Rubroboletus sp.1100August 19, Fujian
      Russula foetens1100August 26, Fujian
      Russula japonica247000May 25 to August 26, Guangxi, Hunan, Sichuan, Guizhou, Yunnan, Chongqing, Fujian, and Zhejiang
      Russula japonica and R. punctipes G1200May 31, Hunan
      Russula leucocarpa U and Russula sp.1400September 4, Fujian
      Russula punctipes1600August 23, Hunan
      Scleroderma aff. albidum2900March 7 and July 9, Guangxi and Sichuan
      Scleroderma cepa4700July 5 to August 25, Yunnan; October 27 to November 15, Hunan
      Suillus pinetorum, Amanita javanica E, Boletus bainiugan E and Phlebopus portentosus E1800April 15, Yunnan
      Thicholoma highlandense1100November 20, Guizhou
      Trametes hirsuta M, Irpex lacteus M and Schizophyllum commune E,M1100February 28, Guangdong (dried mushrooms from Sichuan)
      Tricholoma stans1200November 3, Yunnan
      Tricholoma aff. stans2500November 2 and December 1, Guizhou and Yunnan
      Psycho-neurological disorder
      Amanita ibotengutake11700September 5, Shandong
      Amanita melleialba1100August 10, Yunnan
      Amanita orientigemmata1200August 10, Yunnan
      Amanita pseudopantherina1100August 9, Yunnan
      Amanita pseudosychnopyramis21100April 6 and 15, Fujian and Zhejiang
      Amanita orsonii and Amanita sp. U1300June 29, Chongqing
      Amanita rufoferruginea1600July 6, Sichuan
      Amanita subglobosa41300June 29 to August 19, Sichuan and Hunan
      Amanita sychnopyramis f. subannulata1500May 28, Guangxi
      Clitocybe subditopoda1300October 26, Guizhou
      Clitocybe sp.1200October 18, Hainan
      Gymnopilus dilepis3500May 1 to July 2, Sichuan and Guizhou
      Inocybe aff. glabrodisca1400November 26, Guizhou
      Inosperma muscarium2700May 30 and June 5, Guangxi and Fujian
      Lanmaoa asiatica1100July 2, Yunnan
      Lanmaoa asiatica, Heimioporus japonicus G and Tylopilus neofelleus G1400January 27, Chongqing (dried boletes bought from market)
      Panaeolus bisporus1200August 14, Guizhou
      Pseudosperma arenarium nom. prov.2300September 22 and 30, Ningxia and Shaanxi
      Pseudosperma umbrinellum and Mallocybe fulvoumbonata P1200September 21, Ningxia
      Psilocybe ovoideocystidiata1200March 26, Guizhou
      Psilocybe papuana1200April 30, Hunan
      Unclassified
      Cortinarius cupreorufus U1300September 3, Ningxia
      Laccaria vinaceoavellanea E1200August 1, Yunnan
      Leucoagaricus barssii E1200September 6, Ningxia
      Porphyrellus nigropurpureus U1400August 1, Fujian
      Russula densifolia E1200August 13, Yunnan
      Scleroderma yunnanense E1400July 2, Yunnan
      Stropharia rugosoannulata E2200April 29 and May 16, Hunan and Chongqing
      Tricholoma myomyces E1200March 16, Hunan
      Note: Species newly recorded as poisonous mushrooms in China are in italic bold.
      Abbreviations used for mushroom poisoning incidents with more than two species: ARF=Acute renal failure, G=Gastroenteritis, P=Psycho to neurological disorder, M=Medicinal, U=Unclassified, E=Edible.

      Table S1.  Mushroom species involved in poisoning incidents and their spatial and temporal distribution in China, 2021.

Reference (12)

Citation:

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