Advanced Search

Preplanned Studies: Mushroom Poisoning Outbreaks — China, 2022

View author affiliation
  • Summary

    What is already known about this topic?

    Mushroom poisoning is one of the most serious food safety issues in China. By the end of 2021, over 520 poisonous mushrooms had been discovered in China. The Southwest region of China was the most severely affected. Mushroom poisonings mainly concentrated in the summer and autumn months.

    What is added by this report?

    In 2022, China CDC conducted an investigation of 482 incidents of mushroom poisoning across 21 provincial-level administrative divisions (PLADs). This resulted in 1,332 patients and 28 deaths, with a total case fatality rate of 2.1%. A total of 98 mushrooms were identified, causing 7 different clinical types of diseases. Three provisional new species (Collybia humida nom. prov., Spodocybe venenata nom. prov., and Omphalotus yunnanensis nom. prov.) were newly recorded as poisonous mushrooms in China, in addition to 10 other species.

    What are the implications for public health practice?

    In view of the extensive impact and harm of poisonous mushrooms on public health, it is necessary to promote prevention and improve the ability of professionals to identify, diagnose, and treat mushroom poisoning.

  • loading...
  • Funding: The research was financed by the National Natural Science Foundation of China (32270021)
  • [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] Li HJ, Zhang HS, Zhang YZ, Zhou J, Yin Y, He Q, et al. Mushroom poisoning outbreaks — China, 2021. China CDC Wkly 2022;4(3):35 − 40. http://dx.doi.org/10.46234/ccdcw2022.010CrossRef
    [4] Reschke K, Popa F, Yang ZL, Kost G. Diversity and taxonomy of Tricholoma species from Yunnan, China, and notes on species from Europe and North America. Mycologia 2018;110(6):1081 − 109. http://dx.doi.org/10.1080/00275514.2018.1512295CrossRef
    [5] Zhou H, Cheng GQ, Sun XM, Cheng RY, Zhang HL, Dong YM, et al. Three new species of Candolleomyces (Agaricomycetes, Agaricales, Psathyrellaceae) from the Yanshan Mountains in China. MycoKeys 2022;88:109 − 21. http://dx.doi.org/10.3897/mycokeys.88.81437CrossRef
    [6] Li YC, Yang ZL. The boletes of China: Tylopilus s.l. Singapore: Springer. 2021. http://dx.doi.org/10.1007/978-981-16-2986-0.http://dx.doi.org/10.1007/978-981-16-2986-0
    [7] Cai Q, Cui YY, Yang ZL. Lethal Amanita species in China. Mycologia 2016;108(5):993 − 1009. http://dx.doi.org/10.3852/16-008CrossRef
    [8] 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
    [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;85:87 − 108. http://dx.doi.org/10.3897/mycokeys.85.71957CrossRef
    [10] 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
  • FIGURE 1.  Monthly distribution of mushroom poisonings in China, 2022.

    FIGURE 2.  Poisonous mushrooms identified from mushroom poisoning incidents in China in 2022.

    Note: 1: Amanita exitialis; 2: A. fuliginea; 3: A. fuligineoides; 4: A. rimosa; 5: A. subfuliginea (provided by Yalin Zhou); 6: A. subjunquillea; 7: A. pallidorosea; 8: Galerina sulciceps; 9: Lepiota brunneoincarnata; 10: Russula subnigricans; 11: A. neoovoidea; 12: A. oberwinklerana; 13: A. pseudoporphyria; 14: Paxillus orientalis; 15: Cordierites frondosus; 16: Chlorophyllum molybdites; 17: Russula japonica; 18: Scleroderma cepa (provided by Tianhong Li); 19: Coprinopsis aesontiensis (provided by Wensong Chen); 20: Leucoagaricus purpureolilacinus species complex (provided by Xia Rong); 21: Omphalotus yunnanensis nom. prov.; 22: Tricholoma olivaceum; 23: Lanmaoa asiatica (provided by Guanliang Wen); 24: Gymnopilus dilepis (provided by Ya’an CDC); 25: Anthracoporus nigropurpureus; 26: Amanita rufoferruginea; 27: A. sychnopyramis f. subannulata (provided by Zuohong Chen); 28: Anthracoporus holophaeus (provided by Yanchun Li); 29: Collybia humida nom. prov.; 30: Spodocybe venenata nom. prov.

    TABLE 1.  Geographical distribution of mushroom poisoning incidents in China, 2022.

    PLADNumber of incidentsNumber of patientsDeathsMortality (%)
    Yunnan13140492.23
    Hunan8922973.06
    Sichuan5713021.54
    Guangxi2910600
    Chongqing278211.22
    Zhejiang277200
    Guangdong2046510.87
    Guizhou198711.15
    Ningxia192900
    Hubei174200
    Shandong91915.26
    Fujian81516.67
    Jiangsu72000
    Jiangxi6700
    Anhui51600
    Hebei41000
    Henan36116.67
    Shanghai2200
    Liaoning1500
    Shanxi1300
    Heilongjiang1200
    Total4821,332282.10
    Note: Species newly recorded as poisonous mushrooms in China are in italic bold.
    Abbreviation: ALF=Acute liver failure; ARF=Acute renal failure; G=Gastroenteritis; P=Psycho to neurological disorder; M=Medicinal; U=Unclassified; E=edible.
    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(1417) PDF downloads(13) Cited by()

Share

Related

Mushroom Poisoning Outbreaks — China, 2022

View author affiliation

Summary

What is already known about this topic?

Mushroom poisoning is one of the most serious food safety issues in China. By the end of 2021, over 520 poisonous mushrooms had been discovered in China. The Southwest region of China was the most severely affected. Mushroom poisonings mainly concentrated in the summer and autumn months.

What is added by this report?

In 2022, China CDC conducted an investigation of 482 incidents of mushroom poisoning across 21 provincial-level administrative divisions (PLADs). This resulted in 1,332 patients and 28 deaths, with a total case fatality rate of 2.1%. A total of 98 mushrooms were identified, causing 7 different clinical types of diseases. Three provisional new species (Collybia humida nom. prov., Spodocybe venenata nom. prov., and Omphalotus yunnanensis nom. prov.) were newly recorded as poisonous mushrooms in China, in addition to 10 other species.

What are the implications for public health practice?

In view of the extensive impact and harm of poisonous mushrooms on public health, it is necessary to promote prevention and improve the ability of professionals to identify, diagnose, and treat mushroom poisoning.

  • 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

  • Funding: The research was financed by the National Natural Science Foundation of China (32270021)
  • Online Date: January 20 2023
    doi: 10.46234/ccdcw2023.009
  • Mushroom poisoning has become a serious food safety issue in China. With the support of the government, over the past decade, China has gradually established a mushroom poisoning prevention and treatment system involving experts in disease prevention and control, clinical diagnosis and treatment, fungal classification, and basic medicine (1-3). In recent years, a mushroom-poisoning information collecting, diagnosis, and treatment support network has been established, utilizing WeChat, telephone, email, and other methods. After poisoning incidents occur, mushroom samples are collected by CDC staff or hospital professionals and sent to mycological researchers at universities and institutions for identification, based on morphological characters and DNA sequence data (1-3).

    In 2022, China CDC investigated 482 mushroom poisoning incidents involving 1,332 patients and 28 deaths, with a total case fatality rate of 2.1%. The number of cases per incident ranged from 1 to 28, with an average of 2. A total of 13 incidents involved more than 10 patients. Of these cases, 73 patients from 23 incidents ate poisonous mushrooms purchased from markets or given by friends; 9 patients from 6 incidents were poisoned after eating raw Chlorophyllum molybdites, Boletus bainiugan, and Macrocybe gigantea, although the last two species were considered to be edible after proper cooking (Supplementary Table S1); 44 patients from 7 incidents were poisoned after eating dried mushrooms; and 213 patients and 3 deaths from 55 incidents ate mixed mushrooms.

    The temporal distribution shows that mushroom poisonings occurred in all months, with the highest number of incidents occurring between May and November (460 incidents, 1,234 patients, and 22 deaths). The first death occurred in mid-February in Fujian. The top 3 months for deaths were June (13 deaths), July (3 deaths), and September (3 deaths) (Figure 1).

    Figure 1.  Monthly distribution of mushroom poisonings in China, 2022.

    In terms of geographical distribution, mushroom poisoning incidents were reported in 21 provincial-level administrative divisions (PLADs). Overall, 10 PLADs had more than 10 incidents, and Yunnan, Hunan, Sichuan, Guangxi, Chongqing, and Zhejiang were the top 6 (Table 1); 11 PLADs had more than 20 patients, and Yunnan, Hunan, Sichuan, and Guangxi had over 100 patients each (Table 1). Yunnan, Hunan, and Guangdong were the top 3 PLADs in terms of deaths, with 9, 7, and 5 deaths, respectively (Table 1). Southwest China (Yunnan, Sichuan, Chongqing, and Guizhou) was the most severely affected region, with 234 incidents, 703 patients, and 13 deaths. This was followed by Central China (Hunan, Hubei, and Henan) with 109 incidents, 277 patients, and 8 deaths; East China (Zhejiang, Fujian, Jiangsu, Jiangxi, Anhui, and Shanghai) with 55 incidents, 132 patients, and 1 death; South China (Guangxi and Guangdong) with 49 incidents, 152 patients, and 5 deaths; Northwest China (Ningxia) with 19 incidents, 29 patients, and 0 deaths; North China (Shandong, Hebei, and Shanxi) with 14 incidents, 32 patients, and 1 death; and Northeast China (Liaoning and Heilongjiang) with 2 incidents, 7 patients, and 0 deaths. Detailed information for each PLAD is presented in Table 1.

    PLADNumber of incidentsNumber of patientsDeathsMortality (%)
    Yunnan13140492.23
    Hunan8922973.06
    Sichuan5713021.54
    Guangxi2910600
    Chongqing278211.22
    Zhejiang277200
    Guangdong2046510.87
    Guizhou198711.15
    Ningxia192900
    Hubei174200
    Shandong91915.26
    Fujian81516.67
    Jiangsu72000
    Jiangxi6700
    Anhui51600
    Hebei41000
    Henan36116.67
    Shanghai2200
    Liaoning1500
    Shanxi1300
    Heilongjiang1200
    Total4821,332282.10
    Note: Species newly recorded as poisonous mushrooms in China are in italic bold.
    Abbreviation: ALF=Acute liver failure; ARF=Acute renal failure; G=Gastroenteritis; P=Psycho to neurological disorder; M=Medicinal; U=Unclassified; E=edible.

    Table 1.  Geographical distribution of mushroom poisoning incidents in China, 2022.

    In 2022, 98 species of poisonous mushrooms were successfully identified from mushroom poisoning events, resulting in seven different clinical syndromes. Among these 98 species, 13 were newly recorded as poisonous species in China. Collybia humida nom. prov., Spodocybe venenata nom. prov., and Omphalotus yunnanensis nom. prov. represented 3 undescribed species. The first two species contained muscarine and stimulated the parasympathetic nervous system, while the last species caused gastroenteritis. Coprinopsis aesontiensis and Leucoagaricus purpureolilacinus species complex were two new records in China causing gastroenteritis. The eight remaining species, previously of unclear edibility, were confirmed to be poisonous based on poisoning incidents. These species were Tricholoma olivaceum, a species originally discovered in China and causing gastroenteritis (4); Candolleomyces yanshanensis, Anthracoporus holophaeus, Anthracoporus nigropurpureus, Inocybe cf. assimillata, Inocybe aff. decemgibbosa, Inocybe aff. pseudoreducta, and Inosperma cf. gregarium, which caused psycho-neurological disorders (5-6).

    The top three lethal mushroom species were Amanita exitialis, A. rimosa, and Russula subnigricans, which caused 7, 7, and 6 deaths, respectively (Figure 2, Supplementary Table S1). Chlorophyllum molybdites, the most widely distributed mushroom (discovered in 16 PLADs), caused the most poisonings incidents (appearing in 114 incidents and affecting 257 patients) and had a distinct long active period (from early April to early December).

    Figure 2.  Poisonous mushrooms identified from mushroom poisoning incidents in China in 2022. Note: 1: Amanita exitialis; 2: A. fuliginea; 3: A. fuligineoides; 4: A. rimosa; 5: A. subfuliginea (provided by Yalin Zhou); 6: A. subjunquillea; 7: A. pallidorosea; 8: Galerina sulciceps; 9: Lepiota brunneoincarnata; 10: Russula subnigricans; 11: A. neoovoidea; 12: A. oberwinklerana; 13: A. pseudoporphyria; 14: Paxillus orientalis; 15: Cordierites frondosus; 16: Chlorophyllum molybdites; 17: Russula japonica; 18: Scleroderma cepa (provided by Tianhong Li); 19: Coprinopsis aesontiensis (provided by Wensong Chen); 20: Leucoagaricus purpureolilacinus species complex (provided by Xia Rong); 21: Omphalotus yunnanensis nom. prov.; 22: Tricholoma olivaceum; 23: Lanmaoa asiatica (provided by Guanliang Wen); 24: Gymnopilus dilepis (provided by Ya’an CDC); 25: Anthracoporus nigropurpureus; 26: Amanita rufoferruginea; 27: A. sychnopyramis f. subannulata (provided by Zuohong Chen); 28: Anthracoporus holophaeus (provided by Yanchun Li); 29: Collybia humida nom. prov.; 30: Spodocybe venenata nom. prov.

    In 2022, nine species causing acute liver failure were identified in China (Figure 2, Supplementary Table S1). Amanita exitialis was the most dangerous species, causing 7 deaths in 14 incidents involving 41 patients. Amanita rimosa and Galerina sulciceps caused seven and three deaths, respectively. Amanita subfuliginea, a lethal species originally described from Guangdong in 2016 (7), was also identified. On May 29, two people from Chongqing were poisoned by a gray amanita mushroom, marking the first reported poisoning incident since the mushroom was described and the first record of this gray poisonous amanita in Southwest China (7).

    Three species of mushroom were identified as causing acute renal failure in mushroom poisoning incidents (Figure 2, Supplementary Table S1). Amanita pseudoporphyria was the most common, appearing in 12 incidents either alone or in combination with other species. Amanita neoovoidea had the longest active period, occurring from mid-June to early November.

    Russula subnigricans was linked to 15 incidents of rhabdomyolysis, involving 44 patients and resulting in 6 deaths, either alone or in combination with other mushroom species. This species was found in Yunnan, Hunan, and Zhejiang from June to September. The first Paxillus orientalis poisoning incident from China, resulting in hemolysis, occurred in Sichuan in early June (Figure 2, Supplementary Table S1).

    A total of 51 species causing gastroenteritis were identified from mushroom poisoning incidents in China in 2022 (Supplementary Table S1). Among them, four species were identified as poisonous mushrooms and subsequently added to the Chinese poisonous mushroom list (1-3,8). Omphalotus yunnanensis nom. prov. was discovered from a poisoning incident in Yunnan. The top three species in this category were Chlorophyllum molybdites, Russula japonica, and Scleroderma cepa (Figure 2).

    In 2022, 32 species of mushrooms causing psycho-neurological disorders were identified in China (Supplementary Table S1). Nine of these species were newly discovered as poisonous (1-3,8), including Collybia humida nom. prov. and Spodocybe venenata nom. prov., which need to be formally described. The top five species were Lanmaoa asiatica, Gymnopilus dilepis, Anthracoporus nigropurpureus, Amanita rufoferruginea, and Amanita sychnopyramis f. subannulata (Figure 2).

    On September 30, five Burmese workers in Dehong, Yunnan were poisoned by Inosperma hainanense, a newly discovered species containing muscarine that was identified in Hainan in 2021 (9).

    • In 2022, mushroom poisoning incidents and patients were more than those in 2019 and 2021 but fewer than in 2020, while deaths slightly increased (28 compared to 22, 20, and 25) (1-3). Heilongjiang was newly recorded with poisoning incidents (1-3). A total of 98 poisonous species were successfully identified from poisoning incidents in 2022, among which 62 species had already been recorded from 2019 to 2021 (1-3), raising the total number of species from incidents to over 190 in China by the end of 2022. The most dangerous mushrooms were Amanita exitialis and A. rimosa, each causing seven deaths in 2022, different from 2019 to 2021 (1-3).

      Temporal distribution analysis showed that mushroom poisonings in 2022 were concentrated from May to November, similar to 2021 but longer than 2019 and 2020 (1-3). The peak occurred in June and the incidents decreased in July and August, likely due to the rare drought in southern China. With the arrival of rain in September, mushroom poisoning reached its second peak in September and then gradually decreased in the following three months (Figure 1).

      From 2019 to 2021, Hunan was the province with the most incidents among PLADs. However, in 2022, Yunnan had the highest number of incidents, and Southwest China remained the most severely affected area (1-3). Yunnan also had the most deaths over the last four years (1-3).

      On June 5, one person in Sichuan was poisoned by Paxillus orientalis, resulting in hemolysis. This was the first reported case of poisoning from this species in China (10). In 2020 and 2021, species of the same genus, Paxillus involutus, were reported to have caused poisoning in Xizang (Tibet) and Inner Mongolia (2-3). We strongly advise against collecting and eating species of Paxillus, despite their previous acceptance as edible and/or medicinal fungi in China and the perception of safety among many people (8,10).

      In 2022, 51 species of gastroenteritis-causing organisms were identified, more than in 2019 (30 species) and 2021 (39 species), but slightly fewer than in 2020 (56 species). The top two species were Chlorophyllum molybdites and Russula japonica, which remained the same from 2019 to 2021, but the third species in 2022 was Scleroderma cepa, instead of Entoloma omiense in the previous three years (1-3).

      In 2022, 32 species causing psycho-neurological disorders were identified, more than the 18, 28, and 22 species reported in the previous three years (1-3). Surprisingly, Lanmaoa asiatica ranked first, unlike the previous three years when Amanita subglobosa was the most common (1-3). Lanmaoa asiatica is a delicious bolete that must be cooked properly (8). The increased poisoning incidents of this species may be partially attributed to the rise of online shopping, which lacks face-to-face communication about proper cooking.

      Anthracoporus nigropurpureus (Porphyrellus nigropurpureus), a black bolete, caused nine poisoning incidents in Sichuan, Yunnan, and Zhejiang, resulting in dizziness, blurred vision, amyosthenia, headache, muscle cramps, hand or foot tremors, and red eyes, among other symptoms. However, its toxicity remains unclear, and further studies are urgently needed. Another species from the same genus, Anthracoporus holophaeus, was also identified from two incidents with similar clinical manifestations. At present, we strongly advise against collecting and eating black boletes of the genus Anthracoporus.

      Cordierites frondosus is a species morphologically similar to edible Auricularia spp., but the former species can cause typical photosensitive dermatitis, which poisoned three people from Chongqing on April 21, 2022. Compared to 2019, we found that this species appeared in different months in different areas; for example, two incidents occurred in Yunnan in early June and in Guizhou in early December (1). Further research is needed to uncover its spatial and temporal distribution characteristics and rules for better poisoning control.

      Sixteen edible mushrooms were identified from mushroom poisoning incidents in 2022 (Supplementary Table S1). These incidents were likely due to the consumption of mixed mushrooms with poisonous mushrooms, contaminated mushrooms, or some species that may be poisonous to certain individuals.

      This study only represents a portion of actual mushroom poisonings. In some cases, no mushroom specimens were obtained, making it impossible to confirm the exact poisonous mushroom species. To reduce the risk of poisoning, we recommend that people set aside some fruiting bodies before eating or take a photo of the fresh mushrooms before cooking. Knowledge popularization of poisonous mushrooms is also important to decrease the number of poisoning incidents. To this end, we recommend creating more scientific, plain, and varied popularization materials and publicizing them to people at risk before and throughout the poisoning season. In the past decades, our knowledge of poisonous mushrooms has increased drastically, and more patient poisoning incidents have become more standardized.

      The previous practice of controlling and preventing mushroom poisoning demonstrates that more effort and closer cooperation are urgently needed from governments, CDC staff, doctors, and mycologists 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 Sciences), Prof. Tolgor Bau (Jilin Agricultural University), Drs. Niankai Zeng, Yuguang Fan (Hainan Medical University), Prof. Liping Tang (Kunming 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. Liangdong Guo, Lei Cai, Ruilin Zhao, Xiaoyong Liu (Institute of Microbiology, Chinese Academy of Sciences); involved CDCs and hospitals.

Reference (10)

Citation:

Catalog

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return