Mushroom poisoning in Ireland: The collaboration between the National Poisons Information Centre and expert mycologists

Abstract

Background. Occasionally, mycologist assistance is requested to reliably identify mushroom species in symptomatic cases where there is a concern that a toxic species is involved. The aim of this study was to describe the epidemiology of mushroom poisoning in Ireland, to describe the working arrangement between the National Poisons Information Centre (NPIC) and professional mycologists and to present a case series detailing the circumstances when mycologists were consulted.

Methods. Computerised records from 1 January 2004 to 31 December 2009 were retrospectively reviewed and data on patient demographics, circumstances, and mushroom species collated. In 1999, the NPIC established a national registry of volunteer professional mycologists who are available 24 h/day for mushroom identification. The NPIC staff liaises directly with the mycologist and arranges transport of mushroom material. Digital photographic images are requested if there is likely to be a delay in arranging transportation of mushroom material, and the images are subsequently emailed to a mycologist. Five cases of suspected mushroom poisoning were chosen to demonstrate the inter-professional collaboration between the NPIC and mycologists.

Results. From 2004 to 2009, the NPIC was consulted about 70 cases of suspected mushroom exposures. Forty-five children ingested unknown mushrooms, 12 adults and 2 children ingested hallucinogenic mushrooms and 11 adults ingested wild toxic mushrooms that were incorrectly identified or confused with edible species. The mycologists were consulted 10 times since 1999. In this series, Amanita species were identified in two cases. In three cases, the species identified were Clitocybe nebularis, Coprinus comatus and Panaeolina foenisecii, respectively, and serious poisoning was excluded. Incorrect mushroom identification by a health care professional using the Internet occurred in two cases. The mycologists assisted Poisons Information Centres in Northern Ireland and the United Kingdom in two cases. Digital photographs facilitated tentative mushroom identification in two cases.

Conclusion. Poison information centres should maintain a registry of expert mycologists who are available for consultation following potentially serious mushroom intoxications. Health care workers should not attempt to identify toxic mushroom species using the Internet as erroneous identification can occur. Digital photography may help with mushroom identification when there is likely to be a delay organising a physical examination of mushroom tissue.

Keywords:

• Mushroom
• Poisoning
• Mycologist

Acknowledgements

The authors would like to acknowledge Mr Hubert Fuller for critical evaluation of the manuscript. The NPIC would like to thank the following mycologists for providing their valuable services and expert knowledge: Mr Hubert Fuller (University College Dublin), Professor Derek Mitchell (University College Dublin), Dr John Feehan (University College Dublin), Professor Paul Dowding (Trinity College Dublin), Dr Tom Harrington (University of Limerick), Ms Maria Cullen (University of Limerick), Dr Don Cotton (Institute of Technology, Sligo), Mr Howard Fox (National Botanic Gardens, Dublin), Mr Donal Synnott (National Botanic Gardens, Dublin), Dr Roy Anderson (Queen's University, Belfast) and Mr Mark Wright (Environment and Heritage Service, Belfast).