SYNDROME PHALLOÏDIEN: QUELLE EST LA PLACE DU DOSAGE DES α-ET γ-AMANITINES PAR ELISA (BÜHLMANN)? Résultats préliminaires

Abstract

After consumption of mushrooms containing amatoxins (Amanita, Lepiota, and Galerina species), symptoms usually develop after a long delay (>6h). Initial symptoms start as severe gastroenteritis, progressing to liver failure and possibly death as a result of hepatic coma. Since the survival rate of poisoned patients is claimed to depend on the time of beginning of efficient treatment, fast and reliable assays for amatoxins in biological fluids are essential. Described analytical methods for amatoxins include high performance liquid chromatography and radioimmunoassay (RIA). Recently, a new enzymelinked immunosorbent assay (Bühlmann Amanitin ELISA™ kit) has been introduced as an alternative method to RIA. This ELISA-based assay offers several advantages: no complex extraction procedure is required (vs. HPLC) and no safety precautions concerning radioactivity have to be taken (vs. RIA). From August 2004 to October 2005, a pilot study was performed to test the practicability and the clinical utility of this method in emergency situations. Results: ten urines, 9 serums and 1 faeces from 10 patients suffering from acute gastroenteritis after mushroom ingestions (7 contaminated meals) were analyzed. Definitive diagnosis of amatoxin poisoning was made in 4 cases (3 contaminated meals) on the basis of the anamnesis, laboratory results, and clinical course. A patient developed a severe amatoxin poisoning with urinary amanitins level < 1.5 μg/L (urines were collected more than 72h after mushroom ingestion). Two patients were paucisymptomatic with urinary amanitins levels > 10 μg/L (urines were collected before the 36^th hour). Conclusion: Urine is the sample of choice for the determination of amatoxins. The most critical factor to invalidate the usefulness of this analysis is time. After 36h, the sensitivity is unreliable.

Keywords:

• syndrome phalloïdien
• amanitine
• ELISA

Keywords:

• amatoxin poisoning
• amanitin
• ELISA