The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) said mushroom picking had started earlier than usual in 2023.

Rainy weather in several regions in August encouraged the growth of mushrooms. Growth varies yearly, depending on various things, including weather.

Since the start of August, intoxications reported to poison control centers (CAP) have increased. More than 250 cases have already been recorded, twice as many as in the same period in 2022.

There are several reasons for poisonings, including confusion of an edible species with a toxic variety or consumption of edible mushrooms in poor condition that were poorly preserved or insufficiently cooked.

It is not recommended to serve infants picked wild mushrooms but 74 young children were poisoned, including an 11-month-old child who required treatment in intensive care.

Not a new problem
Although ANSES issues recommendations yearly, cases are frequently reported to poison control centers.

Between July and December 2022, 1,923 poisonings were reported to CAPs. This was more than 1,269 cases in 2021. However, the number of serious cases was down slightly from 41 in 2021 to 37 in 2022. There were two deaths compared to four fatalities in 2021. The peak this past year was in October when more than 1,000 cases were recorded.

From all poisonings, 30 people had used recognition applications on smartphones. This is not advised due to the high risk of error.

Pick only specimens in good condition and take the entire mushroom to help with identification. Do not pick mushrooms near potentially polluted sites such as roadsides and landfills.

Store mushrooms in the fridge at a maximum of 4 degrees C (39.2 degrees F), avoid all contact with other foods, and consume within two days of picking. Ensure they are correctly cooked – 20 to 30 minutes in a pan or 15 minutes in boiling water – and don’t eat too many in one sitting.

ANSES recommends only collecting mushrooms they know, as some highly toxic ones are similar to edible species. Poisonous types can also grow where edible varieties had been picked in the past. If there is the slightest doubt, consult a specialist before consumption.

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Researchers analyzed the cause of household foodborne disease outbreaks from 2010 to 2020 using data from the National Foodborne Disease Surveillance System.

A total of 17,985 outbreaks, which resulted in 73,252 illnesses, 38,829 hospitalizations, and 1,269 deaths, were reported. Most episodes were from May to October, and the highest number occurred in July.

A similar study, published in China CDC Weekly, looked at outbreaks in catering facilities in the country using data from the same time period.

Wild mushroom problem
Fungi, mainly poisonous mushrooms, were the most implicated food category, with 8,873 household outbreaks. The second was toxic plants and their products, with 1,552. These include aconite, potherb, tung seed or oil, bitter bottle gourd, and Masang fruit. Fungi were the primary etiologic agent, with 31,125 illnesses and 736 deaths.

Household outbreaks rose from 118 in 2010 to 4,140 in 2020. Almost 700 outbreaks were from unknown food. Alcohol products caused the highest case fatality rate, found in the study published in the Foodborne Pathogens and Disease journal.

Salmonella was the top bacterial pathogen with 437 outbreaks, and the principal chemical agent was nitrite, causing 476 outbreaks. Pupal toxicants, tetrodotoxin (TTX), and saxitoxin were the leading poisonous animal toxins. Norovirus was the primary virus, with 13 outbreaks. The cause was unknown for more than 4,200 outbreaks with 75 deaths.

Plant saponin toxicants were mainly found in vegetables. Eggs and egg products were mostly contaminated by Salmonella, followed by meat and meat products with the same pathogen. Chemical pesticides were primarily found in vegetables.

Tackling the issues
Researchers said most poisonous mushroom outbreaks occurred in southwest China, including Yunnan, Hunan, and Guizhou provinces.

Outbreaks from vegetable products were mainly caused by improper processing. Inedibility and misuse, especially wrong identification, were the top contributing factors to illnesses related to poisonous mushrooms, mainly in southwest China. The leading cause of Salmonella contamination in meat and meat products was improper processing and poor storage.

“The reason is that wild poisonous mushrooms are similar in appearance to edible mushrooms, and it is difficult for ordinary people to distinguish edible mushrooms from poisonous mushrooms without proper equipment. This study showed that targeted interventions to reduce mushroom poisoning are critical in China,” said researchers.

“Severe and even fatal aconite root poisoning may occur after consuming herbal soups and foods prepared from aconite roots. If the raw preparations and large amounts of aconite root are used, even prolonged boiling may not have a protective effect.

“All regions should strengthen market surveillance and improve laboratory surveillance of pathogenic bacteria such as Salmonella in meat. Residents should raise their awareness of food safety and ensure meat safety by processing meat and raw foods separately and storing them safely.” 

Public health agencies should also boost the supervision of foodborne diseases to reduce the risks.

“Governments should strengthen supervision for provinces with a high incidence of foodborne diseases, especially during peak seasons. In addition, health education for household food handlers, such as proper food handling behavior and emphasis on kitchen hygiene, should be strengthened to improve residents’ awareness of food safety and effectively reduce the occurrence of foodborne diseases among families,” said researchers.

Scientists said it was necessary to change understanding around aconitum plants. Aconite roots are used to prepare herbal soups and meals for their beneficial health effects.

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Four people were taken to the hospital on July 30 after they became ill following a meal at a house in Leongatha, a town in the state of Victoria, the previous day.

Two women, aged 66 and 70, died in the hospital on Aug. 4. A third person, a 70-year-old man, died in the hospital on Aug. 5. A 68-year-old man remains in the hospital in a critical condition.

Don and Gail Patterson and her sister Heather Wilkinson died from symptoms consistent with death cap mushroom poisoning, according to media reports. Ian Wilkinson is the patient still in hospital.  

Investigators from Victoria police executed a search warrant at a residence in Leongatha. Detectives also interviewed a 48-year-old woman who was released pending further enquiries.

Local media said the suspect, Erin Patterson, was the daughter-in-law of the couple who died.

An investigation surrounding the exact circumstances of the incident is ongoing and police are working with the Victorian Department of Health.

Poisonous mushroom risk
In April this year, the Victorian Department of Health warned that eating just one death cap mushroom may kill an adult. Poisonous mushrooms, including death caps, occur in Victoria during autumn, as the weather becomes wetter and cooler.

Cooking, peeling or drying these mushrooms does not remove the poison. There is no home test available to distinguish safe and edible mushrooms from poisonous types.

Symptoms of poisoning can include violent stomach pains, nausea, vomiting and diarrhea and usually occur six to 24 hours after eating the mushrooms. Even if initial symptoms subside serious liver damage may have occurred.

People should urgently attend an emergency department if they believe they’ve eaten a poisonous mushroom and take any remaining mushrooms with them for identification.

The Food Safety Information Council regularly warns people to be extremely careful around wild mushrooms because of the poisoning risk.

In April 2022, a young child was hospitalized in the Australian Capital Territory (ACT) after consuming a death cap mushroom. In 2012, two people died after eating these mushrooms at a New Year’s Eve party in Canberra and in 2014 four people in the ACT were seriously poisoned.

“Death cap mushrooms can appear at any time of year but are more common a week or two after good rains. They have been found in the Canberra region, in and around Melbourne, in Tasmania and in Adelaide. They are not native to Australia and are often found near oak trees growing in warm wet weather,” said Cathy Moir.

“Death cap mushrooms are difficult to distinguish from some other wild mushrooms so we recommend you play it safe and only eat mushrooms that you have purchased from a supermarket, greengrocer or other reputable source.”

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In addition to the two deaths, the outbreak traced to Dave’s Sushi in Bozeman, MT, sickened more than 50 people and sent three to hospitals. People became ill between March 28 and April 17 this year, according to the Gallatin City-County Health Department. The local department worked with the Montana Department of Public Health and Human Services and the U.S. Food and Drug Administration, as well as the U.S. Centers for Disease Control and Prevention, on the outbreak investigation.

“Study results indicated that consuming morel mushrooms at the restaurant was strongly associated with developing GI illness. Additionally, individuals who reported consuming a greater quantity of sushi containing morels were more likely to develop illness compared to those who reported consuming fewer pieces,” according to the local health department’s final report, which was released July 19.

“. . . According to documents provided by the restaurant, the morel mushrooms served during March and April 2023 were prepared raw or only lightly cooked, depending on the date of preparation.”

The sick people in the outbreak ranged from 18 to 74 years old. Most became ill within three hours of their meal at Dave’s Sushi. The most common symptoms reported were diarrhea, nausea, vomiting, and abdominal pain.

Public health officials interviewed 63 people who ate at the restaurant during the implicated time frame. Of those, 41 reported becoming ill after their meal there. 

The interviews also showed that the majority of people who became ill ate the mushrooms and the illnesses were “strongly associated” with the mushrooms.

Health officials performed DNA sequencing on the morel mushroom samples collected from the restaurant, and identified the species as Morchella sextelata, a type of “true morel.” Samples of morel mushrooms collected after the illnesses occurred were also screened for pesticides, heavy metals, bacterial toxins, and pathogens. No significant findings were identified, according to the health department’s report.

“The toxins in morel mushrooms that may cause illness are not fully understood. However, it is known that using proper morel mushroom preparation techniques, including cooking, can help reduce toxicity and risk of illness,” according to the health department.

Owners of Dave’s Sushi told health department officials that morels served on April 8 underwent some light cooking by being marinated in a sauce immediately after the sauce had been boiled. Morels served on April 17 were not cooked. The majority of patients reported becoming ill after eating mushrooms at the restaurant on April 17.

The U.S. Food and Drug Administration conducted a traceback investigation and found that restaurants in other states received morel mushrooms from the same supplier during the same timeframe as Dave’s Sushi. An investigation into six of those restaurants found that all six throughly cooked the morels they served. None of those restaurants received any reports of illnesses.

The local public health officials reported the investigation into the outbreak was limited in at least two ways. First, the investigators could not determine what specific characteristic of the morel mushrooms caused the outbreak. Second, the specific toxin or pathogen in the morel mushrooms served at the restaurant is unknown and could not be confirmed through laboratory testing.

“However, the signs and symptoms of illness reported were consistent with what could result from eating morel mushrooms that were not properly handled, prepared, or cooked. 

“There are scientific gaps in knowledge regarding morel mushrooms in the wider public health, medical toxicology, and mycology realms that need further research in order to better understand how morel mushrooms affect human health,” the health department report said. 

The FDA’s investigation has ended and but state and local public health officials are continuing to conduct follow-up activities related to this incident, however, there does not appear to be any further risk to the public, according to a statement from the FDA.

Advice
Anyone eating, selling, or serving morel mushrooms should use caution when doing so. There are varieties of poisonous wild mushrooms that look very similar to morel mushrooms.

Public health officials recommend those preparing morels should confirm the identity of each mushroom, and consult with a knowledgeable expert, as poisonous species have been known to grow near edible species in the wild. Choose mushrooms that are dry and firm, and avoid those that are bruised, discolored, slimy, or otherwise spoiled. 

Morel mushrooms should be refrigerated at a temperature of 40 degrees F or below, in breathable type packaging, such as a paper bag. Morels should be cooked thoroughly prior to consumption, as this is likely to reduce toxin levels present in the mushrooms.

Individuals who become ill after consuming morels should contact their healthcare provider immediately and/or call the Poison Control Hotline at 800-222-1222.

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From 2010 to 2020, China’s catering service facilities reported 18,331 outbreaks, which resulted in 206,718 illnesses, 68,561 hospitalizations, and 201 deaths.

There were 5,607 outbreaks in restaurants, 2,876 outbreaks from street vendors, and 2,560 in employee canteens. Rural banquets and street vendors were associated with 64 and 34 deaths, respectively. Data comes from the Foodborne Disease Outbreak Surveillance System (FDOSS).

The median number of patients per outbreak was 15, with a median of three hospitalizations per event, according to the study published in the journal China CDC Weekly.

Past research has shown that inadequate time-temperature control, poor kitchen hygiene, and the presence of infected food handlers in catering facilities, contribute to foodborne illnesses.

Agent behind incidents
The number of outbreaks and cases climbed rapidly from 2010 to 2018, with a peak of 3,610 outbreaks and 31,230 cases in 2018. A decrease in 2020 could be related to the COVID-19 pandemic and control measures, found the study.

Pathogenic microorganisms were the primary cause of outbreaks in southern, northwestern, eastern, central, and northern regions of China, while toxic animals, plants, and poisonous mushrooms were the leading cause in northeastern and southwestern regions.

Chemical-related incidents resulted in the most fatalities in the northeastern, northwestern, central, and northern regions. While toxic animals and plants were the leading cause of deaths in southern and eastern regions. Poisonous mushrooms accounted for the highest fatality rates in the southwestern region. 

Pathogens accounted for 4,883 outbreaks, 94,047 cases, 32,170 hospitalizations, and 21 deaths. Toxic animals, plants, and mushrooms were responsible for 3,279 outbreaks, 30,698 cases, 12,338 hospitalizations, and 95 deaths. The cause was unknown for more than 18,500 outbreaks with 21 deaths.

Chemical substances, such as methanol and nitrite, caused 63 fatalities. Vibrio parahaemolyticus, Salmonella, and Staphylococcus aureus were the most prevalent pathogens, resulting in 3,333 outbreaks, 60,520 cases, 21,491 hospitalizations, and nine deaths.

Meat products, aquatic goods, and vegetables were associated with 2,724, 1,595, and 1,571 outbreaks, respectively, between 2010 and 2020.

Outbreaks by cause

The main causes of outbreaks in restaurants were incorrect processing, accidental ingestion, and cross-contamination. The primary causes in street vendors were accidental ingestion, improper storage, and inadequate processing. Staff canteens had outbreaks mainly due to undercooking, accidental ingestion, and improper processing.

Despite the presence of food safety management systems in many restaurants and cafeterias, implementation was not always effective, said researchers. Control measures include public health education on foodborne diseases at these sites and regular food safety training for restaurant employees and managers.

Aquatic products contaminated with Vibrio parahaemolyticus at restaurants and rural banquets, as well as lectins in red kidney beans in staff canteens, were the primary contributors to outbreaks in catering operations.

“Due to shifts in dietary patterns and the fast-paced nature of modern life, an increasing number of individuals have opted to dine at foodservice establishments in recent years. It has been documented that a variety of food safety risks exist in foodservice facilities, such as restaurants, including those associated with food ingredients, handling practices, storage, and transportation. These risks may contribute to the occurrence of foodborne disease outbreaks.”

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The Food Safety Information Council conducts consumer research to see how Australians are doing in certain areas related to food safety.

Almost one in three surveyed have a meat thermometer at home, which is a 4 percent increase since the buy and use a meat thermometer campaign began a decade ago. A total of 14 percent have one in their household and have used it in the past month, compared to 11 percent in 2012 and 23 percent have a meat thermometer at home and have used it in the past year, up from 20 percent. Using a meat thermometer is the only way to ensure foods like poultry, cuts of meat, ground (minced) meat, and sausages are cooked in the center.

In the past six months, 28 percent of survey respondents said they had eaten raw meat such as beef, pork, lamb, kangaroo, and offal and 33 percent had eaten rare meat. People aged 18 to 34 are more likely to do this with almost half having eaten raw red meat in the past six months and half having eaten rare red meat in the same period. Only 21 percent of those above the age of 65 had eaten rare red meat in the past six months. Eating raw or rare meat increases the risk of food poisoning from pathogens such as E. coli and parasite infections such as Toxoplasmosis.

The report card was released ahead of World Food Safety Day on June 7. This year’s theme is: Food standards save lives.

Handwashing and wild mushroom stats

Cathy Moir, council chair, said food standards help keep the community safe and ensure that Australia continues to have a reputation for a safe and high-quality food supply.

There are an estimated 4.67 million cases of food poisoning in Australia each year that result in 47,900 hospitalizations, 38 deaths, and a cost to the economy of AU $2.1 billion (U.S. $1.4 billion).

An Omnipoll survey for Global Handwashing Day in October 2022 showed that 82 percent of Australians always wash their hands after going to the toilet, which was down from 83 percent the previous year. A total of 53 percent said they always wash their hands before touching food, which was down from 58 percent. Handwashing is particularly important in preventing norovirus and hepatitis A infections.

Men were less likely than women to always wash their hands after going to the toilet and before touching food. Young people were also less likely than older age groups to always wash their hands after using the toilet and before touching food. Poor handwashing knowledge among young people is a concern as they can become employed as food handlers, said the charity.

In 2022, the New South Wales Poisons Information Centre received 382 calls regarding mushroom poisoning. Of these, 159 were from people ingesting wild mushrooms intentionally, either foraging for food or recreationally. They also included 196 mushroom exposures in children under 15 years old. The number of calls was down from 549 in 2020.

The charity also urged people to get food safety advice from reputable sources rather than online influencers, some of whom have been promoting risky activities such as eating raw liver and dumpster diving for scavenged food.

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The charity said that mushrooms are growing around the country after wet weather. A similar warning was issued in previous years.

Cathy Moir, Food Safety Information Council chair, said that foraging for food is becoming popular but gathering mushrooms outdoors can be dangerous.

“The poison in one death cap mushroom, if eaten, is enough to kill a healthy adult. In April 2022, a young child was hospitalized in the Australian Capital Territory (ACT) after consuming a death cap mushroom. While in 2012, two people died after eating the deadly mushrooms at a New Year’s Eve dinner party in Canberra, and in 2014 four people also in the ACT were seriously poisoned,” she said.

“Deathcap mushrooms can appear at any time of year but are more common a week or two after good rains. They have been found in the Canberra region, in and around Melbourne, in Tasmania, and in Adelaide. They are not native to Australia and are often found near oak trees growing in warm wet weather. Similar native marbled death cap mushrooms have been found in Western Australia, although they may not be as toxic.

“Deathcap mushrooms are difficult to distinguish from some other wild mushrooms so we recommend you play it safe and only eat mushrooms that you have purchased from a supermarket, greengrocer, or another reputable source. People born overseas, especially in Asian countries, should be aware that these deadly mushrooms can look like edible mushrooms they may have gathered in their home countries.”

Children often affected
Toxins in death cap mushrooms are not destroyed by peeling, cooking, or drying. Symptoms of poisoning include vomiting, diarrhea, and stomach cramps and usually appear 10 to 16 hours after eating. They may ease for 2 to 3 days before a terminal phase of 3 to 4 days. Without early medical intervention, people may go into a coma and die after weeks of liver and kidney failure.

Moir said while the death cap variety is linked to the most deaths, other mushroom types can cause illness.

“There are other wild mushrooms in Australia that have caused fatalities or can make you seriously ill with abdominal pain, vomiting, and diarrhea. These include the Cortinarius (webcap) and Galerina species, the ghost mushroom (commonly mistaken for oyster mushrooms), and the yellow stainer which resembles a field mushroom and is the most commonly ingested poisonous mushroom in Victoria and New South Wales,” she said.

“Many accidental exposures to poisonous mushrooms are in children under 5 years old, remember that small children have a natural inclination to put things in their mouths so keep an eye on them when outdoors. If you suspect you or your child may have eaten a death cap mushroom don’t wait for symptoms to occur but go to a hospital emergency department taking the mushroom with you if you can.”

It is not just Australia where wild mushrooms prompt concern. In 2022, almost 500 mushroom poisoning outbreaks were recorded in China with 28 associated deaths.

In September 2022 in France, at least 60 cases linked to wild mushrooms were reported.

Data from Tox Info Suisse, Switzerland’s poison information center, showed there was an increase in calls related to poisoning by plants and food and drink in 2022 while poisoning or suspected mushroom poisoning reports rose by 25 percent from 2021.

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This past year, China CDC investigated 482 incidents of mushroom poisoning across 21 regions. This resulted in 1,332 patients and 28 deaths.

Incidents and patients were more than in 2019 and 2021 but fewer than in 2020, while deaths slightly increased.

Mushroom poisoning has become a serious food safety issue in China, said researchers in the journal China CDC Weekly.

Information on incidents
The number of cases per outbreak ranged from 1 to 28. Thirteen incidents involved more than 10 patients. Of these, 73 patients from 23 incidents ate poisonous mushrooms purchased from markets or given by friends; 44 patients from seven incidents were poisoned after eating dried mushrooms; and 213 patients and three deaths from 55 incidents ate mixed mushrooms.

Mushroom poisonings occurred in all months, with the most between May and November. The first death occurred in mid-February in Fujian. The top three months for deaths were June with 13 and three each in July and September. A peak occurred in June and incidents decreased in July and August, likely because of a drought in southern China. With the arrival of rain in September, poisoning levels reached a second peak.

Yunnan, Hunan, Sichuan, and Guangxi had more than 100 patients each, and Yunnan, Hunan, and Guangdong had the most deaths.

Southwest China — including Yunnan, Sichuan, Chongqing, and Guizhou — was the most severely affected region followed by Central China in Hunan, Hubei, and Henan.

A total of 98 mushrooms were identified, causing seven different clinical types of disease. Three provisional new species were recorded as poisonous mushrooms in China as well as 10 other types. In total, 62 species had already been recorded from 2019 to 2021. This raises the number of species from incidents to more than 190 in China by the end of 2022.

Sixteen edible mushrooms were identified from poisoning incidents in 2022. These incidents were likely because of the consumption of mixed mushrooms with poisonous ones, contaminated mushrooms, or some species that may be poisonous to certain people, said scientists.

Mushroom types implicated
The top three lethal species were Amanita exitialis and Amanita rimosa which caused seven deaths each and Russula subnigricans, which was behind six fatalities. Chlorophyllum molybdites caused the most poisonings.

In June, one person in Sichuan was poisoned by Paxillus orientalis, resulting in hemolysis. This was the first reported case of illness from this species in China. Researchers strongly advised against collecting and eating types of Paxillus, despite previous acceptance as edible, used in medicine, and a perception of safety.

In 2022, 51 species of gastroenteritis-causing organisms were identified. The top two were Chlorophyllum molybdites and Russula japonica.

Overall, 32 species caused psycho-neurological disorders. Lanmaoa asiatica ranked first. Scientists said the increased poisonings may be partially attributed to the rise of online shopping, which lacks face-to-face communication about the proper cooking.

“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. 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. We recommend creating more scientific, plain, and varied popularization materials and publicizing them to people at risk before and throughout the poisoning season,” said researchers.

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Recent weather conditions have favored the growth of wild mushrooms and more than 60 intoxications have been reported to poison control centers since early September. Only a few cases occurred in July and August likely because of the very hot weather and drought, according to researchers.

Poisonings have a variety of causes: some people mistook a toxic species for an edible one, sometimes it is because of a smartphone app for wild mushroom identification providing incorrect information about the mushrooms picked, or consumption of edible mushrooms that are in poor condition or have been undercooked.

A yearly problem
Between July and December 2021, there were 1,269 cases reported to poison control centers in France. The majority of the mushrooms responsible had been picked in the wild but some cases involved mushrooms purchased commercially.

Symptoms were mainly digestive with abdominal pain, nausea, vomiting and diarrhea. There were 41 severe cases including four deaths. Fifteen young children were poisoned and one of them needed a liver transplant. French authorities said picked mushrooms should not be given to young children.   

Between July and December 2020, there were 1,300 poisonings reported. Overall, 29 life-threatening cases were identified and five people died.

The French Agency for Food, Environmental and Occupational Health and Safety (ANSES), poison control centers, and the Directorate General for Health (DGS) advised people to only pick mushrooms they know very well as some poisonous fungi closely resemble edible species. If there is the slightest doubt about the identification of any picked mushrooms, the agencies said they should not be consumed until they are checked by a specialist.

People should note the time of the last meal and onset of first symptoms, and keep any leftover wild mushrooms for identification. Officials advise taking a picture of the picked mushrooms before eating to help poison control center experts decide on the correct treatment if illness occurs.

Other countries impacted
Data from Tox Info Suisse, the Swiss poisons information center, revealed 529 mushroom poisoning cases in Switzerland in 2021.

The Belgian Poison Center (Centre Antipoisons) received almost 350 calls about potential mushroom poisonings in Belgium and Luxembourg in 2021.

In Germany, an average of 10 cases of mushroom poisoning per year are reported to the German Federal Institute for Risk Assessment (BfR) by doctors, and poison centers in the federal states answer more than 3,000 related inquiries annually. 

Popular domestic edible types include the field mushroom (Agaricus campestris) and edible Russula species. Often collectors confuse edible mushrooms with the highly toxic death cap (Amanita phalloides). Toxins contained in death cap cause liver failure and even eating small amounts can be fatal. 

About five percent of all mushroom poisonings are because of consumption of the death cap mushroom, which grows from July to October, mainly in forests, but also in parks. The BfR estimates that it causes at least 80 percent of all fatal mushroom poisonings in Germany.

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The group said deathcap (Amanita phalloides) mushrooms are difficult to distinguish from some other wild varieties and advised people to only eat mushrooms bought from a supermarket, greengrocer or other reputable source.

People from other countries should also be cautious as the mushrooms can look like edible types that grow in their own countries.

Weather impact
Cathy Moir, council chair, said that foraging for wild food is becoming popular but gathering wild mushrooms can be life threatening.

“Deathcap mushrooms can appear any time of year but are usually more common during autumn, a week or two after good rains. However, during a wet summer like this one, fruiting has occurred much earlier with reports of them in the Australian Capital Territory (ACT) and Adelaide Hills region since Christmas,” she said.

“They have been found in the Canberra region, in and around Melbourne, in Tasmania and in the Adelaide region. They are not native to Australia and are found near oak, hazel or chestnut trees. The similar native marbled deathcap mushrooms have been found in Western Australia in eucalypt forest, although they may not be as toxic. While no cases have been reported in other states it is possible that they also grow there.”

In November 2021 in the ACT, three people went to emergency departments after ingesting wild mushrooms. The state has seen four deaths associated with Death Cap mushrooms since 2002.

Toxin in deathcap mushrooms is not destroyed by peeling, cooking or drying. Symptoms of poisoning include vomiting, diarrhea and stomach cramps and usually appear six to 24 hours after eating. They may ease for two to three days before a terminal phase of three to four days. Without early medical intervention people may go into a coma and die after two or three weeks of liver and kidney failure.

Burden for children
Most deaths from mushroom poisoning in Australia result from deathcap mushrooms. However, there are other wild mushrooms that have caused fatalities or can make people ill.

These include various Cortinarius (webcap) and Galerina species, the ghost mushroom (often mistaken for oyster mushrooms), and the yellow stainer which resembles a field mushroom and is the most commonly ingested poisonous mushroom in Victoria and New South Wales (NSW).

“The NSW Poisons Information Centre, which receives enquiries from NSW, the ACT and Tasmania as well as after-hours enquiries for all of Australia, received 549 calls during 2020 regarding exposures to mushrooms with another 133 recalls about these cases. 23 percent of calls were intentional recreational or foraging exposures in adults,” said Moir.

“More than a third of these calls were accidental exposure in children under 5 years, so remember that small children have a natural inclination to put things in their mouths so keep an eye on them when outdoors. Parents, schools and childcare workers should regularly check outdoor areas and gardens for mushrooms and remove them to reduce the risk of accidental poisoning. This will also protect your pets.”

This past year, South Australians were warned about picking mushrooms. From January to March 2021, the poisons center handled 14 mushroom related cases with four referred to hospitals. There were 111 incidents in 2020 with 12 calls referred to hospital.

“Each year, around two-thirds of calls made to the hotline about mushroom poisonings involve children less than 5 years of age. In 2020 there were 20 percent more calls made about mushroom exposure to the Poisons Information Centre than the previous year, which may be attributed to more people being active outside when COVID-19 restrictions were in place,” said Dr. David Simon.

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In 2021, there were 327 investigations involving 923 patients and 20 deaths. Mushroom poisoning incidents and patients were more than 2019 but less than 2020 as deaths slightly decreased.

The number of patients in outbreaks ranged from one to 20 and six incidents involved more than 10 patients, according to a study published in the journal China CDC Weekly.

A total of 68 patients from 14 incidents ate poisonous mushrooms from a market or given to them by friends; 46 people from 10 incidents were poisoned after eating dried mushrooms .and 113 patients from 28 incidents ate mixed mushrooms.

Overall, 74 poisonous mushrooms species causing six different clinical syndromes were identified, 15 of which were newly recorded in China. In nine cases, it was previously unknown if the species was poisonous or not. This takes the number of mushroom species linked to intoxications past 150.

Further analysis showed that mushroom poisonings occurred every month, centered from May to November and reaching a peak in August. The first death was in early March. The top three months for deaths caused by poisonous mushrooms were September, July and November.

Types of mushrooms behind intoxications
The top three lethal mushroom species were Russula subnigricans, Galerina sulciceps, and Lepiota brunneoincarnata, which caused six, five, and three deaths, respectively. Chlorophyllum molybdites was behind the most poisonings incidents.

Eight species causing acute liver failure and three linked to acute renal failure were identified.

Mushroom poisoning resulting in acute liver failure caused by Amanita spp. dropped sharply. Researchers said this progress was mainly because of continuous science popularization and health education.

Thirty-nine species causing gastroenteritis were documented in 2021. The top three were Chlorophyllum molybdites, Russula japonica, and Entoloma omiense.

Researchers urged people to not collect or eat unfamiliar wild mushrooms.

“Mushroom poisoning is one of the most serious food safety issues in China. 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,” they said.

“Promoting knowledge about poisonous mushrooms is essential and urgent to reduce mushroom poisonings. Timely and precise species identification after mushroom poisoning is important for appropriate diagnosis and treatment. Many deaths were linked to delayed hospitalization.”

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In July and August, 330 cases of poisoning were reported to French poison control centers. Three of these were very serious and potentially life-threatening and three deaths have been recorded.

Weather conditions in July and August favored early picking of mushrooms, according to the French Agency for Food, Environmental and Occupational Health and Safety (ANSES).

Poisoning risks include confusing edible types with toxic species, or consumption of edible mushrooms that are in poor condition, undercooked, or have been incorrectly stored.

Five deaths in 2020; three in 2019
Results from the previous season show that between July and December, 2020, 1,300 poisonings were reported to poison control centers in the country with more than half of them in October. This was when conditions such as rain, humidity and freshness favored the growth of mushrooms and their picking.

The majority of illnesses were linked to picked mushrooms, but in 4.5 percent of cases, they had been bought in a market or shop. A few incidents were caused by confusion with an edible species related to the use of a digital recognition app available on smartphones.

People were most often poisoned during a meal but 3 percent of cases followed ingestion, by a child or a vulnerable adult, of a piece of an inedible mushroom found in the garden or schoolyard.

Although most intoxications were not serious, 29 life-threatening cases were identified and five people died.

In 2019, more than 2,000 cases were reported to poison control centers between July and December. While most were minor, there were 24 cases of high severity with life-threatening prognosis and three deaths.

Swiss and Belgian figures
Data from Tox Info Suisse, the Swiss poisons information center, revealed at least 76 mushroom poisoning cases in Switzerland in 2020 including two serious cases.

The Belgian Poison Center (Centre Antipoisons) reported almost 500 mushroom poisonings in Belgium and Luxembourg in 2020 with children slightly more affected than adults.

Symptoms are mainly digestive and include abdominal pain, nausea, vomiting, and diarrhea. The onset of illness varies and is usually within a few hours of consumption, but maybe longer and exceed 12 hours. People should note the time of the last meal and onset of first symptoms, and keep any leftover wild mushrooms for identification.

Officials advise taking a picture of the picked mushrooms before eating to help poison control center experts decide on the correct treatment if illness occurs.

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Mushroom poisoning is the leading cause of foodborne disease outbreaks and outbreak-associated deaths in the country despite people being advised to not collect or eat wild mushrooms.

The 10,036 outbreaks resulted in at least 38,676 illnesses, 21,967 hospitalizations and 788 deaths from 2010 to 2020. The number of recorded outbreaks increased each year, from 37 in 2010 to 2,705 in 2020.

A large proportion of outbreaks occurred between May and October, according to data from the Foodborne Disease Outbreaks Surveillance System, which is managed by the China National Center for Food Safety Risk Assessment.

Risk of picking wild mushrooms
Among all reported outbreaks, 84.7 percent were associated with food prepared in private homes, followed by 8.8 percent from food prepared in street stalls, and 2.5 percent in canteens. The major cause of domestic outbreaks was self-harvest of wild mushrooms. Non-expert wild mushroom picking increases the risk of poisoning because of the difficulties of distinguishing between poisonous and edible mushrooms.

Most outbreaks involved fewer than 10 patients but 12 had more than 30 patients, according to the study published in the journal China CDC Weekly.

A rise in incidents between 2010 and 2020 is associated with implementation of compulsory surveillance in 2011, increasingly strict requirements for outbreak reporting, and enhancement of reporting awareness.

Mushroom poisonings were reported throughout the country, but was highest in the southwest and central areas, likely due to the warm and damp conditions, said researchers.

Only 3,872 outbreaks were reported with mushroom names. Absence of relevant mushroom samples and ingestion of multiple mushrooms increased the difficulty of identifying causative species. More than 180 mushroom names were reported. Accurate and prompt species identification is crucial for diagnosis and treatment.

Educating people
Mushroom poisoning occurred every month, the study found, with peaks in summer and autumn. Seasonality suggests health education is crucial in those periods. Mushroom picking is more frequent in rural environments so education targeted for specific groups in such areas is also essential to reduce poisonings.

Researchers said efforts should be made to improve investigative procedures, reporting practices, and data collection as some of the epidemiological information is not complete or accurate.

Another study found the amount of mushroom poisonings and number of people affected doubled this past year in China compared to 2019.

Other work revealed poisonous mushrooms were the most common cause of outbreaks in China during a 14-year period.

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In 2020, the number of investigations reached 676, involving 102 species of poisonous mushrooms, 24 of which were newly recorded in China.

Mushroom poisoning incidents from 24 provincial-level administrative divisions involved 1,719 patients and 25 deaths. In 2019, 276 incidents involved 769 patients and 22 deaths.

In 2020, the number of cases ranged from one to 27, and 14 outbreaks involved more than 10 patients. Most incidents were reported in Hunan, Yunnan, Guizhou, Zhejiang and Sichuan. Of these, 93 patients from 24 incidents had eaten poisonous mushrooms purchased from a market or given by friends; 51 people from 12 outbreaks had been poisoned after eating dried mushrooms; and 404 patients from 131 incidents with seven deaths ate mixed mushrooms. Experts in the China CDC Weekly journal strongly advised people to avoid having mixed wild mushrooms and alcohol.

Main types behind intoxication
There were also more occasions when patients consumed a combination of poisonous mushrooms, which increases difficulty and risk for diagnosis and treatment because of the different symptoms.

Like in 2019, mushroom poisonings occurred in every month but mainly from June to October. There were two peaks in June and September involving 428 and 412 patients, and eight and three deaths, respectively.

The most lethal species of those identified were Lepiota brunneoincarnata with five deaths and Russula subnigricans, and Amanita subpallidorosea with four deaths each. Chlorophyllum molybdites caused the most poisonings, being mentioned in 154 incidents with 304 patients.

Lepiota brunneoincarnata, the most dangerous species in 2020, was responsible for 15 incidents, 29 patients, and five deaths as the lone cause or in combination with other species.

A total of 56 species causing gastroenteritis were identified from intoxications in 2020. Among them, Baorangia major, Chlorophyllum demangei, Entoloma caespitosum, Gymnopus densilamellatus, Lactarius atromarginatus, Lactifluus deceptivus, Micropsalliota furfuracea, Neonothopanus nambi, Pulveroboletus subrufus, Russula rufobasalis, and Tricholoma stans were newly discovered as lethal and were added to the poisonous mushroom list.

Controlling the problem
Another 28 species causing psycho-neurological disorders were linked to incidents including Clitocybe subditopoda, Gyromitra venenata, Mallocybe fulvipes, and Pseudosperma yunnanense, which were new species added to the poisonous mushrooms list.

Gyromitra venenata was discovered in incidents in the Yunnan and Guizhou provinces and were the first reported poisonings because of gyromitrins in China since 2000. The rare poisoning Shiitake mushroom dermatitis was also reported. Hemolysis poisoning caused by Paxillus involutus was recorded for the second time since the beginning of this century, resulting in one death in Inner Mongolia.

Epidemiological investigations, timely and accurate species identification, toxin detection, and appropriate diagnosis and treatment are key to control mushroom poisoning, said researchers.

“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,” they said.

“Promoting knowledge about safe consumption of mushrooms is essential to reduce mushroom poisonings. It is not wise to collect and eat wild mushrooms.”

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The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) reported that since the start of the mushroom-picking season in early autumn, poison control centers have recorded a sharp increase in cases, particularly in recent weeks.

Poisoning risks include confusion of an edible type with a toxic species, or consumption of edible mushrooms that are in poor condition, undercooked, or have been incorrectly stored. Most cases are due to foraged mushrooms but occasionally they are because of the purchase at a market or in a shop, or consumption in a restaurant.

Latest intoxication stats
Since July 2020, poison control centers have recorded 732 cases of intoxication, including five people with serious life-threatening illnesses.

Confusion between species sometimes happens through the use of fungi recognition apps on smartphones, which incorrectly identify the foraged mushrooms, according to ANSES.

In 2019, more than 2,000 cases were reported to poison control centers between July and December. While most poisonings were minor, there were 24 cases of high severity with life-threatening prognosis and three deaths. More than half of all cases occurred in October when weather conditions combining rainfall, humidity, and cooler temperatures favored wild mushroom growth and picking.

Symptoms are mainly digestive and include abdominal pain, nausea, vomiting, and diarrhea. The onset of illness varies and is usually within a few hours of consumption, but maybe longer and exceeds 12 hours. People should note the time of the last meal and onset of first symptoms, and keep any leftover wild mushrooms for identification.

This type of poisoning can have serious health consequences such as severe digestive disorders, kidney complications, or liver damage requiring a transplant leading to hospitalization or death.

A problem elsewhere
In October this year, the Ontario Poison Centre warned the public of the dangers of mushroom foraging after an increase in calls. The rise included cases where people had to be hospitalized after consuming wild mushrooms. In September, the center received 72 calls directly related to mushroom exposures, compared to 38 in September 2019.

In the same month, officials in the Italian city of Sassari detected three cases of wild mushroom poisoning. The first involved a child who ate edible porcini mushrooms. The second intoxication was caused by consumption in excessive quantities of mushrooms from the species Leucopaxillus lepistoides. The third case occurred after eating Amanita phalloides and the patient needed hospital treatment.

Authorities in Hong Kong investigated suspected poisoning related to the consumption of wild mushrooms in September. A five-year-old boy and 47-year-old woman developed nausea, vomiting, and diarrhea for about one hour after consuming mushrooms at home. One month earlier, a 54-year-old woman reported nausea, abdominal pain, and diarrhea one hour after having cooked mushrooms at home and required hospital treatment.

In May, a number of serious poisonings occurred in Victoria, Australia due to Death Cap and Yellow-staining mushrooms. The mushroom season in South Australia coincided with more people being at home and there was an increase in calls to the poisons information hotline from those seeking help after eating wild mushrooms. In total, 21 of 30 calls in 2020 involved young children, and five were referred to the hospital.

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Researchers looked at data reported to the National Foodborne Disease Outbreak Surveillance System from 2003 to 2017 and published findings in the journal Food Control.

A total of 19,517 outbreaks, which resulted in 235,754 illnesses, 107,470 hospitalizations, and 1,457 deaths, were recorded during the period.

Stats on mushroom outbreaks
Of the 13,307 outbreaks with known etiology, almost a third were caused by poisonous mushrooms, followed by Vibrio parahaemolyticus at 11 percent while the percentage linked to saponin, Salmonella, nitrite, pesticides, Staphylococcus aureus and Bacillus cereus were all in single figures.

Of 13,305 outbreaks associated with a single food category, fungi – mainly poisonous mushrooms – were most commonly implicated, followed by meats, vegetables, aquatic animals, condiments, poisonous plants such as saponin, tung oil or seed and aconite, as well as grains such as rice and noodles.

Among almost 19,000 outbreaks with reported settings, nearly half were associated with food prepared in a household, followed by less than a quarter with food made in a restaurant, and less than a fifth prepared in a canteen.

“Analysis of foodborne disease outbreaks can provide insight into the most important causative agents and sources of foodborne disease, and assist public health agencies determine the high-risk etiology and food pairs, specific points of contamination and settings to reduce foodborne disease illnesses,” said researchers.

Wild mushroom poisoning incident
Another study, published in China CDC Weekly, described 10 cases of wild mushroom poisoning in a city of Zhejiang Province this past year.

From late June to mid-July, 2019, three suspected food poisoning events occurred in Shaoxing City, Zhejiang Province. Ten patients with different degrees of liver damage were found and one person died. Poisonings were caused by ingestion of a wild mushroom (Amanita rimosa) containing amanitin toxins.

The Xinchang County CDC of Shaoxing City, received a report from a local hospital that six patients in a family went to a doctor with suspected food poisoning in late June. Patients had gastrointestinal irritation symptoms including nausea, vomiting, and diarrhea in the early stages.

They then developed different degrees of liver function damage. One person died of acute liver failure but the other patients improved after medical treatment and were discharged one week later. On July 11, the Shaoxing City CDC got a report from the local hospital of another two patients with similar symptoms.

Until July 25, 10 patients meeting the case definition were found, including six in Xinchang County and two each in Keqiao District and Zhuji County. Before 2019, there were one to two cases of wild mushroom containing amanitin toxins poisoning each year in Zhejiang Province.

All patients came from three families in Shaoxing City, who lived tens of kilometers apart. The families did not know each other, nor did they have any other common exposure factors. All patients became sick 10 to 22 hours after family dinners. Wild mushrooms were collected on mountains near the residences and were one of the main foods with noodles or as a soup. Amanitin toxins were found in eight patients’ plasma samples and two people’s urine samples.

CDCs in Shaoxing city carried out publicity and education about wild mushroom poisonings and prohibited residents from picking and eating them. No similar incidents occurred until mid-August 2019. In China, about 20 species of mushrooms can cause death, and most people are not able to identify which types are edible.

The rainy season in Zhejiang Province is from the middle of June to mid-July and with the average temperature, combined to make suitable growing conditions for wild mushrooms. Local CDCs decided to set up warning signs prohibiting the picking and eating of wild mushrooms in mountain areas to prevent such incidents.

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Officials are investigating a link to Lincoln Bakery Café in Carlton. The shop was closed on May 8.

A total of 36 people who are thought to have eaten there before onset of symptoms are affected with enquiries ongoing to find the source of illness.

Local media reported the Victorian Department of Health and Human Services and City of Melbourne council are investigating the outbreak by interviewing those who are ill, testing food samples and looking at food handling practices at the café.

Most people infected with Salmonella develop signs and symptoms 12 to 72 hours after being exposed to the bacteria. They can include diarrhea, fever, and abdominal cramps. In some people, diarrhea may be so severe that they need to be hospitalized.

Illness usually lasts about a week or less in healthy adults, but other groups are at a higher risk of developing serious infections and complications. High-risk people include children younger than 5 years, adults older than 65, and people with weakened immune systems, such as cancer patients, transplant recipients and HIV patients.

Wild mushroom warning
Meanwhile, Dr. Angie Bone, deputy chief health officer in Victoria, has warned about poisonous Death Cap and Yellow-staining mushrooms growing around the state due to recent heavy rain.

A number of serious mushroom poisonings have occurred in the past two weeks. She urged people not to pick and eat wild mushrooms in Victoria unless they were an expert. Cooking, peeling or drying them does not remove the poison. The Victorian Poisons Information Centre received 226 calls about mushrooms in 2018.

Eating one Death Cap mushroom can kill an adult. Symptoms of poisoning can include violent stomach pains, nausea, vomiting and diarrhea. Symptoms may subside after one or two days but serious liver damage may have occurred that may result in death.

Consuming Yellow-staining mushrooms causes nausea, stomach cramps, diarrhea and vomiting. Severity of symptoms varies with the amount eaten.

In South Australia, around two-thirds of calls to a poisons information hotline about mushroom poisoning involve children under five years old, with 21 of the 30 calls this year about young children and five being referred to hospital. In 2019, 93 calls were received and 72 concerned children with 31 referred to hospital.

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The issue constitutes a growing national health threat, wrote Dr. Douglas Hamilton and Dr. Gerard Meagher, from the department of public health, HSE Midlands in the first edition of Epi Insight Volume 21, Issue 1 for 2020.

They said there is currently no established coordination system for surveillance, public information and advice about wild mushrooms. Investment in effective prevention would lead to significant human and economic cost savings, the researchers reported.

The Health Protection Surveillance Centre (HPSC) is Ireland’s agency for surveillance of communicable diseases and part of the Health Service Executive (HSE).

Poisoning stats and case study
Based on data from the National Poisons Information Centre, from the start of 2019 to end of September 2019, there were 18 confirmed mushroom poisonings, with two patients having had severe or life threatening symptoms. From the end of September to Nov. 19, 2019, a six more cases were recorded. From 2014 to 2018, there were 85 mushroom poisonings reported, with two being severe or life threatening.

The centre receives calls on ingestion of poisonous mushrooms. Poisonous mushrooms in the wild may be misidentified and used to cook meals, or unsupervised children may eat them from yards, parks or gardens. Incorrect mushroom identification by health professionals via the Internet has been reported.

The numbers compare to France where more than 10,600 people were poisoned by mushrooms and 22 deaths were reported from 2010 to 2017.

In Ireland in September 2019 an individual developed liver failure after foraging for mushrooms in a local wood. They went to the hospital emergency department complaining of vomiting and abdominal pain, having eaten wild mushrooms the previous evening.

Admission was followed by rapid deterioration of liver function tests, transfer to the intensive care unit, and then to St Vincent’s University Hospital liver unit, where an emergency liver transplant was done – all within three days.

The individual progressed well in the 24 hours post-transplant but deteriorated to multi-organ failure. This was followed by slow recovery, with weeks in ICU, remaining in hospital for almost three months. There was no underlying illness, history of viral hepatitis or use of medications so the incident was attributed to consumption of Amanita virosa. An expert mycologist consulted by the National Poisons Information Centre identified the mushroom as Amanita virosa known as the Destroying Angel. 

There are hundreds of different species of mushrooms growing in the Ireland. The Amanita genus is one of the most toxic worldwide and flourishes in Ireland. It is recognized by a bulbous cup around the base of the stem. It does not have a repugnant taste and can be mistaken for button mushrooms especially Amanita virosa. They tend to grow around broad leaved trees.

Raising public awareness
Most patients with mushroom poisoning experience minor symptoms, like nausea or one or two episodes of vomiting and only need normal fluid intake. Some toxic species can cause sweating, salivation, hallucinations, flushed skin, dilated pupils, delirium, and drowsiness.

Amanita cause severe vomiting and diarrhea followed by liver damage, sometimes leading to liver failure, even after consuming only one 30-gram mushroom. Amatoxins are thermo-stable so toxic effects are not reduced by cooking. Symptoms of vomiting are often delayed for more than six hours after ingestion.

The Food Safety Authority of Ireland (FSAI) has raised public awareness on poisonous mushrooms in the past, but as foraged berries and mushrooms are for personal consumption and not commercial foods it does not fall within its remit.

A campaign of social media, alerts, radio interviews and signs was held to raise awareness and may have prevented poisonings in the latter part of the season.

Hamilton and Meagher said awareness campaigns need to be repeated pre-season every year and a notification system for mushroom poisoning should be established.

They also said a coordination system for health protection should be determined with public health as the lead agency but including the National Poisons Information Centre and Safefood.

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A total of 10,625 cases of unintentional poisoning because of ingestion of mushrooms were recorded by French poison control centers (PCCs), according to a study published this month.

The poisonings involved two or more people during the same meal in more than half of the cases. The peak of cases was in October although there was a monthly peak in August for two years. Intoxications occurred mostly in the west, south and east of France.

Ages of patients ranged from 9 months to 96 years old. Almost two-thirds of cases were between 30 and 69 years of age and 3.3 percent were younger than 5 years old. More than 90 percent of the people poisoned had one or more digestive symptoms, followed by general and/or neurological signs.

Almost all had been intoxicated during a meal, but 5 percent were intoxicated by what researchers determined to be ignorance of the risk, such as biting into a mushroom after picking it up. One third of children under 5 had eaten the poison mushrooms during a meal.

Severe illness and death
Mushrooms most often involved were boletus at 26.3 percent of cases, followed by agarics, clitocybes, lepiotas, amanita, chanterelles or tricholomas. In about 30 percent of cases the species was not identified.

For the eight years of study, 239 cases of high severity were identified, varying from 11 in 2016 to 44 in 2010. Twenty-two deaths were observed from zero to five each year. Deaths were due to phalloid (68.2 percent) or sudorian (31.8 percent) syndromes. Ten men and 12 women aged 38 to 88 died.

Seasonal surveillance was set up in 2010 by l’Institut de veille sanitaire (InVS, which is now Santé Publique France) following a report of poisoning caused by phalloid amanita in Pays de la Loire.  The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) has been monitoring the situation since 2016.

Surveillance from July to December consists of monitoring how many poisoning cases come from mushrooms recorded by French poison control centers, as well as the number of severe cases and deaths. The objective is to detect in real-time any increase in poisonings so health authorities can be alerted and recommendations for mushroom picking and consumption disseminated to the public.

Apart from a lower number of cases in 2016 with 877, probably linked to a relatively hot and dry summer, the annual distribution of poisoning by mushrooms varied between 1,248 cases in 2014 and 1,596 in 2017.

The rate of mushroom poisonings decreased from 2010 to 2014, then increased in 2015 before being strongly dropping in 2016. However, it went back up in 2017 as this was the year with the most cases in the period covered by the report.

Preventing poisoning
Each year, a public alert was put out by health authorities at the first peak of poisoning. A second or third alert was published when the number persisted such as in 2010 and 2015 or when cases were severe or deaths were recorded.

The number of cases tended to decline after each alert but it was not possible to tell whether that was due to the natural fall in the epidemic peak, linked to a decrease in the growth of mushrooms or if it was prevention messages from authorities being heard. The number of cases seems more linked to weather conditions favoring growth than to communication measures.

More than 1,000 mushroom poisonings are recorded every year by French poison control centers. They represent 2 percent of all poisonings and are at the same level as poisonings by plants at 3.1 percent.

In 2017 in Switzerland, 1.8 percent of poisoning cases were due to mushrooms and 2.5 percent in Sweden. In Belgium, 5.1 percent of poisonings were associated with plants and/or mushrooms while in the United Kingdom, 2.8 percent of requests for toxicological investigations in 2016 to 2017 were linked to exposure to plants and/or mushrooms.

Many factors are involved in poisonings: confusion of an edible species with a toxic one; eating edible mushrooms that are in poor condition; failure to cook species that have heat-labile toxins; too many consumed; and individuals’ sensitivity.

The researchers wrote that while surveillance is necessary to disseminate national recommendations when peaks of poisoning occur, local intermediaries such as an associations of mycologists and pharmacists are essential to help identify the mushroom and limit the number of cases. The public is advised to take a photo of mushrooms before cooking an not to give wild mushrooms to young children.

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In June, a 63-year-old man died after eating water hemlock — also known as water dropwort —  after confusing it with root parsley that he grew and picked in his own garden. Between 2012 and 2019, poison control centers in the country recorded 15 other cases in which water hemlock was confused with an edible plant.

The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) called for greater vigilance and issued advice on avoiding the risk of potentially deadly intoxication resulting in poisoning.

The agency said some toxic plants resemble edible plants, leading to confusion in the wild, in home gardens, or in vegetable patches. Picking plants for consumption is not without risk, according to the agency.

Common plant type confusion
In 2018, a 78-year-old man died after picking and eating monkhood leaves while out walking. He had confused the highly toxic plant with striped hemlock, which is usually eaten with salad.

Last May, the Regional Health Agency for Eastern France issued an alert after poison control centers reported 20 cases of intoxication caused by confusion between meadow saffron and wild garlic or perennial leek.

Since 2012, ANSES has registered more than 250 cases per year of mistaken identity in plants that lead to illnesses. Overall, 1,872 victims were registered between 2012 and 2018. All age groups were involved, including children younger than 6 years old.

Cases of mistaken identity concern all sorts of plants and depending on the season may involve flowers, bulbs, seeds, berries, roots or leaves.

ANSES has a list of the plants, in French, that are most frequently confused and/or cause the most severe cases. It includes bulb plants mistaken for onion, garlic or shallots, horse chestnut for chestnut, colocynth or non-edible squash for edible squash, oand cuckoo pint for sorrel or spinach.

Common symptoms are digestive disorders such as stomach pain, nausea, vomiting and diarrhea, which can be severe in the case of plants such as colocynths.

Some plants cause cardiac or neurological disorders that can prove fatal. This can occur when white hellebore is mistaken for yellow gentian, deadly nightshade for grapevine, or foxglove for comfrey.

Wild mushroom poisoning in Hong Kong
Meanwhile, research in Hong Kong has revealed 46 instances of mushroom poisoning from 2010 to the end of May this year.

The Centre for Health Protection (CHP) of the Department of Health recorded the food poisoning cases related to wild mushrooms. Most such poisoning is caused by eating toxic species mistaken as edible ones.

This past week, CHP revealed it was investigating a suspected food poisoning case related to consumption of wild mushrooms involving a 50-year-old man.

Most toxin-producing mushrooms cannot be made non-toxic by processing methods such as soaking, peeling, cooking or freezing. There is no specific treatment for mushroom poisoning. Patients with liver failure may require transplants as a result of eating poisonous mushrooms.

From 2010 to 2018, the annual number of people affected ranged from two to seven and the most cases were recorded from April to June. Of the 46 patients involved, 17 were male and 29 were female. The age range was from nine to 86 years old. Time from ingestion of the incriminating mushrooms to onset of symptoms ranged from 30 minutes to 19 hours, with a median of two hours.

Hospital treatment and one death
Common symptoms were gastrointestinal including diarrhea, vomiting, abdominal pain and nausea. Other complaints included dizziness, deranged liver function or acute liver failure, sweating, palpitation, weakness, acute kidney injury or failure, numbness, headache, hypotension, difficulty in urination, blurred vision, chest discomfort, chills and rigors, fever, increased salivation and muscle cramping.

Among 46 patients, 44 sought medical attention and 29 required hospitalization. Seven were admitted to intensive care units and two required liver transplants. One death was recorded. It was a 57-year-old man with underlying illness in 2018.

Mushrooms behind the poisonings were most commonly picked from the countryside, hillsides and along roadsides. They were also foraged in parks and residential areas.

Among 30 cases, the incriminating types of mushrooms or toxins were identified 20 times. The two most common types of mushrooms identified were Chlorophyllum molybdites, which contain gastrointestinal toxins, and amatoxin-containing mushrooms. Other mushroom species contained gastrointestinal toxins, muscarine or both. Muscarine affects the smooth muscles and sweat glands.

To prevent wild mushroom poisoning, people should not pick them for consumption in any circumstance, according to the study.

“The identification of toxic mushrooms requires the expertise of mycologists. There is no reliable method for the general public to distinguish toxic mushrooms from non-toxic ones. In fact, the vast majority (about 90 percent) of the wild mushrooms in Hong Kong are inedible or poisonous.”

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Eight people were recently hospitalized in New South Wales due to wild mushroom poisoning. Almost 40 calls were made to the NSW Poisons Information Centre in the past week and last year in the state 70 people were admitted to hospital.

Australian poisons information centers received almost 900 calls about possible wild mushroom poisoning in 12 months and a third were referred to a hospital or for medical treatment.

Since 2002, four people have died after eating death cap mushrooms found in the Australian Capital Territory. In 2012, two people died after eating these mushrooms at a New Year’s Eve dinner party in Canberra, and in 2014 four people were seriously poisoned.

Death cap mushroom

Cathy Moir, FSIC council chair, said that foraging for wild food is becoming popular but gathering wild mushrooms can be a life-threatening risk.

“While this latest spate of wild mushroom poisonings weren’t from death cap mushrooms be aware that the poison in one death cap mushroom if eaten, is enough to kill a healthy adult.”

Death cap mushrooms can appear at any time of year but are more common during autumn after a period of rain.

“They are not native to Australia and are often found near oak trees growing in warm wet weather. The similar marbled death cap mushrooms have also been recently found in Western Australia, although they may not be as toxic,” said Moir.

“Death cap mushrooms are difficult to distinguish from other wild mushrooms so we recommend you play it safe and only eat mushrooms that you have purchased from the supermarket, greengrocer or other reputable sources. People born overseas, especially in Asian countries, should be aware that these deadly mushrooms can look like edible mushrooms that they may have gathered in their home countries.”

ACT and Victoria alerts

Last month, Dr. Kerryn Coleman, acting Australian Capital Territory chief health officer, warned people not to eat or pick wild mushrooms.

Dr. Coleman said it was the first time death cap mushrooms had been seen in Canberra this year, marking the start of the cooler weather season.

“Death cap mushrooms can be lethal if ingested. It is crucial for people to understand that all parts of the mushroom are poisonous and cooking them does not make them safe to eat.”

Dr. Coleman warned people not to touch the mushroom with bare hands and to keep children and animals away from it.

“If you think you have eaten a death cap mushroom, seek urgent medical attention at a hospital emergency department and take any remaining mushroom to the hospital for identification,” she said.

“Symptoms of poisoning generally occur six to 24 hours or more after eating mushrooms and include pains, nausea, vomiting, and diarrhea. The sooner treatment begins, the better the chances of survival.”

The toxin in death cap mushrooms is not destroyed by peeling, cooking or drying. Symptoms may ease for two to three days before a terminal phase of three to four days begins. Without effective medical intervention, people may go into a coma and die after two or three weeks of liver and kidney failure.

Nine out of ten deaths from mushroom poisoning in Australia result from death caps said Moir.

“However there are other wild mushrooms in Australia that, while not fatal, can make you ill with abdominal pain, vomiting, and diarrhea. These include the yellow stainer which resembles a field mushroom and is the most commonly ingested poisonous mushroom in Victoria.”

Dr. Brett Sutton, Victoria’s chief health officer, issued a warning this month for people to avoid gathering wild mushrooms around Melbourne and in rural Victoria.

“Autumn conditions create ideal growing conditions for poisonous mushrooms, and recent rains have seen them start to sprout in Victoria. While commercially-sold mushrooms are safe, poisonings can occur when people gathering wild mushrooms inadvertently include toxic species. Poisonous mushrooms may appear very similar to edible varieties.”

Two toxic mushrooms are the Death Cap fungus, Amanita phalloides and the Yellow Staining mushroom, Agaricus xanthodermus.

The Death Cap is large, with a cap ranging from light olive green to greenish yellow in color. The gills are white and the base of the stem is surrounded by a cup-shaped sac. The commonly found Yellow Staining mushroom turns yellow when the cap or stem is bruised by a thumbnail.

In Hong Kong, The Centre for Health Protection (CHP) is investigating a food poisoning outbreak related to the consumption of wild mushrooms.

Three women aged 36 to 45 developed abdominal pain, nausea, vomiting, diarrhea and sweating 30 minutes after consuming wild mushrooms at home. They were admitted to hospital on the same day but remained in a stable condition and have been discharged.

Investigations revealed the wild mushrooms were picked near Bowen Road on Hong Kong Island.

Late last year, French authorities issued a warning after a spike in poisoning cases.

From July to mid-October, poison control centers recorded between five and 60 cases a week but 249 poisoning cases were recorded in early November. Every year, one thousand cases of mushroom poisoning occur in France.

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From July to mid-October this year, poison control centers recorded between five and 60 cases a week but 249 poisoning cases have been recorded in recent weeks.

Seven serious cases have been noted since July 2018 and four of them were in the past few weeks.

Poisonings due to eating wild mushrooms in France are reported to the French Poison Control and Monitoring Centers (CAP-TVs).

The sharp increase prompted the French Agency for Food, Environmental and Occupational Health and Safety (ANSES) and the Directorate General for Health (DGS) to issue a warning to wild mushroom gatherers and remind them of good practices.

Although weather conditions in September and the first half of October with dry, high temperatures were not conducive to the growth of wild mushrooms, the cooler and wetter conditions of recent weeks have been more favorable, said the agencies.

ANSES and the DGS said the poisoning cases are regularly observed year after year and in most cases, poisonings result from confusion with other edible mushrooms.

Last year, 181 poisoning cases, with five of a serious nature, were recorded in two weeks of September. In 2016, 87 cases, including three serious, were recorded in October.

Poisoning can have serious health consequences such as severe digestive disorders, liver damage that may require a transplant and can be fatal. Symptoms generally appear within 12 hours of consumption and the patient’s condition may deteriorate rapidly. In the event of symptoms, it is useful to note the time of the last meal and onset of the first symptoms and to keep any leftovers from the harvest for identification.

The Centre Antipoisons in Belgium receives around 400 calls a year involving mushrooms with most between June and September. The foundation Tox Info Suisse identified almost 600 poisonings in Switzerland last year.

Mushroom poisoning worldwide

Earlier this year, more than 1,200 people fell sick, 112 were hospitalized and 19 died in Iran with a link to eating wild mushrooms.

New South Wales (NSW) Health warned against eating wild mushrooms in May after 38 poisoning hospitalizations this year, including 14 children, were reported to the NSW Poisons Information Centre. Between 2014 and 2017, there were 281 hospitalizations from mushroom poisoning in NSW and the Australian Capital Territory.

Last month, the Illinois Poison Center (IPC) also issued a warning about mushrooms.

While many types of toxic mushrooms can be found in Illinois, most are minimally to moderately toxic. In rare cases, they can be poisonous and require hospitalization.

“The Illinois Poison Center receives hundreds of calls each year about mushrooms found in lawns, neighborhood parks and forest preserves. Adults, and especially children, should be aware of the health risks associated with consuming wild mushrooms and what to do if they are ingested,” said Michael Wahl, medical director at the IPC.

One of the main concerns when consuming poisonous mushrooms is liver damage from those that contain amatoxin. Amatoxin-containing mushrooms may not produce symptoms until six to 24 hours after ingestion.

From the start of July to mid-August, 45 mushroom exposure cases (38 in humans) were managed by the medical experts at the New Jersey Poison Control Center.

Diane Calello, NJ Poison Control Center executive and medical director, said even experienced mushroom pickers can be fooled by toxic look-a-likes.

“Don’t be fooled – many edible mushrooms have toxic look-a-likes. The cooking process does not prevent the toxic health effects of some mushrooms. Depending on the type of mushroom, eating even a few bites can cause serious health concerns,” she said.

In December 2016, 14 cases of Amanita phalloides (also known as the “death cap”) poisoning were identified by the California Poison Control System (CPCS) among persons who had consumed foraged wild mushrooms. Three patients received liver transplants and while all recovered, a child had permanent neurologic impairment.

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As seasonal rains promote the growth of wild mushrooms, California Department of Public Health Director and State Public Health Officer Dr. Karen Smith is again reminding people that eating wild mushrooms can cause serious illness and even death.

Unseasonably warm, wet weather in other areas of the country is also prompting mushroom growth where frozen ground and snow are the norm for February.

“Telling the difference between wild mushrooms that are safe and those that are poisonous can be difficult for many people,” Smith said in a news release earlier this week. “Wild mushrooms should not be eaten unless they have been examined by a mushroom expert and determined to be edible.”

The most serious illnesses and deaths have been linked primarily to wild mushrooms known to cause liver damage, including Amanita phalloides, which are also known as the “death cap,” and Amanita ocreata, known as “destroying angel.” A bloom of Amanita phalloides in winter 2017 resulted in 14 mushroom poisonings in California that required hospitalization. Three of the people needed a liver transplants.

According to the California Poison Control System, 1,038 cases of poisonous mushroom ingestion were reported throughout the state from November 2016 to Jan. 15, 2018. Among those cases:

• 16 suffered major health problems, such as liver failure leading to coma and/or a liver transplant, or kidney failure requiring dialysis.
• 51 suffered moderate health problems, such as dehydration due to vomiting and diarrhea, or injury to the liver or kidney.
• 433 were children younger than 6, most of whom ate a small amount of a mushroom from yards or neighborhood parks.
• 522 were treated at health care facilities.
• 16 were admitted to intensive care units.

Eating poisonous mushrooms can cause abdominal pain, cramping, vomiting, diarrhea, liver damage or death. Anyone who develops symptoms after eating wild mushrooms should seek immediate medical attention. People in California who develop these symptoms, or their treating health care providers, should immediately contact the state’s Poison Control System at 800-222-1222.

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Fourteen people were confirmed with poisoning from unknowingly eating Amanita phalloides — commonly known as death cap mushrooms — during a two-week period in December 2016 in California, according to the Morbidity and Mortality Weekly Report posted Thursday by the Centers for Disease Control and Prevention.

Three of the victims required liver transplants because of irreversible fulminant hepatic failure. One of those patients, an 18-month-old child, developed cerebral edema and suffered permanent neurologic sequelae.

The death cap is a triple threat, according to the research posted by the CDC:

• The death cap is easily confused with non-poisonous species;
• The substances in death caps that are toxic to humans are heat stable and are not inactivated by cooking; and
• A lethal dose can be as low as 0.1 mg/kg, and a single mushroom can contain up to 15 mg.

“The morbidity and potential lethality associated with A. phalloides ingestion are serious public health concerns and warrant medical provider education and dissemination of information cautioning against consuming foraged wild mushrooms,” the public health researchers wrote.

The death cap is responsible for the most deaths following ingestion of foraged mushrooms worldwide.

Public health officials were not completely surprised by the unusually high number of poisonings this past foraging season.

In late November 2016, members of the Bay Area Mycological Society notified the California Poison Control System (CPCS) of an unusually large seasonal bloom of A. phalloides mushrooms in the greater San Francisco Bay Area. Five days later, CPCS received notification of the first poisoning of the season. During the next two weeks, CPCS was notified of the other 13 cases of hepatotoxicity from A. phalloides ingestion.

“CPCS strongly advises against eating foraged mushrooms without their being evaluated by a trained mycologist,” the researchers wrote in the CDC report. “In addition, health care providers should be aware of potential toxicity of A. phalloides and contact their local poison control center for assistance if they see patients who are ill after eating foraged mushrooms.

“… Patients who are evaluated early in the course of their illness might be discharged home only to return later with indications of liver failure, contributing to the relatively high case fatality rate of 10 percent to 20 percent.”

In California, particularly the state’s northern coastline areas, the death cap grown in a symbiotic relationship with oaks and other hardwood trees. Though they are abundant in early winter, the foggy coastal climate and increasingly warmer temperatures support year-round growth, according to the researchers.

“A general increase in naïve foraging and wildcrafting activities, i.e., gathering plant material from its native environment for food or medicinal purposes, raises risk for poisoning,” the scientists wrote.

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The measure, HB 5532, was approved along party lines by the Republican-controlled Michigan House of Representatives and Senate — 57-52 in the House and 26-11 with one not voting in the Senate. The GOP governor did not agree with the GOP legislators.

Locavores and the highly toxic nature of many mushroom species combined to give Snyder all the motivation he needed to get out his veto pen.

“With the increased popularity of local foods over the past several years, there has been a significant increase in the demand for wild mushrooms by food establishments, wholesalers and processors,” Snyder said in his Jan. 5 veto letter. “The requirement for wild mushroom pickers to be experts has been in the FDA Food Code which Michigan adopts by reference since 2000.

“Despite this, there has been an increase in poisonings in Michigan related to morels. Consequently, a formal certification course was developed in 2015 to assure that individuals picking wild mushrooms to sell to food businesses could identify safe vs. toxic mushroom varieties. This certification is good for five years. It is important that wild mushrooms entering our food supply meet the same high safety standards as other products and ingredients.”

Snyder’s veto letter said he appreciates the legislature’s desire to streamline food safety regulations and that he would continue discussions. However, he also pointed out a problem with the mushroom bill language that suggests he won’t take food safety discussions lightly.

“Further, by simply using the lay term ‘morel’ in the bill rather than specifying the particular organisms qualified for exemption — in this case Marcella species — (the legislation) would have the unintended consequence of including species in addition to morels for exemption from the certification process.”

The man behind the bill, Rep. Triston Cole, R-Mancelona, responded to the governor’s veto the same day it was penned, saying he was “profoundly disappointed.” Cole invoked the spirits of generations of mushroom hunters as well as the livelihood of small businesses in his response.

“The Michigan Department of Agriculture’s concern with a practice that has taken place for generations by morel mushroom enthusiasts is egregious. It is a flawed, bureaucratic process implemented by a department to over-regulate businesses and hinder their ability to add this unique delicacy to their menu,” Cole’s said in a written statement.

“This legislation was brought about by local restauranteurs that were and are continuing to struggle to purchase fresh picked, seasonal morel mushrooms. I continue to have the upmost respect and confidence that our chefs know what they are purchasing, preserving and preparing for food enthusiasts.”

Cole said he was “in communication with the governor’s office” to find a solution.

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The substance is called silibinin, and is derived from the milk thistle plant. It works by preventing the mushroom’s poisonous amatoxins from reaching and damaging liver cells.
Amatoxins are released by the Amanita mushroom, a poisonous genus that accounts for 95 percent of human illnesses from mushrooms in the U.S..

The treatment of mushroom poisoning has historically been an imperfect science. Given the rarity of these illnesses in the United States, doctors do not have many opportunities to figure out what works best for these patients.  

A little over 1,300 illnesses were linked to mushroom poisoning in 2010, according to the American Association of Poison Control Centers. Of these cases, 41 were considered severe, and 3 deaths occurred.

Indeed, the occurrence of 4 cases in the D.C. metro area in a span of 2 weeks is “extremely rare,” says Dr. Jaqueline Laurin, a liver specialist at Georgetown Hospital and the doctor who prescribed silibinin to the patients there, who before last month had not yet treated a case of Amanita poisoning in her 17-year career.

While silibinin has been approved for use in Europe, and has proven effective there, in the U.S. it is only approved for conditional use. Doctors must submit an application to the National Institutes of Health to gain access to it for a patient. 

Dr. Laurin had read about silibinin’s success in Europe and in studies in the United States. So when 4 patients from the D.C. metro area presented with high liver toxicity after ingesting amanita mushrooms, she decided the drug was worth a shot.

And though 3 out of the 4 patients arrived outside of the 24 hr window – the time after ingestion in which treatment is most successful – all 4 achieved full recoveries and have now been discharged from the hospital.

Laurin says silibinin likely led to a better outcome for the patients than the standard forms of treatment for mushroom poisoning.

Penicillin G is one of the drugs most commonly given to patients who have eaten poisonous fungi. However, while the drug “has a similar effect, it doesn’t appear to have as strong an effect as silibinin,” she says. 

But, Laurin explains, in order for silibinin to be more widely accepted as a treatment for Amanita mushrooms, its effects must be more widely studied.

“The problem with the silibinin is there aren’t any large controlled trials, especially against placebos, for ethical reasons,” she says.

And while rains continue to fall in the northeast, Laurin warns residents there – and anyone picking wild mushrooms – to be sure they know what they’re putting on the table.

“People are out there with their field guides picking mushrooms, but field guides may not have enough detail to be able to help people tell the difference between the edible varieties and the poisonous varieties,” she says.

Symptoms of amanita poisoning usually appear 6 to 12 hours after ingestion. Patients experience severe, watery diarrhea, nausea and vomiting. After 1-2 days, symptoms disappear for a period of time, but amatoxins continue to attack the liver, and can remain in the body anywhere from 5 to 7 days.