Toxic Potential of Traditionally Consumed Mushroom Species-A Controversial Continuum with Many Unanswered Questions

A guide to mycetisms: A toxicological and preventive overview

Fungi are often considered a delicacy and are primarily cultivated and harvested, although numerous species are responsible for intoxication due to toxin content. Foodborne diseases are a significant public health concern, causing approximately 420 000 deaths and 600 million morbidities yearly, of which mushroom poisoning is one of the leading causes. Epidemiological data on non-cultivated mushroom poisoning in individual countries are often unrepresentative, as intoxication rarely requires emergency intervention. On the other hand, the lack of specialist knowledge among medical personnel about the toxicological manifestations of mushroom consumption may result in ineffective therapeutic interventions. This work aims to provide an easy-to-consult and wide-ranging tool useful for better understanding the variability of mushroom intoxications, the associated symptoms, and the main treatments for the most severe cases, given the absence of a complete species mapping tool toxic. Moreover, we establish an effective collection network that describes the incidence of mushroom poisonings by reporting the species and associated toxicological manifestations for each case. In conclusion, we highlight the need to establish appropriate primary prevention interventions, such as training the affected population and increasing consultancy relationships between mycological experts and specialised healthcare personnel.

The effects of CDP-choline treatment in Amanita phalloides mushroom toxicosis

Amanita phalloides poisoning is known to be the most fatal case among mushroom poisoning cases. Its main mechanism of toxicity is that it leads to cell death by the irreversible binding of its toxins to the DNA-dependent RNA polymerase II enzyme. This study was planned to analyze the effects of the CDP-choline molecule on Amanita phalloides mushroom poisoning cases. The extract of the Amanita phalloides mushroom was taken and intraperitoneally administered to male Wistar Albino rats at a dose of 0.3 g/kg. In the experiment phase, the rats were divided into three groups of CDP-choline treatment according to the doses of 100 mg/kg, 250 mg/kg, and 500 mg/kg, and one control group was administered a 1 ml/kg dose of 0.9% isotonic NaCl solution. The treatments were then administered intraperitoneally at the 2nd hour, and at the 6th hour, the rats were sacrificed. The degree of damage in the liver and kidney tissues of the rats was evaluated histopathologically. It was concluded that CDP-choline reduced or prevented the damage that occurred in the liver significantly and dose-dependently in the toxicosis picture caused by Amanita phalloides, and it showed a tendency to lower or prevent the damage in the kidney, albeit not significantly.

Chlorophyllum molybdites poisoning on Reunion Island

In France, mushroom picking is part of the culture. The practice is not without risk, as around 1300 people are poisoned each year by eating wild mushrooms on the French mainland. However, this practice is not part of local culture on Reunion Island, a French territory located in the Indian Ocean. Indeed, there are practically no reports of mushroom poisoning on Reunion Island. Here we describe, through a retrospective study, cases of mushroom poisoning recorded in the Indian Ocean toxicosurveillance system database from 2020 to 2021. Overall, 19 people were poisoned following wild mushroom ingestion on Reunion Island: 15 in 2020 and 4 in 2021. Six events were recorded: the majority of poisonings involved clusters (n = 5) during a shared meal (pan-fried), only one case was single mushroom poisoning by ingesting a raw mushroom. Of all patients, 15 cases presented a gastrointestinal irritant syndrome (latency between 30 min and 3 h). Chlorophyllum molybdites was positively identified by mycologists in 4 cases, suspected by emergency doctor in 1 case and in one self-declared case, Volvariella volvacea was consumed. Poisoning following ingestion of wild mushrooms does occur on Reunion Island, and Chlorophyllum molybdites is the main culprit.

A Further Step toward Sustainable Development: The Case of the Edible Mushroom Supply Chain

This study provides an accurate economic characterization of the supply of edible mushrooms throughout Italy within the European context to fill the relevant research gap and highlight barriers and opportunities that are consistent with the Sustainable Development Goals. Italian companies operating in this field were identified and economically characterized using the Chamber of Commerce's Register of Companies. A qualitative web content analysis was then conducted to extract information about the marketed products, mushroom species, and retail channels, as well as the adopted certifications. The obtained data were quantitatively analyzed through descriptive statistics and multiple correspondence analysis. The Italian market is concentrated in northern areas of the country, and the limited company size indicates fragmentation at the production level, which led to Italy not being competitive enough and, thus, heavily rely on imports. Production is limited to less than 10 species, and innovative mushroom-based products, such as burgers, have shown a limited presence on the market, although they are gaining market share online. The novelty of growing kits highlights the potential to use food production waste to create fungal substrates. Investments in training new mushroom growers and studying new formulations and new fungal species are needed; these investments could allow greater market differentiation and be a good opportunity to promote local economies and create new job opportunities, thus meeting the requirements for sustainable development.

Mortality Cases of Mushroom Poisoning with Russula subnigricans

Mushroom poisoning is increasing worldwide, as well as the incidence of fatal mushroom poisoning. Several new syndromes associated with mushroom poisoning have been described in the literature. Notably, 1 of the newly identified mushroom poisonings is Russula subnigricans poisoning. R subnigricans can be classified as causing a delayed-onset rhabdomyolytic syndrome as patients with this severe poisoning present with severe rhabdomyolysis, acute kidney injury, and cardiomyopathy. However, there are only a few reports on the toxicity of R subnigricans. We recently treated 6 patients with R subnigricans mushroom poisoning, of whom 2 died. The 2 patients showed severe rhabdomyolysis, metabolic acidosis, acute renal failure, electrolyte imbalance, and irreversible shock, which caused their deaths. Mushroom poisoning should be considered in the evaluation of rhabdomyolysis of unknown origin. In addition, in cases of mushroom poisoning with severe rhabdomyolysis, R subnigricans poisoning should be promptly identified.

The effect of arsenic, cadmium, mercury, and lead on the genotoxic activity of Boletaceae family mushrooms present in Serbia

The aim of this study was to determine accumulation of heavy metals and metalloids which are widely distributed in the environment and in food chain using wild edible mushrooms belonging to the Boletaceae family mushrooms. In addition, methanol extracts of mushrooms were tested for in vitro protective effect by the cytochalasin-B blocked micronucleus (CBMN) assay using chromosome aberrations in human peripheral lymphocytes as a model. The genotoxic activity of methanol extracts prepared at 4 different concentrations (1, 2, 3 or 6 µg/ml) was examined using amifostine and mitomycin C as positive controls. Extracts of species B. regius and B. edulis exhibited the greatest reduction in the frequency of micronuclei (MN). Extract of B. regius at concentrations of 2 µg/ml showed the highest decrease in number of MN. In comparison, extract of mushroom B. edulis at a concentration of 3 µg/ml displayed less reduction. However, as heavy metals and metalloids are found in mushrooms, another aim was to examine whether these agents affected genotoxicity. Principal component analysis (PCA) identified clustering differences between control and heavy metals and metalloids groups and might explain the influence of heavy element content and genotoxic activity in mushrooms.

Safety and commercial issues in fresh mushrooms and mushroom-based products sold at retail in Tuscany region

The compliance to European and National safety and labelling requirements relating to the sale of spontaneous and cultivated mushrooms and mushroom-based products in Tuscany was assessed. The evidence was collected by the Mycological Inspectorate of North-West Tuscany Local Health Authority during 90 inspections (from 2016 to 2020) at large-scale distribution stores, wholesalers, and restaurants in 10 cities belonging to 3 provinces, and on the labelling analysis of 98 commercial products collected at retail in 2021. Despite a substantial compliance of the inspected activities and products with the regulatory requirements, critical issues were highlighted: 1) EU legislative gap in the definition of specific measures for the safe sale of spontaneous mushrooms; 2) improper shelf storage temperatures of fresh-cut products; 3) incorrect condition of use on the labels of pre-packaged products; 4) lack of countryof- origin declaration in pre-packaged products. Furthermore, the labelling analysis highlighted that 18.4% and 15.3% of the products presented issues in the validity and correctness of the scientific names respect to national requirements in. A revision of the current EU legislation is needed to guarantee consumers safety, also considering the relevant number of poisoning cases related to false mycetisms (ingestion of edible mushrooms unproperly stored or used). Also, a specific revision and harmonization of the EU labelling of mushrooms would be desirable to protect consumers.

Alternative protein sources of plant, algal, fungal and insect origins for dietary diversification in search of nutrition and health

This review aimed to compare alternative protein sources in terms of nutritional composition and health benefits with the purpose of disseminating up-to-date knowledge and contribute for diversification of the food marked and consumers decision-making. Plant-based is the most well-established category of alternative proteins, but there is still room for diversification. Less conventional species such as chia seeds are prominent sources of ω-3 (∼60% total lipids), while hempseed and quinoa are notable sources of ω-6 (up to 58% and 61%, respectively). Edible insects and microalgae are alternative foods rich in protein (up to 70%), fibers (∼30%), as well as peptides and polysaccharides with antimicrobial, antioxidant, anti-hypertensive, antidiabetic, antidepressant, antitumor, and immunomodulatory activities. Additionally, lipid contents in insect larvae can be as high as 50%, on a dry weight basis, containing fatty acids with anti-inflammatory and antitumor properties. In contrast, edible fungi have low lipid contents (∼2%), but are rich in carbohydrates (up to 79%) and have balanced amino acid profiles. The results suggest that food formulations combining different alternative protein sources can meet dietary requirements. Further studies on flavoring and texturing processes will help to create meat and dairy analogs, thus helping to broaden acceptance and applicability of alternative protein sources.

Edible Mushrooms for Sustainable and Healthy Human Food: Nutritional and Medicinal Attributes

Global food production faces many challenges, including climate change, a water crisis, land degradation, and desertification. These challenges require research into non-traditional sources of human foods. Edible mushrooms are considered an important next-generation healthy food source. Edible mushrooms are rich in proteins, dietary fiber, vitamins, minerals, and other bioactive components (alkaloids, lactones, polysaccharides, polyphenolic compounds, sesquiterpenes, sterols, and terpenoids). Several bioactive ingredients can be extracted from edible mushrooms and incorporated into health-promoting supplements. It has been suggested that several human diseases can be treated with extracts from edible mushrooms, as these extracts have biological effects including anticancer, antidiabetic, antiviral, antioxidant, hepatoprotective, immune-potentiating, and hypo-cholesterolemic influences. The current study focuses on sustainable approaches for handling edible mushrooms and their secondary metabolites, including biofortification. Comparisons between edible and poisonous mushrooms, as well as the common species of edible mushrooms and their different bioactive ingredients, are crucial. Nutritional values and the health benefits of edible mushrooms, as well as different biomedical applications, have been also emphasized. Further research is needed to explore the economic sustainability of different medicinal mushroom bioactive compound extracts and their potential applications against emerging diseases such as COVID-19. New approaches such as nano-biofortification are also needed to supply edible mushrooms with essential nutrients and/or to increase their bioactive ingredients.

Effect of Four-in-One Optimized Emergency Nursing Procedure on Symptoms and Vital Signs of Patients with Mushroom Poisoning

Most members of the general public find it difficult to identify poisonous wild mushrooms, resulting in family food poisoning. Toxic mushroom poisoning can produce nausea, vomiting, abdominal pain, and other severe symptoms 30 minutes or more after ingestion that can even lead to death. Using a “four-in-one” optimized emergency nursing procedure to treat mushroom poisoning can reduce the rescue time and improve the survival rate of patients. This study aimed to analyze the influence of a “four-in-one” optimized emergency nursing procedure to treat patients with toadstool poisoning. A prospective randomized study was conducted. Sixteen cases of toadstool poisoning, corresponding to 78 patients admitted to our hospital from January 2017 to July 2020, were selected and divided into a study group and a control group of 39 cases each using a random number table. The control group was provided with routine emergency care, and the study group was given a “four-in-one” treatment that optimized the emergency care process; both groups were subjected to basic treatment + blood purification and other treatment measures, and the treatment time in the rescue room and the first blood purification time of the two groups were compared. Differences in routine blood tests, liver and kidney function indices, hospitalization time, coma time, treatment outcome, and nursing satisfaction before and after treatment were found. The treatment time and the first blood purification time of the study group were lower than those of the control group, and the difference was statistically significant (P < 0.05); ALT, AST, TBIL, TBA, and ALB were measured upon admission for the study and the control groups. The measured values of PT, APTT, CK, CK-MB, and BUN were compared for the two groups, but the difference in the values between the two groups was not statistically significant (P > 0.05); after 7 days of treatment, the ALT, TBA, and APTT indicators of the study group were lower than those of the control group, and the difference was statistically significant (P < 0.05); the measured values of ALT, AST, TBIL, TBA, ALB, PT, APTT, CK, CK-MB, BUN, and Scr after 7 days of treatment were significantly lower than those before treatment for both groups (P < 0.05). The length of stay for the study group was lower than that for the control group, and the difference was statistically significant (P < 0.05); the treatment efficiency was 87.18% for the study group, compared with 82.05% for the control group, but the difference was not statistically significant (P > 0.05). The study group rated nursing care as follows: very satisfactory, 79.49%; relatively satisfactory, 15.38%; and acceptable, 5.13%; the control group rated nursing care as follows: very satisfactory, 51.28%; relatively satisfactory, 30.77%; and acceptable, 12.82%; the results were statistically significant (P < 0.05). Using a “four-in-one” optimized emergency care process to treat patients with mushroom poisoning can significantly reduce the rescue room treatment time and the first blood purification time and improve nursing satisfaction, but has a limited effect on improving the treatment efficiency.

Building of an Internal Transcribed Spacer (ITS) Gene Dataset to Support the Italian Health Service in Mushroom Identification

This study aims at building an ITS gene dataset to support the Italian Health Service in mushroom identification. The target species were selected among those mostly involved in regional (Tuscany) poisoning cases. For each target species, all the ITS sequences already deposited in GenBank and BOLD databases were retrieved and accurately assessed for quality and reliability by a systematic filtering process. Wild specimens of target species were also collected to produce reference ITS sequences. These were used partly to set up and partly to validate the dataset by BLAST analysis. Overall, 7270 sequences were found in the two databases. After filtering, 1293 sequences (17.8%) were discarded, with a final retrieval of 5977 sequences. Ninety-seven ITS reference sequences were obtained from 76 collected mushroom specimens: 15 of them, obtained from 10 species with no sequences available after the filtering, were used to build the dataset, with a final taxonomic coverage of 96.7%. The other 82 sequences (66 species) were used for the dataset validation. In most of the cases (n = 71; 86.6%) they matched with identity values ≥ 97–100% with the corresponding species. The dataset was able to identify the species involved in regional poisoning incidents. As some of these species are also involved in poisonings at the national level, the dataset may be used for supporting the National Health Service throughout the Italian territory. Moreover, it can support the official control activities aimed at detecting frauds in commercial mushroom-based products and safeguarding consumers.

Ribotoxin-like proteins from Boletus edulis: structural properties, cytotoxicity and in vitro digestibility

Porcini are edible mushrooms widely used in cooking due to their extraordinary taste. Despite this, cases of food poisoning have been reported in the recent literature also for ingestion of porcini. Here, we report the isolation from Boletus edulis fruiting bodies of two novel ribotoxin-like proteins (RL-Ps), enzymes already studied in other organisms for their toxicity. These RL-Ps, named Edulitin 1 (16-kDa) and Edulitin 2 (14-kDa), show peculiar structural and enzymatic differences, which probably reflect their different bio-activities and a dose/time dependent toxicity (Edulitin 2) on normal and tumoral human cells. Particularly interesting is the resistance to proteolysis of Edulitin 2, for which it was observed that its toxicity was abolished only after heat treatment (90 °C) followed by proteolysis. As mushroom poisoning is a serious food safety issue, data here presented confirm the existence of toxins also in porcini and the importance of a proper cooking before their consumption.