Abstract:Rationale:Acute liver failure (ALF) induced by amatoxin-containing mushrooms accounts for more than 90% of deaths in patients suffering from mushroom poisoning. However, due to the fact that most hospitals cannot identify the species of mushrooms involved, or detect amatoxins, the early diagnosis of amatoxin intoxication remains a significant challenge in clinical practice.Patient concerns:Two patients were had ingested wild mushrooms 15 hours before admission. Six hours prior to admission they experienced nau… Show more
“…Patients with amatoxin-induced ALF have a poor prognosis, and LT is the only lifesaving therapy. In the pretransplantation era, the survival rate was 10-30%; however, transplantation has greatly improved the survival rate to 87% [10,12]. At present, reports on LT for PALF caused by mushroom poisoning are mainly from developed countries [13].…”
Section: Discussionmentioning
confidence: 99%
“…After the toxin enters the intestinal tract, amatoxin binds to DNA-dependent RNA polymerase II, inhibits protein synthesis, and induces the production of cytokines, ultimately resulting in the death of hepatocytes [7,10]. The clinical course of amatoxin poisoning is classically divided into four consecutive phases.…”
Section: Discussionmentioning
confidence: 99%
“…Approximately 400 of these are toxic to humans. Over 90% of fatal mushroom poisonings in the world occur after ingestion of Amanita species [ 8 – 10 ]. There are two distinct groups of toxins isolated from Amanita : phallotoxins and amatoxins.…”
Background: Pediatric acute liver failure is a rare, life-threatening illness. Mushroom poisoning is a rare etiology. For patients with irreversible pediatric acute liver failure, liver transplantation is the ultimate lifesaving therapy. However, it is difficult to determine the optimal timing of transplantation. Here, we present a case of pediatric acute liver failure due to mushroom poisoning in northeastern China. He was treated with liver transplantation and recovered. To our knowledge, there are few reports about liver transplantation for pediatric acute liver failure caused by mushroom poisoning in mainland China. Case presentation: The patient was a previously healthy 9-year-old boy who gradually developed nausea, vomiting, jaundice and coma within 5 days after ingesting mushrooms. He was diagnosed with mushroom poisoning and acute liver failure. He was treated with conservative care but still deteriorated. On the 7th day after poisoning, he underwent LT due to grade IV hepatic encephalopathy. Twenty days later, he recovered and was discharged. A review of the literature revealed that the specific criteria and optimal timing of transplantation remain to be determined. Conclusions: Patients with pediatric acute liver failure should be transferred to a center with a transplant unit early. Once conservative treatment fails, liver transplantation should be performed.
“…Patients with amatoxin-induced ALF have a poor prognosis, and LT is the only lifesaving therapy. In the pretransplantation era, the survival rate was 10-30%; however, transplantation has greatly improved the survival rate to 87% [10,12]. At present, reports on LT for PALF caused by mushroom poisoning are mainly from developed countries [13].…”
Section: Discussionmentioning
confidence: 99%
“…After the toxin enters the intestinal tract, amatoxin binds to DNA-dependent RNA polymerase II, inhibits protein synthesis, and induces the production of cytokines, ultimately resulting in the death of hepatocytes [7,10]. The clinical course of amatoxin poisoning is classically divided into four consecutive phases.…”
Section: Discussionmentioning
confidence: 99%
“…Approximately 400 of these are toxic to humans. Over 90% of fatal mushroom poisonings in the world occur after ingestion of Amanita species [ 8 – 10 ]. There are two distinct groups of toxins isolated from Amanita : phallotoxins and amatoxins.…”
Background: Pediatric acute liver failure is a rare, life-threatening illness. Mushroom poisoning is a rare etiology. For patients with irreversible pediatric acute liver failure, liver transplantation is the ultimate lifesaving therapy. However, it is difficult to determine the optimal timing of transplantation. Here, we present a case of pediatric acute liver failure due to mushroom poisoning in northeastern China. He was treated with liver transplantation and recovered. To our knowledge, there are few reports about liver transplantation for pediatric acute liver failure caused by mushroom poisoning in mainland China. Case presentation: The patient was a previously healthy 9-year-old boy who gradually developed nausea, vomiting, jaundice and coma within 5 days after ingesting mushrooms. He was diagnosed with mushroom poisoning and acute liver failure. He was treated with conservative care but still deteriorated. On the 7th day after poisoning, he underwent LT due to grade IV hepatic encephalopathy. Twenty days later, he recovered and was discharged. A review of the literature revealed that the specific criteria and optimal timing of transplantation remain to be determined. Conclusions: Patients with pediatric acute liver failure should be transferred to a center with a transplant unit early. Once conservative treatment fails, liver transplantation should be performed.
“…86 Likewise, ALF induced by amatoxin-containing mushroom can also be treated by penicillin G, silibinin, and plasma exchange combination regimen. 87 In specialized centers, further therapeutic modalities for critical ALF patients include the application of artificial liver support devices such as MARS (molecular adsorbent recirculating system) or fractionated plasma separation and adsorption. 57,[88][89][90] In general, MARS and fractionated plasma separation and adsorption might have the potential to increase the probability of short-term survival of patients with ALF or ACLF and can be introduced for bridging to liver transplantation; 91 MARS therapy seems to successfully replace hepatic function in ALF, thereby allowing time for spontaneous recovery or transplantation.…”
Acute liver failure is a rare hepatic emergent situation that affects primarily young people and has often a catastrophic or even fatal outcome. Definition of acute liver failure has not reached a universal consensus and the interval between the appearance of jaundice and hepatic encephalopathy for the establishment of the acute failure is a matter of debate. Among the wide variety of causes, acetaminophen intoxication in western societies and viral hepatitis in the developing countries rank at the top of the etiology list. Identification of the clinical appearance and initial management for the stabilization of the patient are of vital significance. Further advanced therapies, that require intensive care unit, should be offered. The hallmark of treatment for selected patients can be orthotopic liver transplantation. Apart from well-established treatments, novel therapies like hepatocyte or stem cell transplantation, additional new therapeutic strategies targeting acetaminophen intoxication and/or hepatic encephalopathy are mainly experimental, and some of them do not belong, yet, to clinical practice. For clinicians, it is substantial to have the alertness to timely identify the patient and transfer them to a specialized center, where more treatment opportunities are available. FIGURE 1. The 3 main well-established classifications for ALF. (i) Williams-Schalm and O'Grady system (ii) Bernuau system, and (iii) Mochida (Japanese) system. ALF indicates acute liver failure.
“…There are only a few laboratories capable of testing biological specimens for amatoxins to confirm human or animal exposures, and even when available, test results might not be available soon enough to help guide treatment. Although there are no FDA-approved antidotes, early diagnosis, aggressive immediate supportive care, and a range of potential therapies can potentially improve patient outcomes [6][7][8][9][10][11].…”
Globally, mushroom poisonings cause about 100 human deaths each year, with thousands of people requiring medical assistance. Dogs are also susceptible to mushroom poisonings and require medical assistance. Cyclopeptides, and more specifically amanitins (or amatoxins, here), are the mushroom poison that causes the majority of these deaths. Current methods (predominantly chromatographic, as well as antibody-based) of detecting amatoxins are time-consuming and require expensive equipment. In this work, we demonstrate the utility of the lateral flow immunoassay (LFIA) for the rapid detection of amatoxins in urine samples. The LFIA detects as little as 10 ng/mL of α-amanitin (α-AMA) or γ-AMA, and 100 ng/mL of β-AMA in urine matrices. To demonstrate application of this LFIA for urine analysis, this study examined fortified human urine samples and urine collected from exposed dogs. Urine is sampled directly without the need for any pretreatment, detection from urine is completed in 10 min, and the results are read by eye, without the need for specialized equipment. Analysis of both fortified human urine samples and urine samples collected from intoxicated dogs using the LFIA correlated well with liquid chromatography–mass spectrometry (LC-MS) methods.
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