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Thursday, March 26, 2020

Orthomyxoviridae (flu virus family)

From Wikipedia, the free encyclopedia

Orthomyxovirus
Virus classification e
(unranked): Virus
Realm: Riboviria
Phylum: Negarnaviricota
Class: Insthoviricetes
Order: Articulavirales
Family: Orthomyxoviridae
Genera

Orthomyxoviridae (ὀρθός, orthós, Greek for "straight"; μύξα, mýxa, Greek for "mucus") is a family of RNA viruses. It includes seven genera: Influenzavirus A, Influenzavirus B, Influenzavirus C, Influenzavirus D, Isavirus, Thogotovirus, and Quaranjavirus. The first four genera contain viruses that cause influenza in vertebrates, including birds, humans, and other mammals. Isaviruses infect salmon; the thogotoviruses are arboviruses, infecting vertebrates and invertebrates, such as ticks and mosquitoes.

The four genera of Influenza virus that infect vertebrates, which are identified by antigenic differences in their nucleoprotein and matrix protein, are as follows:

Classification

Influenza virus
 
In a phylogenetic-based taxonomy, the category "RNA virus" includes the category "negative-sense ssRNA virus", which includes the Order "Mononegavirales", and the Family "Orthomyxovirus" (among others). The genera-associated species and serotypes of Orthomyxovirus are shown in the following table. 

Orthomyxovirus Genera, Species, and Serotypes
Genus Species (* indicates type species) Serotypes or Subtypes Hosts
Influenza virus A Influenza A virus* H1N1, H1N2, H2N2, H3N1, H3N2, H3N8, H5N1, H5N2, H5N3, H5N8, H5N9, H7N1, H7N2, H7N3, H7N4, H7N7, H7N9, H9N2, H10N7 Human, pig, bird, horse, bat
Influenza virus B Influenza B virus* Victoria, Yamagata[5] Human, seal
Influenza virus C Influenza C virus*
Human, pig, dog
Influenza virus D Influenza D virus*
Pig, cattle
Isavirus Infectious salmon anemia virus*
Atlantic salmon
Thogotovirus Thogotovirus*
Tick, mosquito, mammal (including human)
Dhori virus Batken virus, Bourbon virus, Jos virus
Quaranjavirus[6]
Quaranfil virus,* Johnston Atoll virus

Types

There are four genera of influenza virus, each containing only a single species, or type. Influenza A and C infect a variety of species, while influenza B almost exclusively infects humans, and influenza D infects cattle and pigs.

Influenza A

Influenza A viruses are further classified, based on the viral surface proteins hemagglutinin (HA or H) and neuraminidase (NA or N). Sixteen H subtypes (or serotypes) and nine N subtypes of influenza A virus have been identified. 

Diagram of influenza nomenclature

Further variation exists; thus, specific influenza strain isolates are identified by a standard nomenclature specifying virus type, geographical location where first isolated, sequential number of isolation, year of isolation, and HA and NA subtype.

Examples of the nomenclature are:
  1. A/Brisbane/59/2007 (H1N1)
  2. A/Moscow/10/99 (H3N2).
The type A viruses are the most virulent human pathogens among the three influenza types and cause the most severe disease. The serotypes that have been confirmed in humans, ordered by the number of known human pandemic deaths, are:
Known flu pandemics
Name of pandemic Date Deaths Case fatality rate Subtype involved Pandemic Severity Index
1889–1890 flu pandemic
(Asiatic or Russian Flu)
1889–1890 1 million 0.15% possibly H3N8
or H2N2
NA
1918 flu pandemic
(Spanish flu)
1918–1920 20 to 100 million 2% H1N1 5
Asian Flu 1957–1958 1 to 1.5 million 0.13% H2N2 2
Hong Kong Flu 1968–1969 0.75 to 1 million <0 .1="" font=""> H3N2 2
Russian flu 1977–1978 no accurate count N/A H1N1 N/A
2009 flu pandemic 2009–2010 105,700–395,600 0.03% H1N1 NA

Influenza B

Influenza B virus is almost exclusively a human pathogen, and is less common than influenza A. The only other animal known to be susceptible to influenza B infection is the seal. This type of influenza mutates at a rate 2–3 times lower than type A and consequently is less genetically diverse, with only one influenza B serotype. As a result of this lack of antigenic diversity, a degree of immunity to influenza B is usually acquired at an early age. However, influenza B mutates enough that lasting immunity is not possible. This reduced rate of antigenic change, combined with its limited host range (inhibiting cross species antigenic shift), ensures that pandemics of influenza B do not occur.

Influenza C

The influenza C virus infects humans and pigs, and can cause severe illness and local epidemics. However, influenza C is less common than the other types and usually causes mild disease in children.

Influenza D

This is a genus that was classified in 2016, the members of which were first isolated in 2011. This genus appears to be most closely related to Influenza C, from which it diverged several hundred years ago. There are at least two strains of this genus in extant. The main hosts appear to be cattle, but this virus has seen to infect pigs as well.

Morphology

Structure of the influenza virion. The hemagglutinin (HA) and neuraminidase (NA) proteins are shown on the surface of the particle. The viral RNAs that make up the genome are shown as red coils inside the particle and bound to Ribonuclear Proteins (RNPs).

The virion is pleomorphic; the envelope can occur in spherical and filamentous forms. In general, the virus's morphology is ellipsoidal with particles 80 to 120 nm in diameter, or filamentous virions 80–120 nm in diameter and up to 20 µm long. There are some 500 distinct spike-like surface projections of the envelope each projecting 10 to 14 nm from the surface with varying surface densities.

The major glycoprotein (HA) is interposed irregularly by clusters of neuraminidase (NA), with a ratio of HA to NA of about 4–5 to 1.

Cholesterol-laden membranes with protruding glycoproteins enclose the nucleocapsids; nucleoproteins of different size classes with a loop at each end; the arrangement within the virion is uncertain. The ribonuclear proteins are filamentous and fall in the range of 50 to 130 nm long and 9 to 15 nm in diameter. They have a helical symmetry.

Genome

Viruses of this family contain 6 to 8 segments of linear negative-sense single stranded RNA.

The total genome length is 12000–15000 nucleotides (nt). The size of each segment is as follows:

segment protein size (nt) protein size (aa)
PB1 polymerase 2300–2500 757+87 (F2)
PB2 polymerase 2300–2500 759
PA polymerase 2200–2300 716
HA Hemagglutinin 1700–1800 550
NP nucleoprotein 1500–1600 498
NA Neuraminidase 1400–1500 454
M Membrane protein(s) 1000–1100 252+97
NS non-structural protein(s) 800–900 230+121

The Genome sequence has terminal repeated sequences; repeated at both ends. Terminal repeats at the 5'-end 12–13 nucleotides long. Nucleotide sequences of 3'-terminus identical; the same in genera of same family; most on RNA (segments), or on all RNA species. Terminal repeats at the 3'-end 9–11 nucleotides long. Encapsidated nucleic acid is solely genomic. Each virion may contain defective interfering copies. In Influenza A (H1N1) PB1-F2 is produced from an alternative reading frame in PB1. The M and NS genes produce 2 different genes via alternative splicing.

Structure

The following applies for Influenza A viruses, although other influenza strains are very similar in structure:

The influenza A virus particle or virion is 80–120 nm in diameter, usually producing both ellipsoidal, baciliform, and filamentous particles. Unusually for a virus, the influenza A genome is not a single piece of nucleic acid; instead, it contains eight pieces of segmented negative-sense RNA (13.5 kilobases total), which encode 11 proteins (HA, NA, NP, M1, M2, NS1, NEP, PA, PB1, PB1-F2, PB2). The best-characterised of these viral proteins are hemagglutinin and neuraminidase, two large glycoproteins found on the outside of the viral particles. Neuraminidase is an enzyme involved in the release of progeny virus from infected cells, by cleaving sugars that bind the mature viral particles. By contrast, hemagglutinin is a lectin that mediates binding of the virus to target cells and entry of the viral genome into the target cell. The hemagglutinin (H) and neuraminidase (N) proteins are targets for antiviral drugs. These proteins are also recognised by antibodies, i.e. they are antigens. The responses of antibodies to these proteins are used to classify the different serotypes of influenza A viruses, hence the H and N in H5N1.

Replication cycle

Invasion and replication of the influenza virus. The steps in this process are discussed in the text.

Typically, influenza is transmitted from infected mammals through the air by coughs or sneezes, creating aerosols containing the virus, and from infected birds through their droppings. Influenza can also be transmitted by saliva, nasal secretions, feces and blood. Infections occur through contact with these bodily fluids or with contaminated surfaces. Out of a host, flu viruses can remain infectious for about one week at human body temperature, over 30 days at 0 °C (32 °F), and indefinitely at very low temperatures (such as lakes in northeast Siberia). They can be inactivated easily by disinfectants and detergents.

The viruses bind to a cell through interactions between its hemagglutinin glycoprotein and sialic acid sugars on the surfaces of epithelial cells in the lung and throat (Stage 1 in infection figure). The cell imports the virus by endocytosis. In the acidic endosome, part of the haemagglutinin protein fuses the viral envelope with the vacuole's membrane, releasing the viral RNA (vRNA) molecules, accessory proteins and RNA-dependent RNA polymerase into the cytoplasm (Stage 2). These proteins and vRNA form a complex that is transported into the cell nucleus, where the RNA-dependent RNA polymerase begins transcribing complementary positive-sense cRNA (Steps 3a and b). The cRNA is either exported into the cytoplasm and translated (step 4), or remains in the nucleus. Newly synthesised viral proteins are either secreted through the Golgi apparatus onto the cell surface (in the case of neuraminidase and hemagglutinin, step 5b) or transported back into the nucleus to bind vRNA and form new viral genome particles (step 5a). Other viral proteins have multiple actions in the host cell, including degrading cellular mRNA and using the released nucleotides for vRNA synthesis and also inhibiting translation of host-cell mRNAs.

Negative-sense vRNAs that form the genomes of future viruses, RNA-dependent RNA transcriptase, and other viral proteins are assembled into a virion. Hemagglutinin and neuraminidase molecules cluster into a bulge in the cell membrane. The vRNA and viral core proteins leave the nucleus and enter this membrane protrusion (step 6). The mature virus buds off from the cell in a sphere of host phospholipid membrane, acquiring hemagglutinin and neuraminidase with this membrane coat (step 7). As before, the viruses adhere to the cell through hemagglutinin; the mature viruses detach once their neuraminidase has cleaved sialic acid residues from the host cell. After the release of new influenza virus, the host cell dies.

Orthomyxoviridae viruses are one of two RNA viruses that replicate in the nucleus (the other being retroviridae). This is because the machinery of orthomyxo viruses cannot make their own mRNAs. They use cellular RNAs as primers for initiating the viral mRNA synthesis in a process known as cap snatching. Once in the nucleus, the RNA Polymerase Protein PB2 finds a cellular pre-mRNA and binds to its 5' capped end. Then RNA Polymerase PA cleaves off the cellular mRNA near the 5' end and uses this capped fragment as a primer for transcribing the rest of the viral RNA genome in viral mRNA. This is due to the need of mRNA to have a 5' cap in order to be recognized by the cell's ribosome for translation.

Since RNA proofreading enzymes are absent, the RNA-dependent RNA transcriptase makes a single nucleotide insertion error roughly every 10 thousand nucleotides, which is the approximate length of the influenza vRNA. Hence, nearly every newly manufactured influenza virus will contain a mutation in its genome. The separation of the genome into eight separate segments of vRNA allows mixing (reassortment) of the genes if more than one variety of influenza virus has infected the same cell (superinfection). The resulting alteration in the genome segments packaged into viral progeny confers new behavior, sometimes the ability to infect new host species or to overcome protective immunity of host populations to its old genome (in which case it is called an antigenic shift).

Viability and disinfection

Mammalian influenza viruses tend to be labile, but can survive several hours in mucus. Avian influenza virus can survive for 100 days in distilled water at room temperature, and 200 days at 17 °C (63 °F). The avian virus is inactivated more quickly in manure, but can survive for up to 2 weeks in feces on cages. Avian influenza viruses can survive indefinitely when frozen. Influenza viruses are susceptible to bleach, 70% ethanol, aldehydes, oxidizing agents, and quaternary ammonium compounds. They are inactivated by heat of 133 °F (56 °C) for minimum of 60 minutes, as well as by low pH <2 .="" p="">

Vaccination and prophylaxis

Vaccines and drugs are available for the prophylaxis and treatment of influenza virus infections. Vaccines are composed of either inactivated or live attenuated virions of the H1N1 and H3N2 human influenza A viruses, as well as those of influenza B viruses. Because the antigenicities of the wild viruses evolve, vaccines are reformulated annually by updating the seed strains.

When the antigenicities of the seed strains and wild viruses do not match, vaccines fail to protect the vaccinees. In addition, even when they do match, escape mutants are often generated.

Drugs available for the treatment of influenza include Amantadine and Rimantadine, which inhibit the uncoating of virions by interfering with M2, and Oseltamivir (marketed under the brand name Tamiflu), Zanamivir, and Peramivir, which inhibit the release of virions from infected cells by interfering with NA. However, escape mutants are often generated for the former drug and less frequently for the latter drug.

Mushroom poisoning

From Wikipedia, the free encyclopedia
 
Mushroom poisoning
Other namesMycetism, mycetismus
Amanita phalloides 1.JPG
Amanita phalloides accounts for the majority of fatal mushroom poisonings worldwide.
SpecialtyEmergency medicine, toxicology

Mushroom poisoning refers to harmful effects from ingestion of toxic substances present in a mushroom. These symptoms can vary from slight gastrointestinal discomfort to death in about 10 days. The toxins present are secondary metabolites produced by the fungus. Mushroom poisoning is usually the result of ingestion of wild mushrooms after misidentification of a toxic mushroom as an edible species. The most common reason for this misidentification is close resemblance in terms of colour and general morphology of the toxic mushrooms species with edible species. To prevent mushroom poisoning, mushroom gatherers familiarize themselves with the mushrooms they intend to collect, as well as with any similar-looking toxic species. The safety of eating wild mushrooms may depend on methods of preparation for cooking.

Signs and symptoms

Poisonous mushrooms contain a variety of different toxins that can differ markedly in toxicity. Symptoms of mushroom poisoning may vary from gastric upset to organ failure resulting in death. Serious symptoms do not always occur immediately after eating, often not until the toxin attacks the kidney or liver, sometimes days or weeks later.

The most common consequence of mushroom poisoning is simply gastrointestinal upset. Most "poisonous" mushrooms contain gastrointestinal irritants that cause vomiting and diarrhea (sometimes requiring hospitalization), but usually no long-term damage. However, there are a number of recognized mushroom toxins with specific, and sometimes deadly, effects:

Toxin Toxicity Effects
Alpha-amanitin Deadly Causes often fatal liver damage 1–3 days after ingestion. Principal toxin in the death cap.
Phallotoxin Non-lethal Causes extreme gastrointestinal upset. Found in various mushrooms.
Orellanine Deadly Redox cycler similar to paraquat. Causes kidney failure within 3 weeks after ingestion. Principal toxin in genus Cortinarius.
Muscarine Potentially deadly Causes SLUDGE syndrome. Found in various mushrooms. Antidote is atropine
Monomethylhydrazine (MMH) Deadly Causes brain damage, seizures, gastrointestinal upset, and hemolysis. Metabolic poison. Principal toxin in genus Gyromitra. Antidote is large doses of intravenous pyridoxine hydrochloride[1]
Coprine Non-lethal Causes illness when consumed with alcohol. Principal toxin in genus Coprinus.
Ibotenic acid Potentially deadly Excitotoxin. Principal toxin in Amanita muscaria, A. pantherina, and A. gemmata.
Muscimol Potentially deadly Causes CNS depression and hallucinations. Principal toxin in Amanita muscaria, A. pantherina, and A. gemmata.
Arabitol Non-lethal Causes diarrhea in some people.
Bolesatine Non-lethal Causes gastrointestinal irritation, vomiting, nausea.
Ergotamine Deadly Affects the vascular system and can lead to loss of limbs and/or cardiac arrest. Found in genus Claviceps.
The period of time between ingestion and the onset of symptoms varies dramatically between toxins, some taking days to show symptoms identifiable as mushroom poisoning.
  • Alpha-amanitin: For 6–12 hours, there are no symptoms. This is followed by a period of gastrointestinal upset (vomiting and profuse, watery diarrhea). This stage is caused primarily by the phallotoxins and typically lasts 24 hours. At the end of this second stage is when severe liver damage begins. The damage may continue for another 2–3 days. Kidney damage can also occur. Some patients will require a liver transplant. Amatoxins are found in some mushrooms in the genus Amanita, but are also found in some species of Galerina and Lepiota. Overall, mortality is between 10 and 15 percent. Recently, Silybum marianum or blessed milk thistle has been shown to protect the liver from amanita toxins and promote regrowth of damaged cells.
  • Orellanine: This toxin causes no symptoms for 3–20 days after ingestion. Typically around day 11, the process of kidney failure begins, and is usually symptomatic by day 20. These symptoms can include pain in the area of the kidneys, thirst, vomiting, headache, and fatigue. A few species in the very large genus Cortinarius contain this toxin. People having eaten mushrooms containing orellanine may experience early symptoms as well, because the mushrooms often contain other toxins in addition to orellanine. A related toxin that causes similar symptoms but within 3–6 days has been isolated from Amanita smithiana and some other related toxic Amanitas.
  • Muscarine: Muscarine stimulates the muscarinic receptors of the nerves and muscles. Symptoms include sweating, salivation, tears, blurred vision, palpitations, and, in high doses, respiratory failure. Muscarine is found in mushrooms of the genus Omphalotus, notably the jack o' Lantern mushrooms. It is also found in A. muscaria, although it is now known that the main effect of this mushroom is caused by ibotenic acid. Muscarine can also be found in some Inocybe species and Clitocybe species, in particular Clitocybe dealbata, and some red-pored Boletes.
  • Gyromitrin: Stomach acids convert gyromitrin to monomethylhydrazine (MMH), a compound employed in rocket fuel. It affects multiple body systems. It blocks the important neurotransmitter GABA, leading to stupor, delirium, muscle cramps, loss of coordination, tremors, and/or seizures. It causes severe gastrointestinal irritation, leading to vomiting and diarrhea. In some cases, liver failure has been reported. It can also cause red blood cells to break down, leading to jaundice, kidney failure, and signs of anemia. It is found in mushrooms of the genus Gyromitra. A gyromitrin-like compound has also been identified in mushrooms of the genus Verpa.
  • Coprine: Coprine is metabolized to a chemical that resembles disulfiram. It inhibits aldehyde dehydrogenase (ALDH), which, in general, causes no harm, unless the person has alcohol in their bloodstream while ALDH is inhibited. This can happen if alcohol is ingested shortly before or up to a few days after eating the mushrooms. In that case the alcohol cannot be completely metabolized, and the person will experience flushed skin, vomiting, headache, dizziness, weakness, apprehension, confusion, palpitations, and sometimes trouble breathing. Coprine is found mainly in mushrooms of the genus Coprinus, although similar effects have been noted after ingestion of Clitocybe clavipes.
  • Ibotenic acid: Decarboxylates into muscimol upon ingestion. The effects of muscimol vary, but nausea and vomiting are common. Confusion, euphoria, or sleepiness are possible. Loss of muscular coordination, sweating, and chills are likely. Some people experience visual distortions, a feeling of strength, or delusions. Symptoms normally appear after 30 minutes to 2 hours and last for several hours. A. muscaria, the "Alice in Wonderland" mushroom, is known for the hallucinatory experiences caused by muscimol, but A. pantherina and A. gemmata also contain the same compound. While normally self-limiting, fatalities have been associated with A. pantherina, and consumption of a large number of any of these mushrooms is likely to be dangerous.
  • Arabitol: A sugar alcohol, similar to mannitol, which causes no harm in most people but causes gastrointestinal irritation in some. It is found in small amounts in oyster mushrooms, and considerable amounts in Suillus species and Hygrophoropsis aurantiaca (the "false chanterelle").

Causes

New species of fungi are continuing to be discovered, with an estimated number of 800 new species registered annually. This, added to the fact that many investigations have recently reclassified some species of mushrooms from edible to poisonous has made older classifications insufficient at describing what now is known about the different species of fungi that are harmful to humans. Thus, contrary to what older registers state, it is now thought that of the approximately 100,000 known fungi species found worldwide, about 100 of them are poisonous to humans. However, by far the majority of mushroom poisonings are not fatal, and the majority of fatal poisonings are attributable to the Amanita phalloides mushroom.

Amanita spp., immature, possibly poisonous, Amanita mushrooms.
 
Edible shaggy mane Coprinus comatus mushrooms.
 
A majority of these cases are due to mistaken identity. This is a common occurrence with A. phalloides in particular, due to its resemblance to the Asian paddy-straw mushroom, Volvariella volvacea. Both are light-colored and covered with a universal veil when young.

Amanitas can be mistaken for other species, as well, in particular when immature. On at least one occasion they have been mistaken for Coprinus comatus. In this case, the victim had some limited experience in identifying mushrooms, but did not take the time to correctly identify these particular mushrooms until after he began to experience symptoms of mushroom poisoning.

Amanitas, two examples of immature Amanitas, one deadly and one edible.
 
Puffball, an edible puffball mushroom, which closely resembles the immature Amanitas.
 
The author of Mushrooms Demystified, David Arora cautions puffball-hunters to beware of Amanita "eggs", which are Amanitas still entirely encased in their universal veil. Amanitas at this stage are difficult to distinguish from puffballs. Foragers are encouraged to always cut the fruiting bodies of suspected puffballs in half, as this will reveal the outline of a developing Amanita should it be present within the structure.

A majority of mushroom poisonings in general are the result of small children, especially toddlers in the "grazing" stage, ingesting mushrooms found in the lawn. While this can happen with any mushroom, Chlorophyllum molybdites is often implicated due to its preference for growing in lawns. C. molybdites causes severe gastrointestinal upset but is not considered deadly poisonous.

A few poisonings are the result of misidentification while attempting to collect hallucinogenic mushrooms for recreational use. In 1981, one fatality and two hospitalizations occurred following consumption of Galerina autumnalis, mistaken for a Psilocybe species. Galerina and Psilocybe species are both small, brown, and sticky, and can be found growing together. However, Galerina contains amatoxins, the same poison found in the deadly Amanita species. Another case reports kidney failure following ingestion of Cortinarius orellanus, a mushroom containing orellanine.

It is natural that accidental ingestion of hallucinogenic species also occurs, but is rarely harmful when ingested in small quantities. Cases of serious toxicity have been reported in small children. Amanita pantherina, while containing the same hallucinogens as Amanita muscaria (e.g., ibotenic acid and muscimol), has been more commonly associated with severe gastrointestinal upset than its better-known counterpart.

Jack-O-Lantern, a poisonous mushroom sometimes mistaken for a chanterelle.
 
Chanterelle, edible.
 
Although usually not fatal, Omphalotus spp., "Jack-o-lantern mushrooms," are another cause of sometimes significant toxicity. They are sometimes mistaken for chanterelles. Both are bright-orange and fruit at the same time of year, although Omphalotus grows on wood and has true gills rather than the veins of a Cantharellus. They contain toxins known as illudins, which causes gastrointestinal symptoms. 

Bioluminescent species are generally inedible and often mildly toxic.

Clitocybe dealbata, which is occasionally mistaken for an oyster mushroom or other edible species contains muscarine.

Toxicities can also occur with collection of morels. Even true morels, if eaten raw, will cause gastrointestinal upset. Typically, morels are thoroughly cooked before eating. Verpa bohemica, although referred to as "thimble morels" or "early morels" by some, have caused toxic effects in some individuals. Gyromitra spp., "false morels", are deadly poisonous if eaten raw. They contain a toxin called gyromitrin, which can cause neurotoxicity, gastrointestinal toxicity, and destruction of the blood cells. The Finns consume Gyromitra esculenta after parboiling, but this may not render the mushroom entirely safe, resulting in its being called the "fugu of the Finnish cuisine".

A more unusual toxin is coprine, a disulfiram-like compound that is harmless unless ingested within a few days of ingesting alcohol. It inhibits aldehyde dehydrogenase, an enzyme required for breaking down alcohol. Thus, the symptoms of toxicity are similar to being hung over—flushing, headache, nausea, palpitations, and, in severe cases, trouble breathing. Coprinus species, including Coprinopsis atramentaria, contain coprine. Coprinus comatus does not, but it is best to avoid mixing alcohol with other members of this genus.

Recently, poisonings have also been associated with Amanita smithiana. These poisonings may be due to orellanine, but the onset of symptoms occurs in 4 to 11 hours, which is much quicker than the 3 to 20 days normally associated with orellanine.

Paxillus involutus is also inedible when raw, but is eaten in Europe after pickling or parboiling. However, after the death of the German mycologist Dr Julius Schäffer, it was discovered that the mushroom contains a toxin that can stimulate the immune system to attack its own red blood cells. This reaction is rare, but can occur even after safely eating the mushroom for many years. Similarly, Tricholoma equestre was widely considered edible and good, until it was connected with rare cases of rhabdomyolysis.

In the fall of 2004, thirteen deaths were associated with consumption of Pleurocybella porrigens or "angel's wings". In general, these mushrooms are considered edible. All the victims died of an acute brain disorder, and all had pre-existing kidney disease. The exact cause of the toxicity was not known at this time and the deaths cannot be definitively attributed to mushroom consumption.

However, mushroom poisoning is not always due to mistaken identity. For example, the highly toxic ergot Claviceps purpurea, which grows on rye, is sometimes ground up with rye, unnoticed, and later consumed. This can cause devastating, even fatal effects, which is called ergotism.

Cases of idiosyncratic or unusual reactions to fungi can also occur. Some are probably due to allergy, others to some other kind of sensitivity. It is not uncommon for an individual person to experience gastrointestinal upset associated with one particular mushroom species or genus.

Some mushrooms might concentrate toxins from their growth substrate, such as Chicken of the Woods growing on yew trees.

Poisonous mushrooms

Of the most lethal mushrooms, three—the death cap (A. phalloides), destroying angels (A. virosa and A. bisporigera), and the fool's mushroom (A. verna)—belong to the genus Amanita, and two more—the deadly webcap (C. rubellus), and the fool's webcap (C. orellanus)—are from the genus Cortinarius. Several species of Galerina, Lepiota, and Conocybe also contain lethal amounts of amatoxins. Deadly species are listed in the List of deadly fungi.

The following species may cause great discomfort, sometimes requiring hospitalization, but are not considered deadly.

Prognosis and treatment

Some mushrooms contain less toxic compounds and, therefore, are not severely poisonous. Poisonings by these mushrooms may respond well to treatment. However, certain types of mushrooms contain very potent toxins and are very poisonous; so even if symptoms are treated promptly mortality is high. With some toxins, death can occur in a week or a few days. Although a liver or kidney transplant may save some patients with complete organ failure, in many cases there are no organs available. Patients hospitalized and given aggressive support therapy almost immediately after ingestion of amanitin-containing mushrooms have a mortality rate of only 10%, whereas those admitted 60 or more hours after ingestion have a 50–90% mortality rate.

Society and culture

Folk traditions

Many folk traditions concern the defining features of poisonous mushrooms. However, there are no general identifiers for poisonous mushrooms, so such traditions are unreliable. Guidelines to identify particular mushrooms exist, and will serve only if one knows which mushrooms are toxic.

Examples of erroneous folklore "rules" include:
  • "Poisonous mushrooms are brightly colored." – Indeed, fly agaric, usually bright-red to orange or yellow, is narcotic and hallucinogenic, although no human deaths have been reported. The deadly destroying angel, in contrast, is an unremarkable white. The deadly Galerinas are brown. Some choice edible species (chanterelles, Amanita caesarea, Laetiporus sulphureus, etc.) are brightly colored, whereas most poisonous species are brown or white.
  • "Insects/animals will avoid toxic mushrooms." – Fungi that are harmless to invertebrates can still be toxic to humans; the death cap, for instance, is often infested by insect larvae.
  • "Poisonous mushrooms blacken silver." – None of the known mushroom toxins have a reaction with silver.
  • "Poisonous mushrooms taste bad." – People who have eaten the deadly Amanitas and survived have reported that the mushrooms tasted quite good.
  • "All mushrooms are safe if cooked/parboiled/dried/pickled/etc." – While it is true that some otherwise-inedible species can be rendered safe by special preparation, many toxic species cannot be made toxin-free. Many fungal toxins are not particularly sensitive to heat and so are not broken down during cooking; in particular, α-amanitin, the poison produced by the death cap (Amanita phalloides) and others of the genus, is not denatured by heat.
  • "Poisonous mushrooms will turn rice red when boiled." – A number of Laotian refugees were hospitalized after eating mushrooms (probably toxic Russula species) deemed safe by this folklore rule and this misconception cost at least one person her life.
  • "Poisonous mushrooms have a pointed cap. Edible ones have a flat, rounded cap." – The shape of the mushroom cap does not correlate with presence or absence of mushroom toxins, so this is not a reliable method to distinguish between edible and poisonous species. Death cap, for instance, has a rounded cap when mature.
  • "Boletes are, in general, safe to eat." – It is true that, unlike a number of Amanita species in particular, in most parts of the world, there are no known deadly varieties of the genus Boletus, which reduces the risks associated with misidentification. However, mushrooms like the Devil's bolete are poisonous both raw and cooked and can lead to strong gastrointestinal symptoms, and other species like the lurid bolete require thorough cooking to break down toxins. As with other mushroom genera, proper caution is, therefore, advised in determining the correct species.

Notable cases

In fiction

  • In the civil war drama The Beguiled, Clint Eastwood's character John McBurney, an injured Union soldier at a boarding school for girls, was poisoned by a jealous, vengeful headmistress and her young female students. The headmistress was played by Geraldine Page.
  • In Bollywood movie 7 Khoon Maaf, Modhusudhon Tarafdar (Naseeruddin Shah), a Bengali doctor who rescues Susanna from a suicide attempt and marries her, tries to poison Susanna with mushroom soup several years later for her inheritance.
  • Linda Howard's action/romance novel Kiss Me While I Sleep has the anti-heroine use synthetic orellanine as a weapon.
  • In Julius Streicher's Nazi propaganda children's book The Poisonous Mushroom, Jews are compared to deadly fungi.
  • In "The Story of Babar" by Jean de Brunhoff, the King of the Elephants died from eating a poisonous mushroom.
  • The 1993 Italian film Fiorile features a woman who takes revenge on her brother by feeding him poisonous mushrooms.
  • In the 2006 Game Boy Advance video game title 'Mother 3' the main protagonists, Lucas and friends, ingest poisonous mushrooms and have a bad trip.
  • In the 2017 film "Phantom Thread", Alma fed poisonous mushrooms to the renowned fashion designer Reynolds Woodcock.

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