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Preventing mushroom poisonings depends on cooperation between clinical doctors, CDC experts, and mycologists as well as the application of internet technology tools (1). Systematic epidemiological investigations, timely and accurate species identification, toxin detection, and appropriate diagnosis and treatment are key to properly controlling mushroom poisoning events.
In 2020, a total of 676 independent mushroom poisoning incidents from 24 provincial-level administrative divisions (PLADs) involving 1,719 patients and 25 deaths were investigated and the overall mortality was 1.45%. The number of cases ranged from 1 to 27,①and 14 outbreaks involved more than 10 patients. Of these cases, 93 patients from 24 incidents had eaten poisonous mushrooms purchased from market or given by friends; 51 patients from 12 incidents had been poisoned after eating dried mushrooms; 404 patients from 131 incidents with 7 deaths ate mixed mushrooms. Three rare clinical syndromes were recorded: Gamma-Aminobutyric Acid (GABA)-blocking mushroom poisoning caused byGyromitra venenata, Hemolysis poisoning caused byPaxillus involutus, and Shiitake mushroom dermatitis caused byLentinula edodes. Similar to 2019, mushroom poisonings occurred in every month but were centered from June to October (1). There were 2 peaks appearing in June and September involving 160 and 193 incidents, 428 and 412 patients, and 8 and 3 deaths, respectively (Figure 1).
Figure 1.Monthly distribution of mushroom poisonings in China, 2020.
In terms of geographical distribution, Southwest China [Yunnan, Guizhou, Sichuan, Chongqing, and Xizang (Tibet)] were the most severely affected region with 200 incidents, 604 patients, and 15 deaths. Central China (Hunan, Hubei, and Jiangxi) had more incidents (323 incidents), more patients (707 patients), but less deaths (4 deaths). East China (Anhui, Fujian, Jiangsu, and Zhejiang) had 82 incidents, 159 patients, and 0 deaths and were followed by the other regions: South China (Guangdong, Guangxi, and Hainan) had 33 incidents, 146 patients, and 3 deaths; North China (Beijing, Hebei, Henan, Shandong, and Shanxi) had 22 incidents, 69 patients, and 1 death; Northwest China (Ningxia and Gansu) had 13 incidents, 30 patients, and 1 death; and Northeast China (Inner Mongolia and Liaoning) had 3 incidents, 4 patients, and 1 death. In addition, 3 Burmese workers in Yunnan had gastroenteritis after eatingChlorophyllum molybdites. Detailed information for each PLAD was displayed inTable 1.
PLADs Number of incidents Number of patients Deaths Case fatality (%) Hunan 302 666 3 0.45 Yunnan 81 244 7 2.87 Guizhou 43 148 7 4.73 Zhejiang 43 78 0 0 Sichuan 40 123 1 0.81 Chongqing 35 88 0 0 Fujian 18 42 0 0 Guangxi 15 87 3 3.45 Anhui 12 30 0 0 Ningxia 12 29 1 3.45 Hubei 12 24 1 4.16 Guangdong 11 21 0 0 Jiangxi 9 17 0 0 Jiangsu 9 9 0 0 Beijing 8 23 0 0 Hainan 7 38 0 0 Hebei 7 33 0 0 Shandong 3 8 1 12.50 Henan 3 3 0 0 Inner Mongolia 2 2 1 50.00 Liaoning 1 2 0 0 Shanxi 1 2 0 0 Gansu 1 1 0 0 Xizang (Tibet) 1 1 0 0 Total 676 1,719 25 1.45 Abbreviation: PLADs=provincial-level administrative divisions. Table 1.Geographical distribution of mushroom poisoning incidents, cases, deaths, and case fatality in China, 2020.
Approximately 102 species of poisonous mushroom causing seven different clinical syndromes (acute liver failure, acute renal failure, rhabdomyolysis, hemolysis, gastroenteritis, psycho-neurological disorder, and Shiitake mushroom dermatitis) (2–3) were successfully identified. In 2020, 24 species were newly recorded as poisonous mushrooms and were added to the Chinese poisonous mushroom list. The most lethal 3 mushroom species wereLepiota brunneoincarnata,Russula subnigricans, andAmanita subpallidoroseakilling 5, 4, and 4 people, respectively (Supplementary Table S1).Chlorophyllum molybditescaused the most poisonings (appearing in 154 incidents, 304 patients), were the most widely distributed mushroom (discovered in 15 PLADs) and had the longest active period (from late March to late October) in China, 2020 (Supplementary Table S1).
Mushroom species Number of incidents Number of patients Deaths Case fatality (%) Spatial and temporal distribution Acute liver failure Amanita exitialis 11 36 2 5.56 Feb 24 to Mar 30, Guangdong;
June 22 to July 22, YunnanAmanita fuliginea 9 23 0 0 June 1 to July 18, Hunan and Guizhou Amanita fuligineaandA. neoovoideaARF 1 2 0 0 June 28, Zhejiang Amanita fuligineaandA. pseudoporphyriaARF 2 3 0 0 June 2 to 9, Hunan Amanita fuligineaandA. subjunquilleaALF 1 4 3 75.00 July 18, Guizhou Amanita fuligineaandA. oberwinkleranaARF 1 2 0 0 June 23, Hunan Amanita fuligineaandA. fritillariaG/P 3 9 0 0 June 5 to 15, Hunan Amanitacf.fuliginea 2 9 0 0 June 18 to June 19, Guizhou and Chongqing Amanita pallidorosea 4 7 0 0 June 16 to July 8, Guizhou Amanita pallidioroseaandA. sinocitrinaP 1 1 0 0 June 30, Guizhou Amanita pallidoroseaandA. fritillariaG/P 1 2 0 0 June 30, Chongqing Amanita rimosa 4 10 0 0 June 6 to 27, Hunan, Hubei, and Chongqing Amanita rimosaandLepiota brunneoincarnataALF 1 4 0 0 June 12, Hunan Amanita subjunquillea 6 28 0 0 June 18 to 28, Guizhou; Aug 20 to Sept 2, Hebei and Beijing Amanita subpallidorosea 4 8 4 50.00 Sept 16 to Oct 15, Yunnan and Guizhou Amanita subpallidiorosea, A. citrinaPandLactifluus puberulusG 1 3 0 0 Oct 20, Guizhou Amanitasp.,Psathyrella candolleanaG/P,Russulasp.UandAgaricussp.U 1 2 1 50.00 July 13, Sichuan Galerina sulciceps 6 12 2 16.67 Oct 8 to 16, Yunnan, Sichuan, and Guizhou Lepiota brunneoincarnata 14 28 5 17.86 May 13 to July 3, Hubei, Hunan, and Jiangsu; Aug 19 to 30, Ningxia, Gansu, Shandong, Hebei and Liaoning Lepiota brunneoincarnataandGymnopus dryophilusG 1 1 0 0 Sept 14, Guizhou Rhabdomyolysis Russula subnigricans 10 26 4 15.38 June 26 to Oct 4, Yunnan, Zhejiang, and Hunan Russula subnigricansandR. japonicaG 1 4 0 0 July 5, Yunnan Russula subnigricansandEntoloma prismaticumU 1 2 0 0 Aug 8, Sichuan Acute renal failure Amanita gymnopus 3 4 0 0 June 14 to July 7, Hunan and Yunnan; Oct 10, Zhejiang Amanita neoovoidea 4 4 0 0 Sept 24 to Oct 19, Hunan and Sichuan Amanita oberwinklerana 14 36 0 0 June 6 to July 5, Guizhou, Chongqing, Hunan, and Jiangsu; July 26 to Sept 25, Henan, Shanxi, Beijing, Hebei and Hunan Amanita oberwinkleranaandA. cf.ibotengutakeP 1 1 0 0 Sept 5, Beijing Amanita oberwinkleranaandA. pseudoporphyriaARF 2 3 0 0 June 3 to Sept 30, Hunan Amanita pseudoporphyria 14 49 3 6.12 June 6 to Oct 14, Hunan, Guangxi, and Yunnan Amanitaaff.pseudoporphyria 3 10 0 0 June 6 to Oct 5, Hunan Amanita pseudoporphyriaandSuillus placidusG(dried mushrooms) 1 3 0 0 Dec 16, Hunan Hemolysis Paxillus involutus 2 2 1 50.00 Sept 12 to 13, Inner Mongolia Gastroenteritis Baorangia major 1 4 0 0 May 25, Fujian Baorangia majorandB. pseudocalopusG 1 7 0 0 July 19, Yunnan Baorangiasp. 1 5 0 0 July 23, Yunnan Boletelluscf.emodensis 1 1 0 0 Aug 12, Yunnan Chlorophyllum demangeiandScleroderma aurantiacumG 1 2 0 0 July 31, Sichuan Chlorophyllum globosum 3 14 0 0 June 3 to Aug 20, Sichuan Chlorophyllum hortenseandClitocybesp.P 1 1 0 0 Oct 26, Sichuan Chlorophyllum molybdites 152 302 0 0 Mar 28 to Oct 20, Hunan, Guangxi, Zhejiang, Anhui, Sichuan, Hubei, Yunnan, Chongqing, Jiangxi, Hainan, Henan, Guangdong, Fujian, Guizhou, and Jiangsu Chlorophyllum molybditesandCh. hortenseG 1 1 0 0 Sept 13, Hunan Chlorophyllum molybditesandEntoloma omienseG 1 1 0 0 Sept 28, Hunan Chlorophyllumspp. 3 9 0 0 July 31 to Dec 14, Sichuan, Hunan, and Guangdong Cortinariussinensis.EandC. fulminoidesU(bought from market) 1 4 0 0 Sept 8, Ningxia Entoloma caespitosum 1 1 0 0 Sept 20, Hunan Entoloma omiense 28 49 0 0 June 28 to Oct 9, Hunan, Zhejiang, Hainan, and Fujian Entoloma omiense, EntolomaspUandPsathyrella candolleanaG/P 1 1 0 0 July 8, Hunan Entoloma omienseandMicropsalliotaspU 1 3 0 0 Sept 10, Fujian Entoloma omienseandSuillus placidusG 1 4 0 0 Sept 17, Guizhou Entolomacf.rhodopolium 1 5 0 0 Aug 4, Yunnan Entolomacf.sinuatum 2 4 0 0 Sept 14 to 21, Guizhou Entolomaspp. 17 51 0 0 June 5 to Oct 18, Guangxi, Guizhou, Hunan, and Yunnan Gerhardtia sinensis 4 13 0 0 Oct 7 to 11, Hunan Gymnopus densilamellatus 3 19 0 0 Feb 12 to May 31, Hunan and Guizhou Hygrophoruscf.whiteiU,Lycoperdon caudatumUandMegacollybia marginataU 1 5 0 0 Oct 9, Sichuan Hypholoma fasciculare 3 9 0 0 July 8 to Dec 4, Sichuan and Yunnan Lactarius subhirtipes 3 9 0 0 May 31 to July 26, Hunan, Guizhou, and Anhui Lactifluus deceptivus,Lf. pilosusG,Lf. aff.piperatusGandLf. puberulusG(dried mushrooms) 1 2 0 0 Feb 9, Hunan Lactifluus pseudoluteopusU 1 5 0 0 Aug 23, Yunnan Leucocoprinus cretaceousandLc. cepistipesG 1 2 0 0 Sept 13, Hunan Marasmius maximusEandMycenasp.U 1 1 0 0 July 18, Hubei Melanoleuca griseobrunneaU 1 2 0 0 May 12, Zhejiang Micropsalliota furfuracea 1 2 0 0 Sept 14, Hunan Micropsalliotasp.U,Hortiboletus rubellusEandRussula pectinatoidesE 1 2 0 0 Sept 24, Hunan Neoboletus venenatus(patients of two incidents ate dried mushrooms, bought from market) 4 9 0 0 Aug 13 to Sept 24, Xizang, Guangdong, Hunan, and Sichuan Neoboletus venenatusandScleroderma bovistaG(dried mushrooms, bought from market) 1 2 0 0 June 18, Hunan Neonothopanusaff.nambi 2 4 0 0 May 13 to July 13, Yunnan Omphalotus guepiniformis 2 10 0 0 May 28, Guangxi; Oct 4, Hunan Omphalotus olearius 2 16 0 0 Sept 9 to Nov 16, Yunnan Pholiota multicingulata 2 9 0 0 Sept 22 to Oct 5, Hunan Pulveroboletus subrufus,Russula punctipesG,Chiua virensGandSuillus pinetorumG 1 2 0 0 Dec 6, Guizhou Rubroboletus sinicusandNeoboletuscf.multipunctatusU 1 4 0 0 July 28, Guizhou Rubroboletus sinicusandRetiboletus fuscusE 1 3 0 0 June 18, Yunnan Rubroboletussp.U 1 2 0 0 July 25, Hunan Russula viridicinnamomeaE,Agaricussp.U,Termitomyces microcarpusEandLactarius vividusE 1 5 0 0 Aug 2, Sichuan Russula rufobasalis 1 1 0 0 June 10, Hunan Russula rufobasalis,Lactarius atromarginatusG,Amanita fritillariaG/PandRussula citrinaU 1 2 0 0 June 11, Hunan Russula rufobasalis,Amanita fritillariaG/P,Russula compactaE,R. nigricansE,R. subatropurpureaE,R. cf.fragrantissimaU, andCortinarius purpurascensU 1 2 0 0 June 11, Hunan Russula grata, R. cf.subfoetensG,Lactifluusaff.glaucescensG,R. fragrantissimaU,R. pseudoamoenicolorU,R. sarnariiU,R. cyanoxanthaE,R. variataE,R. vescaE,R. virescensEandEntolomacf.undatumU(dried mushrooms, bought from market) 1 3 0 0 Feb 5, Hunan Russula japonica 58 151 0 0 May 31 to Oct 15, Hunan, Zhejiang, Chongqing, Anhui, Yunnan, Guizhou, Fujian, and Hubei Russula japonica, Entoloma omienseGandAgaricussp.U 1 3 0 0 Oct 5, Hunan Russula japonica, R. cerolensE,Leotia lubricaUandPhylloporus dimorphusE 1 2 0 0 July 11, Guizhou Russula japonicaandR. foetensG 1 1 0 0 June 15, Hunan Russula japonicaandR. sanguineaG 1 3 0 0 June 10, Hunan Russula japonicaandR. puncitpesG 1 3 0 0 Oct 3, Hunan Scleroderma areolatum 1 12 0 0 Aug 12, Beijing Scleroderma cepa 4 11 0 0 July 7 to Sept 27, Yunnan, Sichuan, Hunan, and Chongqing Scleroderma citrinum 1 1 0 0 Oct 13, Hunan Suillus granulatus(dried mushrooms, bought from market) 1 2 0 0 Mar 23, Ningxia Suillus granulatus, Amanita sinocitrinaP,A. griseofoliaG/P,Russulaspp.U,Lycoperdonsp.UandGymnopussp.U 1 1 0 0 Sept 24, Hunan Suillus pinetorum 1 8 0 0 July 21, Yunnan Thicholoma highlandense 1 2 0 0 Nov 13, Yunnan Tricholoma sinopardinum, T. sinoportentosumE,Lactarius deterrimusEandAgaricussp.U 1 3 0 0 July 21, Sichuan Tricholoma stans 1 6 0 0 Nov 14, Yunnan Tylopilus neofelleus 1 1 0 0 Aug 9 to Sept 27, Yunnan and Chongqing Psycho-neurological disorder Amanita griseopantherinaandRussula foetensG 1 12 0 0 July 21, Sichuan Amanita melleiceps 5 20 0 0 May 30 to Sept 15, Hunan and Guangxi Amanita orientigemmata 1 1 0 0 Sept 23, Hunan Amanita orsonii, A. pseudovaginataUandEntolomacf.subcorvinumU 1 2 0 0 June 28, Guizhou Amanita rufoferruginea 6 18 0 0 June 6 to Aug 6, Hunan, Chongqing, and Sichuan Amanitacf.subfrostiana 1 2 0 0 July 21, Yunnan Amanita subglobosa 17 49 0 0 June 19 to Sept 24, Guizhou, Anhui, Chongqing, Sichuan, Yunnan, and Hunan Amanita sychnopyramisf.subannulata 4 42 0 0 Apr 26 to June 10, Hainan, Guangxi, and Hunan Butyriboletus roseoflavus(bought from market, maybe from Yunnan) 1 9 0 0 Nov 5, Hainan Clitocybe dealbata 1 2 0 0 July 15, Yunnan Clitocybe subditopoda 1 3 0 0 Oct 5, Guizhou Gymnopilus dilepis 6 13 0 0 June 21 to Sept 23, Sichuan, Yunnan, and Guizhou Gymnopilusspp. 5 8 0 0 May 9 to Oct 3, Jiangxi, Hubei, Hunan, and Yunnan Gyromitra venenata 2 4 0 0 Mar 13 to 21, Guizhou, Yunnan Inocybeaff.ericetorumandRussula insignisG 1 1 0 0 May 26, Hunan Inocybe serotina 1 2 0 0 Sept 19, Ningxia Inocybe serotinaandMallocybe fulvipesP 1 1 0 0 Sept 2, Ningxia Inocybe serotinaandPseudosperma umbrinellumP=Inocybe umbrinella 1 4 0 0 Aug 28, Ningxia Inocybe splendentoides 1 1 0 0 Oct 7, Beijing Inospermaaff.virosum 2 16 0 0 Sept 9 to 16, Yunnan Inospermacf.virosum 1 5 0 0 May 9, Hainan Lanmaoa asiatica 1 4 0 0 July 19, Yunnan Lanmaoa asiatica, Rubroboletus latisporusG,Suillus granulatusG,Caloboletus xiangtoushanensisUandImperatorsp.U(dried mushrooms, from Chongqing) 1 3 0 0 Aug 27, Guangdong Lanmaoa asiatica, Rubroboletus latisporusG,Tylopilus neofelleusG,Neoboletussp.UandSutoriusaff.eximiusG(dried mushrooms, from Chongqing) 1 3 0 0 Oct 13, Zhejiang Panaeolus fimicola 1 2 0 0 June 30, Shandong Pseudospermacf.bulbosissimum 1 4 0 0 Oct 5, Ningxia Pseudosperma umbrinellum,Mallocybe sicilianaP=Inocybe siciliana, Hebeloma dunenseUandPsathyrella candolleanaG/P 1 4 0 0 Sept 4, Hebei Pseudosperma yunnanense 1 1 0 0 July 10, Yunnan Psilocybe cubensis 1 2 0 0 Nov 27, Hunan Shiitake mushroom dermatitis Lentinula edodesE 1 1 0 0 Jan 5, Jiangxi Unclassified Agaricus blazeiE 1 2 0 0 Aug 25, Yunnan Amanitacf.constrictaandEntolomacf.piceinumU 1 5 0 0 Aug 7, Sichuan Amanita griseofolia 1 4 0 0 June 27, Guizhou Butyriboletus yicibusE(from Yunnan) 1 4 0 0 July 26, Hunan Coprinopsis niveaE 1 3 0 0 June 29, Hunan Coprinus comatusE 2 3 0 0 Early August to Oct 25, Beijing and Ningxia Cortinariussinensis.E(bought from market) 1 2 0 0 Sept 24, Ningxia Lactarius cinnamomeusE 1 2 0 0 Mar 14, Hunan Lactifluus tenuicystidiatusE 1 2 0 0 Aug 25, Yunnan Panus gigianteusE 1 4 0 0 Sept 20, Hunan Panus tigrinusE 1 1 0 0 May 16, Yunnan Pleurotus ostreatusE 1 1 0 0 Oct 31, Ningxia Retiboletus fuscusE(dried mushrooms, from Yunnan) 1 2 0 0 Mar 6, Fujian Russulacf.viridicinnamomeaE 1 4 0 0 July 29, Fujian Scleroderma yunnanenseE 3 7 0 0 June 25 to Sept 15, Hunan, Yunnan, and Fujian Stropharia rugosoannulataE 1 1 0 0 Jan 31, Guizhou Xerocomus parvulusE 1 4 0 0 Sept 28, Hunan Abbreviations: ALF=Acute liver failure, ARF=Acute renal failure, G= Gastroenteritis, P= Psycho to neurological disorder, U=Unclassified, E=edible.
Note: Species newly recorded as poisonous mushrooms in China are in bold.Table S1.Mushroom species involved in poisoning incidents and their spatial and temporal distribution in China, 2020.
Similar to 2019, the same 9 species causing acute liver failure were identified in China, 2020 (1).Lepiota brunneoincarnatawas found to be the most dangerous species in 2020, being responsible for 15 incidents, 29 patients, and 5 deaths as the lone cause or in combination with other species.Lepiota brunneoincarnatawas discovered under coniferous trees, but in 2 incidents occurring in 2020, it was found in hardwood forest dominated by fagaceous trees in Guizhou and underZiziphus jujubein Mengcun County, Hebei Province. The incident in Hebei Province on August 29 involved 6 patients.Amanita exitialisalso appeared in Guangdong in late February, which was earlier than in 2019 but resulted in less deaths (1). There were also more incidents of patients consuming a combination of poisonous mushrooms, which can cause greater difficulties and risks for diagnosis and treatment due to species resulting in different symptoms (Supplementary Table S1).
Amanita gymnopuswas a species discovered from poisoning investigations causing acute renal failure that was not found in 2019 (1). Due to delayed diagnosis and treatment, 3 people were killed byA. pseudoporphyriain early June in Guangxi.Amanita oberwinkleranawas discovered in 18 incidents from 8 PLADs.Amanita oberwinklerana, a species occurring in southern China, also caused 6 incidents including 11 patients in North China for the first time from late July to late September. More deaths were caused byRussula subnigricans, which leads to rhabdomyolysis, when compared to 2019 (1,Supplementary Table S1).
On September 12–13, 2 incidents involving 2 patients and 1 death caused byPaxillus involutusresulting hemolysis occurred in Chifeng and Tongliao, Inner Mongolia Autonomous Region. Clinically, this type of poisoning stimulates an autoimmune reaction, with a short incubation period (usually 30 min–3 h), followed by gastrointestinal tract effects (GIT) including nausea, vomiting, abdominal pain, and/or diarrhea. Intravascular haemolysis, anaemia, with potential secondary renal failure, shock, disseminated intravascular coagulopathy, and acute respiratory failure developed on the following few days and even caused death (3).
A total of 56 species causing gastroenteritis were identified from mushroom poisoning incidents in China in 2020 (Supplementary Table S1). Among them,Baorangia major,Chlorophyllum demangei,Entoloma caespitosum,Gymnopus densilamellatus,Lactarius atromarginatus,Lactifluus deceptivus,Lf. puberulus,Leucocoprinus cretaceous,Micropsalliota furfuracea,Neonothopanus nambi,Pholiota multicingulata,Pulveroboletus subrufus,Russula rufobasalis, andTricholoma stanswere species newly discovered as poisonous mushrooms and subsequently added to the Chinese poisonous mushroom list (1–2,4–6). This was the first report ofBaorangia majorin China. The top 3 species wereChlorophyllum molybdites,Russula japonica, andEntoloma omiense, which was the same as 2019, but these 3 species caused more incidents and had wider geographical distribution (1).
About 28 species causing psycho-neurological disorders were identified from mushroom poisoning incidents in China in 2020, includingClitocybe subditopoda,Gyromitra venenata,Inocybeaff.ericetorum,Mallocybe fulvipes,Inospermaaff.virosum,Inospermacf.virosum,Pseudospermacf.bulbosissimum, andPseudosperma yunnanense, which were species newly discovered as poisonous mushrooms and thus added to Chinese poisonous mushroom list (1–2,7–9). The top five species areAmanita subglobose,A. rufoferruginea,Gymnopilus dilepis,A. melleiceps, andA. sychnopyramisf.subannulata(Supplementary Table S1). Among them,Gyromitra venenatais a new species discovered from Yunnan and Guizhou resulting 4 patients poisoned as containing gyromitrins (7).Inospermaaff.virosumandInospermacf.virosumwere potentially two new independent species resulting in typical muscarinic syndrome post ingestion.
Lentinula edodes, commonly known as Shiitake mushroom, is one of the most famous edible mushrooms worldwide (2). Shiitake mushroom dermatitis was also reported, though its pathophysiology is unclear at present (3,10). Clinically, this type of mushroom poisoning presents 1–2 days post ingestion of raw or cooked mushrooms with sudden onset of whiplike (flagellate) linear wheals on limbs, trunk, and/or face/neck, and its toxin was assumed to be the thermolabile polysaccharide, lentinan (3,10). On January 5, an individual showed typical Shiitake mushroom dermatitis after eatingL. edodesfrom Jiangxi. However, two other people who also consumedL. edodeswere asymptomatic.
About 33 edible species were also identified from mushroom poisoning incidents in 2020 (Supplementary Table S1). These poisoning incidents may be attributed to consumption of mixed mushrooms with poisonous mushrooms, contaminated mushrooms, or some species potentially poisonous to certain people.
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When comparing incidents in 2019 to 2020, more mushroom poisoning incidents occurred (276 in 2019vs.676 in 2020) involving more patients (769vs.1719) and deaths (22vs.25) (1). As in 2019, monthly distribution analysis showed that mushroom poisonings occurred every month and were centered from June to October; however, 1 peak appeared in July in 2019 (1), while 2 peaks (June and September) appeared in 2020. Geographical distribution analysis showed that mushroom poisoning incidents were reported in 24 PLADs in 2020—among which, 16 PLADs also reported cases in 2019 with the new PLADs being Anhui, Jiangxi, Beijing, Hebei, Inner Mongolia, Liaoning, Gansu, and Xizang (Tibet) (Supplementary Table S1). The PLADs with the highest number of mushroom poisonings were Hunan, Yunnan, Guizhou, Zhejiang, and Sichuan in 2020 (Supplementary Table S1), and Hunan, Yunnan, Zhejiang, Guizhou, and Chongqing in 2019 (1). Yunnan and Guizhou had the most deaths (7) in 2020, but in 2019, Yunnan had 14 deaths (1). Approximately 102 species of poisonous mushrooms were identified in incidents in 2020, among which 35 species were also identified in 2019, and the total number reached approximately 130 species.
In Spring 2020, 4 people were poisoned by “false morels” resulting in typical metabolic-based pathology secondary to blocking of GABA synthesis in multiple organs. Clinically, the incubation period is 5–12 hours or longer, followed by gastrointestinal system effects, ataxia, hypoglycaemia, haemolysis, methaemoglobinaemia, or even hepatic damage (3). Another study showed that this species was different fromGyromitra esculentaand represented a new species described asG. venenata(7).
Paxillus involutuswas used as medicine for treating lumbago, skelalgia, and limb numbness in China and was considered edible in some areas of Northeast China, and recent studies also showed it was a good source of antioxidant (2). However,Paxillus involutuswas reported as causing hemolysis after repeated exposure, and its toxins and poisoning mechanism are still unclear (3). The 2 incidents in 2020 involving 6 people but only 2 persons were poisoned with 1 death and the other developing renal failure. For safety, we strongly advise not to collect and eat this species although it seems safe to many people.
Gerhardtia sinensiswas identified in 2 incidents involving 6 patients and treated as a highly suspected poisonous species in 2019 (1). In 2020, this species caused 4 incidents involving 13 patients and was confirmed as poisonous although its toxicology was still unclear (Supplementary Table S1). Another mushroom causing 5 people GIT on August 23 from Dehong, Yunnan, was identified asLactifluus pseudoluteopus. As no toxicological knowledge is available, this mushroom is highly suspected as poisonous presently although several closely related species are edible (4).
Patients from many mushroom poisoning incidents consumed mixed wild mushrooms (Supplementary Table S1), and these poisonous mushrooms often caused different clinical syndromes, which put them at high risk. For example, patients consuming togetherAmanita fuligineaandA. neoovoidea,A. fuligineaandA. pseudoporphyria, orA. fuligineaandA. oberwinkleranacould cause acute liver failure and acute renal failure at the same time (Supplementary Table S1).Coprinus comatusis a widely consumed mushroom, but as it is matures, coprine accumulates and may lead GIT, especially when combined with alcohol. Therefore, we strongly advise not combining consumption of mixed wild mushrooms and alcohol.
Over 1,000 edible mushrooms and approximately 500 poisonous species were reported in China (1–2,4). Morphologically, many poisonous species are similar to edible ones, e.g. the lethalRussula subnigricanscausing rhabdomyolysis is similar to the edibleR. nigricans, making it hard to differentiate and repeatedly causing poisoning incidents. Educated individuals with the ability to recognize poisonous mushrooms and people aware of the risk of eating wild mushrooms are the basis for mushroom poisoning prevention and control. Therefore, science education is of great importance for reducing mushroom poisoning. In the last few years, many educational science materials for mushroom poisonings in China were produced with cooperation from governments, CDCs, doctors, and mycologists.
Accurate and timely species identification is of pivotal importance in mushroom poisoning incidents, and progress has been made as more incidents were properly identified, which could better guide the diagnosis and treatments for patients. The number of incidents with satisfactory mushroom identification grew from only 2 during 2010–2014 (11) to over 200 in 2019 (1) and over 600 in 2020. 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. More effort and closer cooperation are still needed urgently from local and national governments, CDC staff, doctors, and mycologists to properly control mushroom poisoning events.
Acknowledgements:Profs. Zuohong Chen, Ping Zhang (Hunan Normal University), Prof. Zhuliang Yang, Gang Wu, Hong Luo, Zaiwei Ge, Yanchun Li (Kunming Institute of Botany, Chinese Academy of Sciences), Profs. Taihui Li, Wangqiu Deng, Dr. Ming Zhang (Guangdong Institute of Microbiology), Prof. Tolgor Bau (Jilin Agricultural University), Dr. Yuguang Fan (Hainan Medical University), Prof. Junfeng Liang, Dr. Jie Song (Research Institute of Tropical Forestry, Chinese Academy of Forestry), Profs. Yucheng Dai, Baokai Cui, Shuanghui He, Dr. Jing Si (Beijing Forestry University, China), Dr. Chuanhua Li (Shanghai Academy of Agricultural Sciences), Prof. Haisheng Yuan (Institute of Applied Ecology, Chinese Academy of Sciences) and Dr. Tiezheng Wei (Institute of Microbiology, Chinese Academy of Sciences); involved CDCs and hospitals.
FootNote
| ① | The median number of cases per incident was two. |
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