Abstract：
Mushroom poisonings are common in the United States. Gyromitrin (acetaldehyde N-methyl-N-formylhydrazone) is a clinically significant mycotoxin primarily associated with the lorchel (i.e. the false morel) Gyromitra esculenta. Resemblance between \'true and false morels\' has resulted in misidentification of Gyromitra spp. as edible and sought after Morchella spp., resulting in toxicity. Despite literature evidence outlining toxic sequalae, Gyromitra spp. mushrooms are commonly consumed and prepared for culinary purposes. Classic clinical teachings emphasize significant neurotoxicity, including seizures, associated with ingestion of gyromitrin-containing mushrooms, stemming from gyromitrin\'s terminal metabolite monomethylhydrazine. We performed a longitudinal descriptive review of the clinical toxicity associated with ingestion of mushroom species known or suspected to contain gyromitrin in cases reported to the Michigan Poison & Drug Information Center between January 1, 2002, to December 31, 2020. Our 19-year descriptive case series of gyromitrin-containing mushroom ingestions reported to our Center demonstrated a preponderance of gastrointestinal signs and symptoms, including hepatotoxicity. Of 118 identified cases, 108 (91.5%) of the reported ingestions involved Gyromitra esculenta. The most frequent clinical findings associated with symptomatic ingestions (n= 83) were the aforementioned gastrointestinal symptoms (n=62; 74.7%). Neurological symptoms were less frequent (n=22, 26.5%) while hepatotoxicity occurred in fewer patients (n=14; 16.9%). Of symptomatic patients, most were treated with symptomatic and supportive care (n=58; 70%). Pyridoxine was used in a total of seven patients (n=7; 8.4%) with either hepatotoxicity or neurotoxicity. Medical outcomes ranged from minor to major, with no reported deaths. Patient presentations (i.e. GI vs. neurotoxic symptoms) following ingestion of gyromitrin-containing mushrooms may be highly variable and multifactorial, owing to differences in dose ingested, geographical distribution, genetic variability of both patient and mushroom species, and species-specific differences in toxin composition. Future research warrants species-level identification of ingested gyromitrin-containing mushrooms and investigating the contribution of genetic polymorphisms to differences in clinical toxidromes.
摘要：
蘑菇中毒在美国很常见。gyromitrin（乙醛N-甲基-N-甲酰腙）是一种临床上重要的霉菌毒素，主要与lorchel（即假羊肚菌）gyromitraesculenta有关。“真羊肚菌和假羊肚菌之间的相似性导致了Gyromitraspp的错误识别。可食用，并受到羊肚菌的追捧。,导致毒性。尽管有文献证据概述了有毒的后遗症，Gyromitraspp.蘑菇通常被食用和准备用于烹饪目的。经典的临床教学强调显著的神经毒性，包括癫痫发作,与摄入含有陀螺蛋白的蘑菇有关，源于陀螺mitrin的末端代谢产物单甲基肼。我们在2002年1月1日至2020年12月31日之间向密歇根毒物和药物信息中心报告的病例中，对与摄入已知或怀疑含有陀螺蛋白的蘑菇物种相关的临床毒性进行了纵向描述性审查。我们向我们中心报告的19年描述性病例系列含有陀螺蛋白的蘑菇摄入，表现出胃肠道体征和症状占优势，包括肝毒性.在118个确诊病例中,报告的摄入中有108例（91.5％）涉及Gyromitraesculenta。与症状摄入相关的最常见的临床表现（n=83）是上述胃肠道症状（n=62；74.7％）。神经系统症状较少（n=22，26.5％），而肝毒性发生在较少的患者中（n=14；16.9％）。有症状的患者，大多数患者接受对症和支持治疗(n=58;70%).共有7例患者（n=7；8.4％）使用了吡哆醇，具有肝毒性或神经毒性。医疗结果从次要到主要，没有死亡报告。患者介绍(即GI与神经毒性症状）摄入含陀螺mitrin的蘑菇后可能是高度可变和多因素的，由于摄入剂量的差异，地理分布,患者和蘑菇物种的遗传变异，和毒素组成的物种特异性差异。未来的研究需要在物种水平上鉴定摄入的含陀螺仪的蘑菇，并研究遗传多态性对临床毒物差异的贡献。
