Emily Johnson
There are several species of wild mushrooms that have been observed to cause an increase in plasma creatine kinase (CK) activities. Tricholoma flavovirens, Boletus edulis, and Tricholoma equestre have all been linked to an increase in CK levels, with the latter also causing acute poisoning in some cases. While the toxic mechanism and substances of these mushrooms are not yet fully understood, the consumption of wild mushrooms is largely based on tradition rather than scientific evidence.
| Characteristics | Values |
|---|---|
| Edible Mushrooms that may cause increase in CK levels | Tricholoma flavovirens, Tricholoma equestre, Flammulina velutipes |
| Symptoms of Mushroom Poisoning | Fatigue, nausea without vomiting, muscle pain, profuse sweating without fever, respiratory insufficiency, weakness and pain in legs |
| Maximum CK levels observed | 8011 IU/L |
| Other maximum levels observed | AST – 408 IU/L, ALT – 154 IU/L, urea – 17.4 mmol/l |
| Laboratory Tests with abnormal results | Creatine kinase (CK), aspartate aminotransferase (AST), alanine aminotransferase (ALT) |
| Laboratory Tests with normal results | Creatinine, troponin I, alkaline phosphatase, total bilirubin, SPA (INR), full blood count |
| Urine Test abnormal results | Severe erythrocyturia – 250 erythrocytes per litre |
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What You'll Learn
Tricholoma equestre (T. equestre) poisoning
Tricholoma equestre (T. equestre), commonly known as the man on horseback or yellow knight, is a species of fungus that forms ectomycorrhiza with pine trees. While it has long been considered a tasty edible mushroom, there have been several reports of T. equestre poisoning, including lethal outcomes.
T. equestre poisoning typically occurs after repeated ingestion of large amounts of the mushroom. Symptoms of poisoning include fatigue, muscle weakness, myalgia, loss of appetite, nausea, and profuse sweating without fever. Laboratory tests of patients with T. equestre poisoning show elevated levels of creatine kinase (CK), aspartate aminotransferase (AST), and alanine aminotransferase (ALT), indicating muscle toxicity and damage to skeletal muscle fibres. The urine may also become dark in colour due to the presence of the muscular protein myoglobin.
In severe cases of T. equestre poisoning, respiratory insufficiency and cardiac changes may occur, leading to a heart attack. Treatment for T. equestre poisoning includes hospitalization, with symptoms and biochemical abnormalities resolving within 23 days.
To avoid T. equestre poisoning, it is recommended to refrain from harvesting and consuming this species of mushroom. It can easily be mistaken for other members of the Tricholoma genus, so proper identification is crucial.
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T. equestre and rhabdomyolysis
T. equestre, or Tricholoma equestre, is a common edible mushroom that is considered toxic under certain conditions. Repeated ingestion of large amounts of T. equestre can cause severe rhabdomyolysis, a condition that results from muscle injury and the release of large quantities of myoglobin, which binds to plasma globulin. When the binding capacity of the plasma protein is exceeded, it is filtered by the glomeruli and reaches the tubules.
There have been several reported cases of rhabdomyolysis after the ingestion of T. equestre. Traditional Lithuanian cuisine regards this mushroom as edible and delicious, and it is often served fried or boiled as a main course. However, in one report, four cases of acute poisoning caused by T. equestre were presented, including one lethal outcome in Lithuania between 2004 and 2013. The symptoms of poisoning included fatigue, nausea without vomiting, muscle pain, profuse sweating without fever, and respiratory insufficiency. Laboratory tests showed an elevation of creatine kinase (CK), aspartate aminotransferase (AST), and alanine aminotransferase (ALT).
The association between T. equestre consumption and rhabdomyolysis has also been confirmed in mice, with increased levels of plasmatic creatine kinase (CK), Alanine aminotransferase (ALAT), and Aspartate aminotransferase (ASAT) activities observed. In addition, repeated consumption of T. equestre can trigger myo-, cardio-, and hepatotoxic effects in mice.
The toxic mechanism and toxic substances of T. equestre remain unclear, and the relation between the picking time, place, and toxicity of the mushroom is not known. However, it is important to note that just one or two cases of poisoning by T. equestre are registered in Lithuania per year, and most poisonings go unidentified due to delayed and unspecific clinical symptoms.
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Psilocybin-containing mushrooms and cardiac arrest
Psilocybin-containing mushrooms, also known as psychedelic mushrooms, magic mushrooms, or simply shrooms, have been used for centuries by indigenous people for spiritual and religious purposes. In recent decades, their usage has increased significantly, particularly among adolescents and young adults, for recreational purposes. While they are known to have a low side-effect profile and toxicity, with most side effects being benign and self-limiting, there have been rare cases of severe clinical complications, including hyperthermia, seizures, coma, and acute kidney injury.
One particular case of cardiac arrest associated with psilocybin use was reported in a 48-year-old male with a history of attention-deficit/hyperactivity disorder (ADHD) who was taking lisdexamfetamine medication. The patient experienced a syncopal episode, or fainting spell, witnessed by his wife at home. Upon arrival, emergency medical services (EMS) found the patient unresponsive and in ventricular fibrillation, a life-threatening condition where the heart beats in an abnormal rhythm. The patient was defibrillated, which resolved the ventricular fibrillation but resulted in a different type of abnormal heart rhythm called supraventricular tachycardia. He was then successfully cardioverted, which restored a normal heart rhythm, and he was intubated and sedated. The presence of psilocybin-containing mushrooms at the scene, identified by the patient's wife, suggested a possible link between his cardiac arrest and mushroom ingestion.
While this case report indicates a potential relationship between psilocybin use and cardiac arrest, it is important to note that the patient's medical history, including ADHD and lisdexamfetamine use, may have contributed to the episode. Additionally, the patient's family history of sudden cardiac deaths among first-degree relatives further complicates the understanding of the exact cause of the cardiac arrest. More research is needed to fully understand the effects of psilocybin on the cardiovascular system and to determine if there is a causal relationship between psilocybin-containing mushroom ingestion and cardiac arrest.
Furthermore, it is worth mentioning that mushroom poisoning (MP) is a global health issue, and certain species of mushrooms are known to cause cardiac arrhythmias and, in rare cases, cardiac arrest. However, these cases are typically associated with specific mushroom species such as Amanita phalloides, Panaeolus subbalteatus, and Conocybe lactea, which are known for their hepatic, renal, and neurological toxicity rather than their direct cardiotoxicity. The consumption of wild mushrooms, especially without proper identification, can lead to serious health risks, including potential cardiac complications.
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T. flavovirens and increased CK in mice
Tricholoma flavovirens, also known as Tricholoma equestre, is a wild mushroom species that was previously considered edible and tasty. However, recent studies have shown that it can cause delayed rhabdomyolysis in humans and elevated creatine kinase (CK) activities in mice.
In one study, 42 mice and 4 humans consumed T. flavovirens mixed with regular food items. The results showed that plasma creatine kinase activity increased in mice at 9 g kg(-1)day(-1). Similar effects were observed with Boletus edulis, indicating that this may not be a species-specific response and may require individual sensitivity and a large amount of ingested mushroom to manifest.
Another study examined the effects of prolonged T. flavovirens consumption at 12 g freshly frozen mushroom kg(-1) day(-1) on mice. The results showed that the exposed mice had higher plasma CK and CK-MB activities and higher plasma bilirubin concentrations compared to control mice. These findings indicate hepato-, myo-, and cardiotoxicity. Additionally, pericardial lymphocyte infiltrates were present in the mice that consumed the mushroom, further suggesting cardiac toxicity.
A separate study investigated the effects of T. flavovirens on laboratory mice (Mus musculus). The results showed that 4-6 g of powdered T. flavovirens kg(-1) body mass divided over 3 days increased serum CK activities and caused various adverse effects, including tachypnea, reduced motor activity, diarrhoea, and muscle fibre disorganization.
In summary, these studies provide evidence that T. flavovirens can lead to increased CK levels in mice, indicating potential hepatic, myotoxic, and cardiotoxic effects. Further research is necessary to fully understand the mechanisms of T. flavovirens poisoning and its specific effects on CK levels in mice and humans.
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Boletus edulis and increased CK in mice
The consumption of wild mushrooms is largely based on tradition rather than scientific evidence. In a study, 42 mice and 4 humans consumed Tricholoma flavovirens mixed with regular food items. In mice, plasma creatine kinase (CK) activity increased at 9 g kg(-1)day(-1). The same was observed with Boletus edulis, a well-known and commercially important mushroom species.
The study found that the effect was likely not species-specific but rather an unspecific response that requires individual sensitivity and a large amount of ingested mushroom to manifest. The authors recommended a screening program to clarify how widespread this effect is among wild mushrooms.
Boletus edulis, also known as king bolete or French cèpe, is a highly appreciated and widely consumed mushroom species. It is one of the most frequently eaten fungi among those harvested in natural conditions in Europe. However, questions have been raised about the presence of allergens in this species.
In the study, mice that consumed Boletus edulis exhibited increased plasma creatine kinase activity, indicating potential myotoxicity. This finding suggests that Boletus edulis may contain chemical compounds that can lead to elevated CK levels and potential muscle damage. However, it is important to note that the histologic appearance of muscle and liver samples from the experimental mice remained unaffected.
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Frequently asked questions
Yes, the ingestion of certain wild mushrooms, such as Tricholoma flavovirens, Boletus edulis, and Tricholoma equestre, has been linked to increased CK levels in both human and animal studies.
Creatine kinase (CK) is an enzyme found in the heart, brain, and skeletal muscles. Elevated levels of CK in the blood can indicate muscle damage or injury.
Symptoms of mushroom poisoning related to elevated CK include fatigue, nausea, muscle pain, excessive sweating, and respiratory problems.
The time frame for the onset of symptoms may vary depending on the type of mushroom and the amount ingested. In some cases, symptoms may appear as early as a few hours after consumption, while in other cases, it may take a few days.
The long-term effects of mushroom-induced CK elevation are not well understood. However, in rare cases, repeated ingestion of certain mushrooms, such as T. equestre, has been linked to severe rhabdomyolysis and potential cardiac changes.
