Sarah Brown
Mushroom poisoning is an increasingly common medical emergency, with 400 people hospitalized annually due to this diagnosis in Spain alone. The orellanus syndrome is a rare cause of acute renal failure, produced by several species from the genus Cortinarius that contain toxins called orellanines, with a marked renal tropism. The nephrotoxicity of C. orellanus was first recognized in the 1950s when this mushroom was identified as the cause of a mass poisoning in Poland. Since then, most reports of poisoning originate in Europe, where mushroom foraging is popular.
| Characteristics | Values |
|---|---|
| Mushrooms that cause Orellanus syndrome | Mushrooms of the genus Cortinarius, including Cortinarius orellanus and Cortinarius speciosissimus |
| Toxin | Orellanine |
| Symptoms | Vomiting, diarrhoea, liquid bowel movements, acute kidney injury (AKI), renal failure, interstitial nephritis, polyuria |
| Treatment | Kidney transplantation, dialysis, high-dose antioxidant therapy, steroids |
| Occurrence | More common in Europe, especially in autumn and late summer |
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What You'll Learn
- Mushrooms that cause Orellanus syndrome include Amanita phalloides and Cortinarius orellanus
- Orellanus syndrome is a rare cause of acute renal failure
- The toxin orellanine is produced by some members of the Cortinarius genus
- Mushroom poisoning is an increasingly common medical emergency
- The nephrotoxicity of Cortinarius orellanus was first recognised in the 1950s
Mushrooms that cause Orellanus syndrome include Amanita phalloides and Cortinarius orellanus
Orellanus syndrome is a rare cause of acute renal failure. It is caused by mushroom poisoning, specifically by species of the genus Cortinarius, which produce the toxin orellanine. This toxin is unique among known mushroom toxins as it is the only one to selectively target the kidney. It frequently causes acute kidney injury (AKI) in humans when ingested.
The clinical symptoms of Orellanus syndrome include delayed polyuric renal failure, with interstitial nephritis. Patients may also experience vomiting and diarrhoea.
Orellanine is also toxic to several mammals, including cats, rabbits, guinea pigs, rats, and mice. It has been identified as the toxin responsible for the nephrotoxicity of C. orellanus and C. speciosissimus mushrooms.
Mushroom poisoning is an increasingly common medical emergency. Annually, 400 people are hospitalised with this diagnosis in Spain alone.
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Orellanus syndrome is a rare cause of acute renal failure
The nephrotoxicity of the Cortinarius orellanus mushroom was first recognised in the 1950s when it was identified as the cause of a mass poisoning in Poland. Since then, most reports of poisoning have originated in Europe, where mushroom foraging is popular. However, Cortinarius species that may contain the orellanine toxin, such as C. gentilis, can also be found in Canada, Australia, the United States, and many other European countries.
Mushroom poisoning is an increasingly common medical emergency, with 400 people hospitalised with this diagnosis annually in Spain alone. It is important to be cautious when consuming wild mushrooms, especially in autumn, as this is when a significant number of poisonings occur. If a patient presents with clinical symptoms of liver and kidney involvement, mushroom poisoning, including Orellanus syndrome, must be considered, especially in regions where wild mushroom picking is common.
There is currently no causative therapy for Orellanus syndrome, and the prognosis is rather poor. Once dialysis is instituted, 50% of patients develop chronic renal failure, and kidney transplantation may be required. High-dose antioxidant therapy and steroids may improve the outcome of acute renal failure caused by Cortinarius mushrooms.
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The toxin orellanine is produced by some members of the Cortinarius genus
Mushroom poisoning is an increasingly common medical emergency, with 400 people hospitalised with this diagnosis annually in Spain alone. Mushroom poisoning is the leading cause of foodborne disease outbreaks and foodborne-related deaths in China. The Chinese Foodborne Disease Outbreak Surveillance System reported a total of 10,036 mushroom poisoning outbreaks in 2010-2020, resulting in 38,676 illnesses and 788 deaths.
The Cortinarius genus includes many species of mushrooms, some of which produce orellanine. These mushrooms can be found in Canada, Australia, the United States, and many European countries, including Poland, Scotland, France, Switzerland, Finland, Italy, Austria, Spain, Norway, Germany, Czechoslovakia, and Sweden. Most reports of poisoning originate in Europe, where mushroom foraging is popular.
The orellanus syndrome is produced by several species from the genus Cortinarius that contain toxins, orellanines, with a marked renal tropism. After a long period without any symptoms (3-17 days), patients present with polyuria and severe renal failure, which is often irreversible.
Orellanine exposure can cause early symptoms due to other components of the mushroom. Orellanine appears to be renal-specific, disrupting cellular metabolism and causing tubulointerstitial nephritis and AKI, with concomitant symptoms and complications. Studies of orellanine poisoning in rats have shown no signs of acute toxicity apart from kidney injury, but a study of orellanine poisoning in mice showed tubular necrosis as well as liver injury.
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Mushroom poisoning is an increasingly common medical emergency
The most common cause of mushroom poisoning is the misidentification of toxic wild mushrooms as edible species. This is particularly common with the Amanita phalloides mushroom, also known as the "death cap", which closely resembles the Asian paddy-straw mushroom, Volvariella volvacea. Other toxic mushrooms that are often misidentified include the yellow-staining mushroom (Agaricus xanthodermus) and Galerina marginata, which looks similar to the Psilocybe species.
To prevent mushroom poisoning, it is important to only eat mushrooms purchased from a reputable source, such as a supermarket or greengrocer. If you choose to forage for wild mushrooms, it is crucial to familiarize yourself with both the edible and toxic species in your local area. Some mushrooms, such as those containing amatoxins, remain toxic even after cooking, so proper identification is essential.
If you suspect that you or someone you know has ingested a poisonous mushroom, it is important to act quickly. Contact your local poison control centre or a medical professional immediately, even if symptoms have not yet appeared. It can be helpful to have a sample or photo of the mushroom for identification purposes. In cases of severe poisoning, call emergency services right away.
While mushroom poisoning is a serious and sometimes life-threatening condition, most cases can be effectively managed with supportive care and the administration of antidotes per toxicologist recommendations. However, it is important to seek medical attention as soon as possible to ensure the best outcome.
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The nephrotoxicity of Cortinarius orellanus was first recognised in the 1950s
Cortinarius orellanus is a highly toxic mushroom species that causes orellanus syndrome, a rare condition that leads to acute renal failure. It is part of the Cortinariaceae family and is also known as fool's webcap. The mushroom is characterised by its cinnamon-brown colour and cobwebby veil. It is difficult to distinguish and identify visually, and its nephrotoxicity was recognised under the name orellanic syndrome.
Orellanine, a highly nephrotoxic bipyridine N-dioxide, is the main toxin found in Cortinarius orellanus. It is the only known mushroom toxin that selectively targets the kidneys, causing acute kidney injury in humans when ingested. The toxin was first identified in 1962 in crude extracts of the mushroom and was subsequently isolated and purified.
The onset of symptoms after ingestion of Cortinarius orellanus is typically delayed by 1-2 weeks, with a minimum of 3 days and a maximum of 3 weeks reported. This long latent period is a unique characteristic of orellanine poisoning. During this time, patients may experience mild gastrointestinal discomfort before developing signs of renal impairment, including vomiting, diarrhoea, loss of appetite, headaches, and a feeling of coldness.
There is currently no specific antidote for orellanine poisoning. Treatment focuses on preventing secondary complications of kidney failure, providing adequate dialysis, and managing chronic renal insufficiency in cases of incomplete recovery.
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Frequently asked questions
Orellanus syndrome is a rare cause of acute renal failure, caused by mushroom poisoning.
Mushrooms of the genus Cortinarius, including Cortinarius orellanus and Cortinarius speciosissimus, cause Orellanus Syndrome.
Symptoms include vomiting, diarrhoea, and liquid bowel movements. Orellanus Syndrome patients often present with polyuria and severe renal failure, which is often irreversible.
Mushroom poisoning is an increasingly common medical emergency. Mushroom gathering is more common in Europe than in North America, and most documented cases of orellanine toxicity are from Europe.
