Cyclopeptides (Amatoxin)-containing mushroom poisoning results in delayed development of gastrointestinal symptoms that may progress to liver failure. There is no established antidotal treatment for cyclopeptide-induced hepatic failure; silibinin is currently under investigation. 

There is a wide range of case fatality reported from cyclopeptides-containing mushroom poisoning: 4.8% to 47%.

National Poison Data System was reviewed from 1/1/2008 to 12/31/2018 for all suspected cyclopeptides containing mushroom poisoning. Out of 8953 suspected cases, 148 cases were included in the study.

Results:

• Northeast 50 (33.8%)
• West cost: 46 (31.1%)
• Southeast: 22 (14.9%)
• Midwest: 24 (16.2%)
• Southcentral: 6 (4.1%)

Therapy:

• NAC: 101 (68.2%)
• Penicillin: 42 (28.4%)
• Multi-dose activated charcoal: 35 (23.6%)
• Silibinin IV: 30 (20.3%)
• Silibinin PO: 12 (8.1%)

Case fatality

• Overall: 8.8%
• Treated with silibinin/silymarin: 9.5%
• Not treated with silibinin/silymarin: 8.5%

Conclusion:

• Overall fatality of cyclopeptide mushroom poisoning was 8.8%
• In this retrospective study, silibinin treatment did not appear to decrease the fatality rate.

References

De Olan J et al. Current fatality rate of suspected cyclopeptide muschroom poisoning in the United States. Clin Toxicol (Phila.) 2020. DOI: 10.1080/15563650.2020.1747624