Fall lovers are enthusiasts of the season for many reasons. For the color of the forests, its festivals and celebrations and also for its gastronomic treasures. It is harvest time, chestnuts, sweet potatoes and, of course, also mushrooms. However, with the well-known drought, it would be expected that the 2023 season will be very poor in number of specimens.
Even so, in the garden of Inga Wisserodt's house, a resilient mushroom has once again appeared, immune to the current climate situation, which she photographed for La Vanguardia's Readers' Photos and gave rise to this report.
This reader, experienced in what is sometimes so lacking called common sense, knows that if she incorporated said mushroom into one of her autumn feasts, it would mean an unpleasant psychotropic trip to the hospital.
The person responsible for such a bad taste in the mouth would be the false oronja (amanita muscaria), a toxic variety, popularly known for its red cap and white scales. This is the mushroom that was found in his garden.
According to Dr. Emilio Salgado, head of the Clinical Toxicology Unit at the Hospital Clínic, the first symptoms would appear between 30 minutes and 3 hours after ingestion, and these could be nausea, abdominal pain, agitation, confusion, delirium, hallucinations, mydriasis, tachycardia and, in some cases, even coma. A symptomatology that, although the expert warns that it does not lead to death, in theory would be enough to dissuade anyone from consuming it.
Dr. Salgado knows well the danger of eating the wrong mushroom, since he has been working at the Hospital Clínic of Barcelona for 20 years, a medical center that for 25 years has been the only one in Spain capable of analyzing hepatotoxic mushrooms. the most dangerous ones.
Samples from patients from all over the country who are suspected of being poisoned by mushrooms arrive at the hospital to be analyzed by the toxicology unit. The reason for this exclusivity is simple: necessity due to a frequent phenomenon in the region. "The areas where these types of accidents have been most prevalent are in Catalonia and Euskadi due to gastronomic tradition. And necessity in the end makes you have and dispose of the technique," explains the doctor.
The key technique for diagnosis consists of a urine analysis for the detection of amatoxins (also called mycotoxins), toxic substances in mushrooms. However, these are only part of the detection of mushroom poisoning.
A brief interrogation is also necessary to find out if the patient has recently consumed mushrooms, what type, the number of diners and, above all, when they did it, the latter aspect being essential to knowing the danger of the case.
In part, the seriousness of the poisoning is determined by the time elapsed since consumption, with two types of poisoning at a syndromic level: those called short incubation period, in which symptoms appear between 30 minutes and three hours later, and those with a short incubation period. long incubation period. "These are the truly dangerous ones, because they can appear between six and eight hours later, preceded by an asymptomatic state," warns Salgado. Thus, the toxins have remained in the body for longer, although their symptoms do not reveal themselves until hours later.
In all cases, treatment is carried out immediately even if the type of poisoning is uncertain: "If we wait until we have the results of determining the amatoxins, it would mean the patient would worsen or die," says the doctor. Even if the patient does not die, in the most serious cases he may end up requiring liver or kidney transplants.
As soon as the affected person arrives at the hospital, action is first taken to alleviate the patient's dehydration, a consequence of vomiting and diarrhea, the first symptoms of pure gastrointestinal syndrome.
Subsequently, they perform an analysis of the most affected organs to measure kidney and liver function, as well as a complete metabolic panel and an ion analysis to measure the amount of fluid in the body.
Activated charcoal is also administered to decontaminate the intestine, and silibilin as an antidote to cut the excretion/reabsorption loop of toxic agents, and expel amatoxins from the liver splint.
Despite the alarm that such a situation can cause, the toxicologist calls for calm, as he assures that poisoning by mushrooms as well as by plants and animals is extraordinarily residual.
According to the latest report from the Institute of Toxicology of the Ministry of Justice in 2022, of the total number of poisoning consultations they received, there were only 178 cases of toxic mushrooms, of the 77,000 treated in the Toxicological Information Service of the National Institute of Toxicology in 2022. .
In the same Hospital Clínic, throughout last year it received 34 suspicious samples from patients who had taken hepatotoxic mushrooms. Of all of them, only five cases tested positive, and two of the positive cases were from the same patient.
For the current campaign it is still early to make assessments but at the moment there are only two cases and it points out that the number of poisonings both now and in the future could go down due to climatic conditions.
However, Jaume Llistosella, mycologist and professor of botany at the UB, points out that neither drought nor climate change will necessarily mean the disappearance of mushrooms or the end of their consumption, since "these will appear at different times than those expected." They do it now."
From the Toxicology Unit of the Clínic, they comment that these poisonings are overwhelmingly accidental, and always occur in the domestic context, given the strict quality control that exists in places like the Central Market of Barcelona. "We usually have cases of confusion between edible and toxic varieties. The most frequent case is that the popular oronja (amanita caesarea) is confused with the deadly oronja (amanita phalloides), which is the most lethal of all," explains Salgado.
Likewise, he also points out as common confusions between the edible blackberry (tricholoma terreum) with the poisonous tricholoma pardinum, or the highly dangerous galerina marginata with the senderuela (marasmius oreades).
In some cases, there has also been controversy about the edibility of some historically highly demanded variants, such as the case of the Knights Mushroom (Tricholoma equestre), of which the marketing was prohibited in Spain in 2006 through the Spanish Food Code. even though for years it was considered edible. "It was discovered that the toxic alkaloids it contains are not eliminated and accumulate in the body until they cause death," explains Llistosella.
When in doubt about the toxicity of mushrooms, it is necessary to resort to academic or official sources such as the Spanish Food Code and banish domestic methods that tradition indicated as reliable.
Both Llistosella and Delgado deny any validity to the "silver spoon" test or "the garlic test", once used to determine the edibility of mushrooms. "Of course today there are many more resources to obtain information, and we have a lot of information at our fingertips," says Salgado, "although I don't think it is making much sense," he adds.
"There is a lack of culture in nature," agrees Llistosella, and warns that the lack of knowledge not only occurs in the aspect of edibility, but also in the search and collection process, since "many mushroom hunters destroy the forest." without knowing it."
Even so, obtaining new data and a deeper understanding of hepatotoxic mushrooms has made it possible to have a higher survival rate today, thanks to the improvement in early diagnoses and the development of specific antidotes such as silibilin. In Europe, "in 1958 there was a mortality rate of 30% and now it is between 9 and 11%, depending on the historical series."
Beyond gastronomic consumption, Salgado categorically discards the idea that poisonings from recreational uses are common, which he describes as "ultra residual cases." Statistics from the Ministry of Health reveal a minimal although stable percentage in the use of magic mushrooms, out of the total count of drug consumption for the period 2011-2022.
The number of consumers who claim to have consumed these substances always ranges between 4.5% and 3% among adults aged 15 to 34, 1.1% and 3% among adults aged 34 to 64. In the same way, he claims to have never seen a case of homicidal use in all the years dedicated to toxicology: "There are really substances much more effective in causing death than a toxic mushroom."
Curiously, despite their harmful potential, various varieties of mushrooms, both deadly and hallucinogenic, have been key tools for the pharmaceutical world, as the high medical usefulness of some of their components has been demonstrated.
A 2017 study by researchers at Michigan State University stated that by sequencing the genome of the Amanita phalloides, hundreds of new drugs could be produced for numerous diseases. Also on September 4, Stockholm's Karolinska University Hospital began clinical trials of a new drug to treat kidney cancer, developed from the deadly web cap (Cortinarius rubellus), one of Sweden's most poisonous mushrooms.
Recently, hallucinogenic mushrooms have even been used to treat mental health problems, as the doctor explains: "In the last two years, there has been special interest from a medical-psychiatric point of view, in using psilocybin mushrooms to treat depression." that do not respond to conventional therapy.
Even so, despite the progress, there is still a lot of work to be done regarding mushrooms, and its appreciation should not be combined with irresponsibility. The best cure for a poisonous mushroom may be silibilin, but even before its discovery, there has always been an even better remedy to save us from ending up being a patient of Dr. Salgado. Because as everyone knows, prevention is better than cure, and the best cure of all remains knowledge, and above all, common sense.
