title: Treatment of amatoxin poisoning: 20-year retrospective analysis.
abstract: BACKGROUND
  Amatoxin poisoning is a medical emergency characterized by a long incubation time lag, gastrointestinal and hepatotoxic phases, coma, and death. This mushroom intoxication is ascribed to 35 amatoxin-containing species belonging to three genera: Amanita, Galerina, and Lepiota. The major amatoxins, the alpha-, beta-, and gamma-amanitins, are bicyclic octapeptide derivatives that damage the liver and kidney via irreversible binding to RNA polymerase II.
  
  
  METHODS
  The mycology and clinical syndrome of amatoxin poisoning are reviewed. Clinical data from 2108 hospitalized amatoxin poisoning exposures as reported in the medical literature from North America and Europe over the last 20 years were compiled. Preliminary medical care, supportive measures, specific treatments used singly or in combination, and liver transplantation were characterized. Specific treatments consisted of detoxication procedures (e.g., toxin removal from bile and urine, and extracorporeal purification) and administration of drugs. Chemotherapy included benzylpenicillin or other beta-lactam antibiotics, silymarin complex, thioctic acid, antioxidant drugs, hormones and steroids administered singly, or more usually, in combination. Supportive measures alone and 10 specific treatment regimens were analyzed relative to mortality.
  
  
  RESULTS
  Benzylpenicillin (Penicillin G) alone and in association was the mostfrequently utilized chemotherapy but showed little efficacy. No benefit was found for the use of thioctic acid or steroids. Chi-square statistical comparison of survivors and dead vs. treated individuals supported silybin, administered either as mono-chemotherapy or in drug combination and N-acetylcysteine as mono-chemotherapy as the most effective therapeutic modes. Future clinical research should focus on confirming the efficacy of silybin, N-acetylcysteine, and detoxication procedures.
authors.affiliation: Laboratoire de Botanique, Phytochimie et Mycologie, Faculté de Pharmacie, Université Montpellier 1, France. fenjalbert@ww3.pharma.univ-montp1.fr
authors.forename: Françoise
authors.initials: F
authors.lastname: Enjalbert
authors.forename: Sylvie
authors.initials: S
authors.lastname: Rapior
authors.forename: Janine
authors.initials: J
authors.lastname: Nouguier-Soulé
authors.forename: Sophie
authors.initials: S
authors.lastname: Guillon
authors.forename: Noël
authors.initials: N
authors.lastname: Amouroux
authors.forename: Claudine
authors.initials: C
authors.lastname: Cabot
mesh_terms: D000363:Agaricales / Q000737:chemistry; D000546:Amanitins / Q000737:chemistry / Q000506:poisoning*; D000818:Animals; D056486:Chemical and Drug Induced Liver Injury / Q000188:drug therapy / Q000209:etiology; D004632:Emergency Medical Services; D006801:Humans; D016031:Liver Transplantation; D009145:Mushroom Poisoning / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D000546:Amanitins; C018207:amatoxin