亚稀褶红菇中毒的物种鉴定、地理分布、中毒特征及救治

目的 探索亚稀褶红菇的物种鉴定、地理分布、中毒症状及救治措施,为该物种造成的中毒事件应急处置及病患救治提供借鉴.方法 结合中毒案例,开展流行病学、临床救治调查分析,对毒蘑菇样本进行形态学和分子生物学鉴定,并对亚稀褶红菇造成的中毒特征及救治方法进行系统整理.结果 2名中毒患者2015年7月26日晚食用了自己采集的“火炭菌”,潜伏期2～3h.主要临床表现为恶心、呕吐、腹痛,伴有酱油色尿,肌酸激酶急剧上升,并伴有丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、肌酸激酶同工酶和血肌酐等的上升,最终表现为肾功能衰竭和呼吸衰竭,符合以往报道的亚稀褶红菇的中毒表现.2位患者给予血液灌流、连续性静脉-静脉血液滤过、保肝、保肾、抗氧化等对症支持治疗,一名患者于40余天后死亡.另一名患者虽然历经转院治疗,至2016年2月底仍未出院,预后不佳.毒蘑菇样本通过形态学结合分子生物学方法鉴定为亚稀褶红菇(russula subnigricans).结论 亚稀褶红菇是一种毒性高的有毒蘑菇,其在我国分布较广,形态学分类结合分子生物学(使用ITS片段)方法是物种鉴定的有效方法,此蘑菇中毒者潜伏期短,人中毒靶器官主要为横纹肌,重症患者预后差.

Species identification,geographical distribution,poisoning symptoms and medical treatment of russula subnigricans

Objective To study species identification,geographical distribution poisoning symptoms of russula subnigricans in order to provide guidelines of prevention and proper treatment.Methods Based on the data of epidemiological investigation,clinical treatment data and suspicious poisonous mushrooms,the collected mushroom were identified by morphological and molecular analysis,and the poisoning symptoms and medical treatment of R.subnigricans were systematically summarized.Results From the present two poisoning case,Epidemiological investigation showed that both patients ate some mushrooms in an appearance of fired charcoal ("huotanjun" called by layman) in the evening on July 26th,2015.The incubation period was 2-3 hours.The main poisoning symptoms were nausea,vomiting,myalgia,typical soy urine,rapid increased in serum creatine kinase (CK),alanine transaminase (ALT),aspartate aminotransferase (AST),creatine kinase MB (CK-MB) and serum creatinine (sCr) were found.Finally patients fell in kidney failure and respiratory failure.All these symptoms met the typical manifestion of mushroom poisoning reported caused by R.subnigricans.These two patients were treated with hemoperfusion,continuous veno-venous hemofiltration (CVVH),liver protecting treatment,protective renal treatment and antioxidant therapy.One patient died after 40 days after admission.Other patient was transferred to a better facility and experienced physicians,and the other patient was still in hospital without any improvement up to the end of Feb.2016 with a gloomy prospect.The mushroom eaten by the patients was identified as russula subnigricans though morphological and molecular analysis.Conclusions Russula subnigricans is a very toxic mushroom,widely distributed in southern China.Morphological and molecular analysis (using ITS sequence) is suitable for species identification of R.subnigricans.The incubation period of R.subnigricans poisioning is usually short,its target organ is mainly striated muscle,and severe patients usually have unfavourable outcome.