Tülin KÖKSAL, Fulya G. DEMİRÇEKEN, Ali Osman KÖKSAL, Zafer ARSLAN

Çocuklarda mantar zehirlenmesi:26 olgunun değerlendirilmesi

Amaç: Amanita phalloides (A phalloides) türü ile olan mantar zehirlenmeleri en tehlikeli mantar zehirlenmeleri olup, ölüme yol açabilmektedir. Fakat, A. Phalloides zehirlenmeleri erken tanı ve etkin tedavi ile kurtarılabilir. Biz uygun veri kaynaklarını kullanarak Ankaradaki mantar zehirlenmelerini araştırdık. Materyal ve Metot: Bu çalışma, Ocak 1998den Haziran 2001e kadar Dr. Sami Ulus Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesinde yatan hasta ve acil servis verilerinden rapor edilen mantar zehirlenmesi olan 26 hastada yapılmıştır. Bulgular: Hastaların yaş dağılımları 2-16 (ortalama 10) yaş arasında değişiyordu. Önemli belirtiler kusma, bulantı, karın ağrısı ve ishal gibi gastrointestinal sistemle ilgiliydi. En sık saptanan patolojik laboratuvar testleri: 6 (%23) hastada karaciğer enzimleri yüksek, 4 (%15,3) hastada protrombin/aktive parsiyel tromboplastin zamanı uzamış ve 3 (%11,5) hastanın böbrek fonksiyon testleri bozulmuştu. Hastaneye başvurudan sonraki ilk 36 saat içinde hastalara mide yıkama, aktif kömür, damar içine sıvı ve penisilin G infüzyonu uygulandı. Spesifik amatoksin antidotu olan silibinin 2001 yılında hastaneye başvuran 10 (%38,4) hastaya verildi. Fulminan hepatik yetmezlik gelişen 2 ve hepatorenal yetmezlik gelişen 1 hastaya ileri tedavi olarak plazmaferez ve hemodiyaliz uygulandı. Hastaların 22 (%84,3) tam iyileşmiş olarak taburcu edildi. Dört hasta (%15,7) ise komplikasyonlara bağlı olarak hastanede öldü. Sonuç: Halk yabani mantar alımıyla oluşabilecek tehlikeler hakkında bilgilendirilmelidir. Toksikoloji merkezlerinde vücut sıvılarından etken mantar türü saptanmalı ve ciddi mantar zehirlenmesi olan hastalara etkin antidot verilmelidir, ancak Türkiye koşullarında bu mümkün değildir.

Mushroom poisoning in children: analyses of 26 patients

Objective: Exposure to Amanita phalloides is the most dangerous mushroom poisoning and can lead to death. However, early diagnosis and effective treatment can be recovered the poisoning with A. phalloides. We described mushroom poisonings in Ankara using available data sources. Material and Methods: We performed the study of 26 patients with mushroom poisoning reported in Dr. Sami Ulus Childrens Health and Diseases Training and Research Hospital inpatient and emergency department data from January 1998 through June 2001. Results: The patients' age ranged between 2 and 16 years, with a median of 10 years of age. Major symptoms were related with the gastrointestinal system such as vomiting, nausea, abdominal pain, and diarrhea. The most frequently reported pathological laboratory tests were increased liver enzymes (23%), prolonged prothrombin/activated partial thromboplastin time (15.3%), and impaired renal functions (11.5%) in the patients. In the first 36 hours after admission to the hospital, the patients were managed with gastric lavage, activated charcoal, intravenous fluid, and penicillin Ginfusion. Silibinin, a specific antidote of amatoksin, was given to 10 patients (38.4%) admitted to the hospital in 2001. Plasmapheresis and hemodialysis were administered as further treatment to the patients who developed fulminant hepatic failure in two and acute hepatorenal failure in one. Twenty-two (84.3%) of the patients were discharged with recovery. Four patients (15.7%) died in the hospital due to complications. Conclusions: The public should be informed about the probable hazards of wild mushroom ingestion. The species of active fungus should be detected in body fluids by the toxicology center and active antidote is given to not possible in throughout Turkey in actuel conditions.

PDF

___

Mat A. Türkiyede mantar zehirlenmeleri, zehirli mantarlar. Tübitak başvuru kitapları, Ankara 1997;1-6:152-6.
Saracel M, Özçelik UT, Özen H. Mantar zehirlenmeleri. Katkı pediatri dergisi 1990;11(3):297-9.
Ünlüoğlu I, Tayfur M. Mushroom poisoning: An analisis of the data between 1996 and 2000. Eur J Emerg Med 2003;10(1):23-6.
French LK, Hendrickson RG, Horowitz BZ. Amanita phalloides poisoning. Clin Toxicol (Phila) 2011;49(2):128-9.
Deniz T, Saygun M. İnvestigation of 62 mushroom poisoning cases applied to the emergency service during one month period. Akademik Acil Tıp Dergisi 2008;7:29-32.
Eren SH, Demirel Y, Serdal U, Can A, Korkmaz I, Güven FMK. Mushroom poisoning: retrospective analysıs of 294 cases. Clinics 2010;65 (5):491-6.
Ergüven M, Caki S, Deveci M. Mantar zehirlenmesi:28 vakanın değerlendirilmesi. Turk J Pediatr 2004;47:249-53.
Bartolini ST, Omer F, Giannini A, Botti P, Caromelli L, Ledda F, et al. Amanita poisoning: A clinical-histopatological study of 64 cases of intoxication. Hepato-gastro-enterol 1985;32(5):229-31.
Krenova M, Pelclova D, Navratil T. Survey of Amanita phalloides poisoning: clinical findings and follow-up evaluation. Hum Exp Toxicol 2007;26(12):955-61.
Beuhler MC, Sasser HC, Watson WA. The outcome of American pediatric unintentional mushroom ingestions with various decontamination treatments: An analysis of 14 years of TESS data. Toxicon 2009;53(4):437-43.
Nicholsan FB, Korman MG. Death from Amanita poisoning. Aust NZ J Med 1997;27(4): 4489.
Parish RC, Doering PL. Treatment of Amanita Mushroom poisoning:a review. Vet Hum Toxicol 1986;28(4):318-322.
Oeckinghause R, Cuneo A,Brockmeier J, Oecinghouse GS, Drewek- Pletera S, et al. Acute hepatic failure after ingestion of mushroom. Internist (Berl) 2012;53(5):619-24.
Pomerance HH, Barness EG, Kohli Kumar M, Arnold SR, Steigelfest J. A 15 year-old boy with fulminant hepatic failure. J pediatr 2000;137(1): 114-8.
Öztekin Mat A. Plant poisoning cases in Turkey. Ann Pharm Fr 1994;52(5):260-5.
Woodle ES, Moodly RR, Cox KL, Cannon RA, Ward RE. Orthotopic liver transplantation in a patient with Amanita poisoning. JAMA 1985;253 (1):69-70.
Vesconi S, Langer M, Iapichino G, Costantino P, Busi C, Fiume L. Therapy of cytotoxic muhsroom intoxication. Crit Care Med 1985;13(5): 402-6.
Rosenthal P, Roberts JP, Ascher NL, Emond JC. Auxiliary liver transplant in fulminant failure. Pediatrics 1997;100(2):E10.
Splendiani G, Zazzaaro D, Di Pietrantonio P, Delfino L. Continuous renal replacement therapy and Charcoal plasma perfusion in treatment of Amanita mushroom poisoning. Artif Organs 2000;24(4):305-8.
From The Centers for Disease Control and Prevention. Amanita Phalloides mushroom poisoning Northern California, January 1997. JAMA 1997;278(1):16-7.
Jander S, Bischoff J. Treatment of Amanita Phalloides poisoning: I. Retrospective evaluation of plasmapheresis in 21 patients. Ther Apher 2000;4(4):303-7.
Özçay F, Baskin E, Özdemir N, Karakayali H, Emiroğlu R, Haberal M. Fulminant liver failure secondary to a liver transplantation unit. Pediatr transplantation 2006;10(2):259-65.