2nd Mushroom Case Fatal; Girl Gets New Liver

With heavy rains producing a bumper crop of deadly mushrooms, authorities said Thursday a Petaluma man had died of mushroom poisoning while a 13-year-old Orinda girl who ate “death cap” mushrooms with her family underwent a rare partial liver transplant designed to save her life.

The girl’s mother and two brothers, who had joined her in gathering the lethal mushrooms on a family outing and eating them in spaghetti sauce they prepared, remained hospitalized with less severe liver damage, doctors said.

The four family members, recent immigrants from Taiwan, apparently mistook the death cap mushrooms--the deadliest of all wild mushrooms--for a popular edible fungus that looks similar and is commonly found in Asia.

By chance, the man and the four family members gathered their mushrooms Saturday and ate them that day. All began experiencing stomach pain within an hour.

But details of the death of 43-year-old Arturo Leyba-Sanchez--who apparently consumed his mushrooms by himself--remained sketchy, according to the Sonoma County Sheriff’s Department.

Despite his symptoms, Leyba-Sanchez did not get medical help until Monday, when he was semiconscious and taken to Petaluma Valley Hospital by a friend. Leyba-Sanchez died the next day. Authorities have not determined what kind of mushrooms he ate, but an autopsy Wednesday concluded that mushroom poisoning killed him.

“We don’t know where the mushrooms came from,” said Sonoma County Sheriff’s Lt. Jay Farmer.

Although some Americans are aficionados of wild mushrooms, hunting for them is a much more popular pastime in other parts of the world, particularly Asia and Europe. Indeed, fungi are an important part of the diet in some cultures.

But mushrooms vary from region to region, and what can look edible in one place can be poisonous in another, said Dr. William Freedman, a retired physician and longtime member of the Mycological Society of San Francisco.

Northern California’s long dry spell and subsequent heavy rains have produced one of the best mushroom seasons in years, he said, and hundreds of people have headed for the woods in recent weeks to collect them.

Representatives of the four family members who ate the death cap mushrooms asked that they be allowed to remain anonymous.

Doctors said the liver damage suffered by the girl was so extensive she would not have lived more than a few days without a transplant. Once diagnosed, she was given top priority in the Bay Area for a donated liver.

Her mother and brothers apparently did not consume such a large dose of the toxin and are recovering without the need for transplants, said Dr. Philip Rosenthal, a pediatrics professor at UC San Francisco Medical Center, where all four patients are hospitalized.

“She may have eaten more mushrooms than the other members of the family,” Rosenthal said. “She would not have recovered on her own.”

The woman and her three children gathered their mushrooms Saturday at Lafayette Reservoir, a park near their town east of San Francisco.

Among the fungi they collected were death cap mushrooms--properly known as Amanita phalloides-- which they apparently confused with straw mushroom, a popular item at Chinese markets and restaurants.

With their father away on a business trip, the four family members cooked the mushrooms in the spaghetti sauce that night and ate them all, making it difficult to immediately pinpoint what they consumed, doctors said.

Within 45 minutes of their meal, all four began experiencing stomach pain. On Sunday morning, still suffering, they sought treatment at the emergency room at Alta Bates Hospital in Berkeley.

Doctors there at first concluded that the stomach symptoms were not consistent with lethal mushroom poisoning, and sent the four home, Alta Bates officials said. But after doing further research, doctors realized that the family could be suffering from death cap poisoning.

Hospital officials tracked down the family and told them to return to the hospital. They were transferred to the hospital in San Francisco when their livers began to show signs of malfunctioning.

The death cap, which causes about 95% of all mushroom fatalities in the United States, destroys cells in the liver, causing liver failure and preventing the blood from clotting. Among its several crucial functions, the liver helps detoxify the blood of any poisonous substances that may be ingested.

In milder cases, patients can recover on their own. But when damage is severe, a liver transplant is the only treatment.

Although rare, such severe poisonings are not unprecedented.

In 1988, five people in Portland became seriously ill after eating the mushrooms in an Oriental stir fry, and two received transplants. In 1985, four Mexicans foraging for food after crossing the border into the United States ate death cap mushrooms, killing three. And in 1982, five Laotian immigrants in San Diego suffered severe liver damage after eating death cap mushrooms they mistook for the edible fungus of their native land.

The transplant received by the Orinda girl Thursday was an experimental technique designed to allow her own seriously damaged liver to regenerate.

Dr. Jean Emond, one of a team of transplant surgeons, said the death cap poison kills liver cells but does not remain in the organ, allowing the liver to regenerate if enough healthy cells survive.

Because recipients of transplanted livers must take anti-rejection drugs for the rest of their lives, he said, doctors decided to remove about 40% of the girl’s damaged liver and graft on a similar-sized portion of the donated organ.

The doctors placed the two liver segments side by side, where they compete for blood supply. In about six months, doctors will decide if the girl’s own organ has made enough of a comeback to halt the anti-rejection drugs, which would cause the transplanted section to wither away.

The other portion of the donated liver was simultaneously transplanted into another patient.

Despite the poisoning, mushroom hunters insist that fungi can be collected from the wild and eaten safely--as long as newcomers learn from experienced pickers what is safe.

California has 2,000 varieties of wild mushrooms and about 200 are edible.

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Deadliest Mushrooms

* Type: Death cap, or Amanita phalloides

* Appearance: Usually greenish or yellowish with an olivaceous disc and paler margin, but sometimes paler and almost white. The stem is white and tapers slightly toward the top. The ball-shaped basal bulb is encased in a large white sac. Odor is sickly sweet to disagreeable.

* Habitat: Usually in woods. Formerly rare but spreading, especially in Northern California. Also found in the East, Pacific Northwest and other parts of California.

* Effects: The death cap is the most deadly fungus known, whether raw, cooked or dried. Kills at a dose of about one gram per kilogram of body weight. Mortality is 50% to 90% and any chance of survival depends on early recognition of the cause of poisoning.

Sources: “Mushrooms of North America” by Roger Phillips and “Mushrooms and Toadstools: A Color Field Guide” by U. Nonis.