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Amanita phalloides poisoning and treatment with silibinin in the Australian Capital Territory and New South Wales

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To the Editor: Roberts and colleagues recently reviewed the frequency and clinical outcomes of poisoning with Amanita phalloides (“deathcap”) mushrooms in the Australian Capital Territory and New South Wales.1 Two widely publicised cases of fatal ingestion occurred on 31 December 2011 after a chef had prepared a meal containing wild mushrooms for his colleagues in the kitchen of an ACT restaurant. The link with the restaurant was only discovered after emergency department staff notified public health authorities, who then interviewed unaffected associates of the index case. It was fortunate that no wild mushrooms were used to prepare food for the public. Material at the restaurant was inspected by the public health unit and destroyed to ensure no Amanita mushrooms entered the food supply.

However, the potential for a cluster of poisonings to occur, for people to be in the early stages of toxicity, and for uneaten mushrooms to pose an ongoing risk to food safety should be considered when a sentinel clinical case of poisoning occurs. Because acutely unwell patients may not provide a thorough account of who consumed wild mushrooms, public health units must seek out contacts to clarify the extent of exposure. The ultimate…