About This Guide
This guide covers the 4 most clinically significant toxic mushroom species documented in Australia β including the lethal amatoxin-producing Amanita phalloides and Galerina marginata, the dermatotoxic Podostroma cornu-damae, and the severe gastrointestinal toxin producer Chlorophyllum molybdites. All four species are found in Australian mainland and island habitats.
Data-only reference β no photographs. Species identification for clinical management must be confirmed by a toxicologist, mycologist, or poison control specialist, not from this text alone.
Australia Poisons Information Centre (tap to call): 13 11 26 β 24 hours, 7 days, nationwide.
Quick Reference β All 4 Species
| Species | Common Name | Tier | Toxin Class | Onset | Primary Risk |
|---|---|---|---|---|---|
| Amanita phalloides | Death Cap | Tier 1 | Amatoxins (Ξ±-, Ξ²-amanitin) | Biphasic: 6β24h GI / 72β96h hepatic | Fulminant hepatic necrosis, death |
| Galerina marginata | Funeral Bell | Tier 1 | Amatoxins (identical to phalloides) | Biphasic: 6β24h avg. (10β12h) | Fulminant hepatic necrosis, death |
| Podostroma cornu-damae | Poison Fire Coral | Tier 1 | Trichothecene mycotoxins (Satratoxins) | Immediate (contact); systemic 1β6h | Dermal blistering, multi-organ failure, death |
| Chlorophyllum molybdites | Green-Gilled Parasol | Tier 2 | Molybdotoxin (GI irritant) | 1β3 hours post-ingestion | Severe GI toxidrome; rarely fatal |
β Tier 1 β Lethal / Severe Systemic Toxicity
Death Cap Tier 1 β Lethal
Amanita phalloides
Introduced from Europe; most common cause of fatal mushroom poisoning in Australia
Photo not yet verified
Tier
Tier 1 β Lethal
Toxin
Amatoxins (Ξ±-amanitin, Ξ²-amanitin, phalloidins)
Onset
Biphasic: 6β24h GI phase / 72β96h hepatic phase
Habitat & Season
Under introduced European oaks, chestnuts, beeches β late summer to autumn (FebβJune); urban parks, gardens, residential plantings
Australian Distribution
ACT (Canberra region), Victoria (Melbourne, Dandenong Ranges), Tasmania, southern NSW; increasingly New South Wales coastal fringe with spread of ornamental European oaks
Voucher Source
Royal Botanic Gardens Victoria (MEL), National Herbarium of NSW (NSW)
β FALSE RECOVERY PHASE: After 24β72h of apparent improvement β including resolution of GI symptoms β hepatocyte destruction continues silently. Do NOT discharge. ICU admission and liver transplant consult must be initiated EARLY regardless of apparent clinical recovery.
ID Features
Cap pale yellowish-green to olive-green or white, smooth, 5β15cm diameter. Gills pure white and free (not attached to stipe). Stipe white with a prominent persistent skirt-like annulus (ring) on upper stalk. Base enclosed in a loose, sac-like volva (cup) β frequently buried in soil or leaf litter and easily overlooked. White spore print. All-white specimens occur and are mistaken for edible species.
Lookalike Confusion
Commonly confused with Volvariella volvacea (Paddy Straw Mushroom) and native Agaricus species (Field Mushrooms) in Australian communities, particularly by recent immigrants from East and Southeast Asia where V. volvacea is a common edible.
Symptoms & Onset
- Phase 1 (6β24h): Sudden severe abdominal cramps, profuse watery to bloody diarrhea, forceful vomiting, dehydration. Onset typically 10β14 hours after ingestion.
- Phase 2 (24β48h): Apparent clinical recovery β GI symptoms resolve, patient appears well. THIS IS A CLINICAL TRAP. Amatoxin-mediated hepatocyte destruction continues.
- Phase 3 (48β96h): Rapid hepatic failure β jaundice, coagulopathy (rising INR/PT), encephalopathy, renal failure, metabolic acidosis. Death from fulminant hepatic failure if untreated.
Lab Monitoring During False Recovery Phase: AST, ALT, INR/PT, bilirubin, creatinine, glucose, ammonia β check every 6 hours. A falling aminotransferase combined with rising INR and worsening encephalopathy indicates total hepatic mass necrosis (not improvement).
ICU Treatment Protocol
Initial Resuscitation
- Aggressive IV fluid resuscitation with balanced crystalloid (Plasma-Lyte 148 or Hartmann's Solution)
- Target urine output β₯ 1.5β2.0 mL/kg/hour to maximise renal excretion of unbound amatoxins
- Nothing by mouth; nasogastric tube if obtunded
- Blood glucose monitoring every 2β4h; D5% supplementation to prevent hypoglycaemia from hepatic failure
- Contact Australia Poisons Information Centre (13 11 26) and toxicology immediately
IV Silibinin (Legalon SIL) β First-Line Antidote
- Loading dose: 5 mg/kg IV over 1 hour
- Maintenance: 20 mg/kg/day continuous IV infusion OR 4 equal doses (5 mg/kg) every 6 hours
- Duration: Continue until clinical evidence of hepatic recovery (falling aminotransferases, improving coagulopathy)
- Pediatric: Weight-based dosing identical to adult; monitor for fluid volume overload in small children
- Note: Legalon SIL may require emergency compassionate use or overseas procurement β contact Poisons Information Centre immediately for sourcing assistance.
IV N-Acetylcysteine (NAC) β Three-Bag Regimen
- Bag 1 (Loading): 150 mg/kg in 200 mL (5 mL/kg pediatric) D5% or 0.9% NaCl over 1 hour
- Bag 2: 50 mg/kg in 500 mL (7 mL/kg pediatric) over 4 hours
- Bag 3: 100 mg/kg in 1000 mL (14 mL/kg pediatric) over 16 hours
- Extended protocol: Continue Bag 3 dosing (150 mg/kg/day continuous) until INR < 2.0, encephalopathy resolves, and aminotransferases trending steadily downward
Pediatric Fluid Resuscitation
- Shock management: 20 mL/kg boluses balanced crystalloid over 10β20 minutes; repeat until peripheral perfusion and capillary refill (<2 seconds) normalise
- Target urine output: 1.5β2.0 mL/kg/hour
- Use D5% in 0.9% NaCl or D5% Hartmann's to prevent hypoglycaemia from liver necrosis
- Calculate maintenance via 4-2-1 rule; supplement for ongoing losses (vomiting, diarrhea, urine volume)
Additional Measures
- Activated charcoal: 1 g/kg if patient presents <2 hours post-ingestion with secure airway; multi-dose (1 g/kg every 4 hours) for confirmed amatoxin ingestion to interrupt enterohepatic recirculation
- Bile acid resins (cholestyramine): 4 g every 6h β adjunct to interrupt enterohepatic circulation; second-line if charcoal not tolerated
- Penicillin G: 300,000β1,000,000 IU/kg/day IV β may displace amatoxins from albumin binding and reduce hepatocellular uptake; used as adjunct in some European protocols
- Liver transplant evaluation: Initiate immediately when King's College Criteria (below) are met or approaching β transplant is the only definitive rescue for fulminant hepatic failure
- Renal replacement therapy (CRRT): Consider early if AKI with rising creatinine; CRRT may clear unbound amatoxin fractions
King's College Criteria β Liver Transplant Evaluation
Adult King's College Criteria (KCC)
Criterion A β Single Parameter (any one sufficient):
- Arterial pH < 7.30 after adequate fluid resuscitation
Criterion B β Three Concurrent Parameters (all three required):
- INR > 6.5 (PT > 100s)
- Serum creatinine > 300 ΞΌmol/L
- Grade III or IV hepatic encephalopathy
Additional Poor Prognostic Markers:
- Serum Bilirubin > 70 ΞΌmol/L (> 4.1 mg/dL) on Day 3 post-ingestion
- Factor V Levels < 20% of normal
- Precipitous AST/ALT drop with rising INR and worsening encephalopathy β indicates total hepatic mass necrosis, not improvement
Pediatric King's College Criteria (under 16 years)
Arterial pH < 7.30 OR any three of:
- INR > 4.0 (or PT > 50 seconds)
- Age < 2 or > 11 years
- Jaundice-to-encephalopathy interval > 7 days
- Bilirubin > 300 ΞΌmol/L
- Ongoing precipitous rise in INR despite treatment
πΎ Veterinary β Dogs
Toxicity: Highly toxic / Fatal. Dogs are highly susceptible to amatoxin poisoning and outcomes are poor without aggressive early intervention.
- Onset: 6β12 hours post-ingestion
- Signs: Delayed hemorrhagic gastroenteritis, weakness, jaundice (yellow mucous membranes and sclera), terminal hepatic encephalopathy, coma
- Treatment: Immediate decontamination if <2h (activated charcoal 1β2 g/kg); aggressive IV fluid diuresis (0.9% NaCl or Plasma-Lyte); multi-dose activated charcoal every 4h; IV N-acetylcysteine (same weight-based regimen); SAMe (S-adenosylmethionine) 20 mg/kg/day orally or via NG for hepatic support; monitor LFTs, PT, glucose every 4β6h; liver transplant not available β prognosis guarded to poor
πΎ Veterinary β Cats
Toxicity: Highly toxic / Fatal. Cats have limited glucuronidation capacity, increasing susceptibility.
- Onset: 6β12 hours
- Signs: Sudden severe dehydration, vomiting, extreme lethargy, yellowed mucous membranes, hypothermia
- Treatment: Intensive IV fluid therapy; SAMe and N-acetylcysteine (15 mg/kg IV slowly β monitor for anaphylactoid reaction); thermal support (hypothermia management); avoid drugs requiring hepatic metabolism; ICU monitoring
Voucher Source: Royal Botanic Gardens Victoria (MEL), Melbourne; National Herbarium of New South Wales (NSW), Sydney. Cross-Reference: European populations (native range); North American introduced populations under European oaks (California, British Columbia, Ontario). Australian specimens morphologically identical to European type; clinical management protocols fully applicable from European and North American case literature.
Differential Diagnosis β Native Australian Non-Toxic Lookalikes
| Feature | Amanita phalloides (Deadly) | Volvariella volvacea (Edible) | Native Agaricus spp. (Edible) |
|---|---|---|---|
| Gill colour at maturity | Pure white throughout | Pink to pinkish-brown | Chocolate-brown to dark brown |
| Spore print | White | Pink | Chocolate-brown |
| Annulus (ring) | Prominent persistent skirt-like ring on upper stipe | No ring (absent) | Ring present; no volva |
| Volva (basal cup) | Prominent loose sac-like cup at stipe base β may be buried | Volva present but closely adhering | No volva |
| Cap colour | Pale yellow-green to olive-white | Tan to grey-brown | White to brown; often yellowing on bruising (A. xanthodermus) |
Key Rule: Any all-white mushroom with a ring on the stipe AND a basal cup (volva) must be treated as Amanita phalloides until proven otherwise by a trained mycologist. The volva is frequently buried β always excavate the stipe base before attempting identification.
Funeral Bell Tier 1 β Lethal
Galerina marginata
Small wood-rotting species; frequently confused with Psilocybe subaeruginosa by recreational foragers
Photo not yet verified
Tier
Tier 1 β Lethal
Toxin
Amatoxins β identical toxin profile to A. phalloides
Onset
6β24h (average 10β12h); identical biphasic syndrome
Distribution
Victoria (incl. Melbourne, Dandenong Ranges), Tasmania, NSW (Blue Mountains), ACT elevated areas; cool temperate wet sclerophyll and sub-alpine forests 300β1500m
Habitat
Saprotrophic on decaying wood β rotting eucalypt logs, buried wood, woodchip garden mulch, sawdust in high-rainfall wet sclerophyll and sub-alpine forests
Season
Late Autumn to Winter β May to August
Voucher Source
Tasmanian Herbarium (HO), Hobart
Cross-Reference
North America (Pacific Northwest), Europe (Boreal forests). Australian populations morphologically identical; target eucalypt debris rather than northern hemisphere conifers.
β CRITICAL MISIDENTIFICATION RISK: Galerina marginata is actively sought by recreational drug users attempting to harvest Psilocybe subaeruginosa (a psychoactive native species found in similar eucalypt wood habitats). Patients presenting after intentional Psilocybe foraging in Victoria or Tasmania must have Galerina co-ingestion excluded. Initiate full amatoxin protocol if onset is >6h or species identification is uncertain.
ID Features
Small cap 1β4cm, convex to flat; sticky when wet; tan to tawny-brown, hygrophanous (fades to paler buff when dry). Gills brown. Small fragile membranous ring on upper stem β may wash off in rain. Rusty-brown to orange-brown spore print. Grows in clusters or scattered on decaying eucalypt wood, woodchips, and buried wood debris.
Symptoms & Onset
- Phase 1 (6β24h): Severe delayed abdominal cramps, forceful vomiting, profuse watery diarrhea β typically 10β12 hours after ingestion
- Phase 2 (24β48h): Brief false recovery β complete apparent resolution of symptoms
- Phase 3 (48β96h): Rapid hepatic necrosis, jaundice, coagulopathy (rising INR), hepatic encephalopathy, multi-organ failure
ICU Treatment Protocol
Identical to Amanita phalloides protocol above. IV Silibinin (Legalon SIL), IV NAC three-bag regimen, King's College Criteria monitoring, and liver transplant evaluation apply identically. Do not delay treatment pending species confirmation if clinical timeline is consistent.
King's College Criteria β Apply Identically to Galerina marginata
See Amanita phalloides section above. Adult and pediatric KCC criteria, all additional poor prognostic markers, and antidotal dosing regimens are fully applicable. Confirm with Poisons Information Centre (13 11 26).
πΎ Veterinary β Dogs
Toxicity: Highly toxic / Fatal. Onset 6β12 hours post-ingestion.
- Delayed bloody diarrhea, weakness, jaundice, terminal hepatic coma
- Treatment: Decontamination (activated charcoal 1β2 g/kg if <2h); aggressive IV fluid diuresis; multi-dose activated charcoal; IV N-acetylcysteine; SAMe hepatic support. High mortality without early intervention.
πΎ Veterinary β Cats
Toxicity: Highly toxic / Fatal. Onset 6β12 hours.
- Sudden severe dehydration, vomiting, extreme lethargy, yellowed mucous membranes
- Treatment: Intensive IV fluid therapy; liver protectants (SAMe / NAC); thermal support; ICU monitoring
Differential Diagnosis β Native Lookalike
| Feature | Galerina marginata (Deadly) | Psilocybe subaeruginosa (Non-lethal; controlled substance) |
|---|---|---|
| Spore print | Rusty-brown to orange-brown | Dark purple-brown to blackish |
| Blue bruising | Never bruises blue | Immediate or delayed intense blue bruising on stem, cap margin, or damaged flesh when handled |
| Annulus (ring) | Small fragile membranous ring, often persistent | Typically absent or reduced to faint dark annular zone only |
| Gills | Brown; uniform rusty tones at maturity | Gills bruise blue-black when damaged |
Clinical Rule: Do NOT use bruising alone to exclude Galerina β spore print is required. Obtain a spore print on white paper: rusty-brown/orange-brown = Galerina (amatoxin protocol); purple-black = Psilocybe (no amatoxin). If species in doubt and onset >6h, treat as amatoxin poisoning.
Poison Fire Coral Tier 1 β Lethal
Podostroma cornu-damae
Contact dermatotoxin; causes blistering on touch β extremely dangerous to handle
Photo not yet verified
Tier
Tier 1 β Lethal
Toxin
Trichothecene mycotoxins (satratoxins, roridin); cytotoxic and haematotoxic
Onset
Immediate contact dermatitis; systemic toxicity 1β6 hours post-ingestion
Distribution
Subtropical and tropical regions: Queensland (especially south-east Queensland rainforest margins), northern New South Wales; also reported northern Australia; associated with warm humid conditions
Habitat
Fruits on deeply decaying buried wood or wet leaf litter in rainforest margins and subtropical wet sclerophyll; typically after prolonged wet season or heavy rainfall events
Season
Wet season / post-rainfall events; primarily summer to early autumn (DecemberβApril) in subtropical Queensland
Voucher Source
Queensland Herbarium (BRI), Brisbane
β CONTACT HAZARD: Podostroma cornu-damae causes immediate skin blistering and mucous membrane damage on direct contact. DO NOT HANDLE WITHOUT GLOVES. Medical staff must wear nitrile gloves when examining skin lesions or handling brought-in specimens. Exposed skin must be irrigated with high-volume running water for minimum 15β20 minutes immediately.
ID Features
Fleshy, unbranched or minimally clubbed cylindrical fingers 3β10cm tall, bright orange-red to fiery blood-red. Smooth, tough surface. Grows from soil surface emerging from deeply decaying buried wood β may appear as if growing from bare rainforest floor. Causes immediate contact dermatitis/skin blistering when touched β this alone distinguishes it from all native lookalikes.
Symptoms & Onset
- Contact (immediate): Erythema, blistering, vesiculation on all exposed skin surfaces; mucous membrane erosion if eye or oral contact
- Ingestion β Early (1β6h): Severe vomiting, abdominal pain, haematemesis; pharyngeal/oral blistering and burning
- Ingestion β Systemic (6β24h+): Bone marrow suppression, leucopenia, thrombocytopenia, haemolysis, DIC; neurological effects including seizure, cerebellar ataxia; multi-organ failure; epistaxis and mucosal bleeding from coagulopathy
- Severe ingestion: Reported fatalities in Japan and Korea; case reports of death within 72 hours from multi-organ failure
ICU Treatment Protocol
Dermal Decontamination (immediate priority)
- Irrigate ALL exposed skin with high-volume running water for minimum 15β20 minutes
- Do NOT scrub β scrubbing disrupts skin barrier and increases toxin penetration
- Remove and bag all clothing; staff must wear nitrile gloves throughout
- If ocular exposure: immediate eyewash or irrigation with 0.9% NaCl for minimum 15 minutes; urgent ophthalmology consult
Ingestion Management
- Secure airway β pharyngeal/laryngeal oedema may develop rapidly from mucosal blistering
- Do NOT induce emesis (blistering agent)
- Activated charcoal 1 g/kg via NG tube if airway secured and ingestion <1β2h
- Aggressive IV fluid resuscitation (Plasma-Lyte 148 or Hartmann's); shock-dose fluids if haemodynamically compromised
- Reverse isolation β patient is immunocompromised from marrow suppression
ICU Monitoring & Supportive Care
- Haematology: FBC, coagulation studies, reticulocyte count every 4β6h; anticipate leucopenia, thrombocytopenia, haemolysis
- DIC management: FFP, cryoprecipitate, platelet transfusion as indicated by haematology
- G-CSF (granulocyte colony-stimulating factor) for severe neutropenia
- Broad-spectrum antibiotics for neutropenic fever β empirical coverage in immunocompromised host
- Neurological monitoring β seizure prophylaxis if encephalopathy present; neurology consult
- No specific antidote available. Management is supportive; contact Australia Poisons Information Centre (13 11 26) and toxicology for real-time guidance
πΎ Veterinary β Dogs
Toxicity: Extremely toxic / Critical Emergency.
- Signs: Paw/pad blistering and sloughing, oral blistering, intense vocalization, immediate bloody emesis, collapse, shock
- Treatment: Immediate dermal decontamination (flush paws and oral cavity with high-volume water); shock-dose IV fluids; ICU monitoring; haematology every 4h; supportive care β no antidote
πΎ Veterinary β Cats
Toxicity: Extremely toxic / Critical Emergency.
- Signs: Paw and facial blistering, oral erosion, salivation, vocalization, rapid deterioration
- Treatment: Dermal decontamination; shock fluids; supportive ICU care; reverse isolation from secondary infection risk
Voucher Source: Queensland Herbarium (BRI), Brisbane. Cross-Reference: Japan and Korea (documented fatal cases); described from subtropical Asia. Australian populations produce identical trichothecene toxin profile. Japanese clinical case literature provides primary human fatality case series.
Differential Diagnosis β Native Lookalikes
| Feature | Podostroma cornu-damae (Deadly) | Native Ramaria species (Coral Fungi) | Cordyceps/Tolypocladium complexes |
|---|---|---|---|
| Structure | Fleshy unbranched or minimally clubbed cylindrical fingers, 3β10cm | Highly branched complex brittle multi-tiered structures | Single club-like stroma emerging from ground |
| Substrate | Buried decaying wood/wet leaf litter in rainforest | Soil, humus; multiple branching arms | Always emerges directly from a buried insect pupa or caterpillar β verifiable by excavation |
| Contact hazard | Immediate blistering/dermatitis on bare skin contact | No dermal toxicity | No dermal toxicity |
| Colour | Bright orange-red to fiery blood-red | Variable β yellow, orange, pink, white, coral | Orange to yellow-orange; smaller, single structure |
Definitive Field Test: Gently touch with the tip of a gloved finger for 2β3 seconds. P. cornu-damae will produce erythema or tingling within seconds on unprotected skin. Native Ramaria and Cordyceps produce zero dermal reaction. If handling is unavoidable, use thick nitrile gloves; avoid mucosal contact absolutely.
β Tier 2 β Severe Morbidity
Green-Gilled Parasol Tier 2 β Severe Morbidity
Chlorophyllum molybdites
Most common cause of mushroom poisoning in Australia by case volume; suburban lawns and parks
Photo not yet verified
Tier
Tier 2 β Severe Morbidity
Toxin
Molybdotoxin and associated thermolabile GI peptides; mechanism incompletely characterised
Onset
1β3 hours post-ingestion; rapid-onset severe GI toxidrome
Distribution
Widespread across subtropical and tropical Australia; Queensland, New South Wales (coastal and inland), Northern Territory, Western Australia (northern coastal); suburban lawns, parklands, golf courses, disturbed grasslands after rain
Habitat & Season
Subtropical and tropical lawns, parks, grasslands, disturbed soil; peaks post-rainfall events throughout the warmer months; year-round in tropical Queensland
β MOST COMMON CAUSE OF MUSHROOM POISONING ADMISSIONS in Australia. Frequently foraged by children in suburban lawns and parklands. Severe GI toxidrome can cause significant dehydration requiring hospital admission but is rarely fatal in healthy adults. High morbidity from vomiting and diarrhea volume.
ID Features
Large white scaly cap 5β30cm; white stem with movable ring; gills begin white but turn dull olive-green to light green at full maturity β the definitive diagnostic marker. White stem is smooth and unpatterned (no snakeskin pattern). Spore print: dull olive-green to light green β diagnostic.
Lookalike Confusion
Commonly confused with Macrolepiota procera (Parasol Mushroom β edible) and Chlorophyllum hortense (a native/naturalised parasol). Both safe lookalikes have pure white gills and white spore prints throughout their life cycle and never develop green discolouration.
Symptoms & Onset
- 1β3 hours: Violent projectile vomiting, watery to green or bloody diarrhea, severe abdominal cramps, diaphoresis
- Profuse fluid losses may cause significant dehydration and electrolyte disturbances, particularly in children and elderly
- Symptoms typically self-limiting within 6β12 hours but can be severe enough to require hospitalisation
- Rarely fatal in healthy adults; higher risk in children, immunocompromised, elderly
Treatment Protocol
Emergency Department Management
- Category 3 Urgent ED Admission: IV access; aggressive IV fluid resuscitation; electrolyte replacement
- Antiemetics: Ondansetron 4β8 mg IV (or Metoclopramide 10 mg IV); Prochlorperazine as second line
- Maropitant 1 mg/kg subcutaneous (veterinary) or Ondansetron IV for severe cases
- Monitor glucose, electrolytes, renal function
- Activated charcoal 1 g/kg if <2h post-ingestion and not actively vomiting
- Gastric lavage only if ingestion <1h and lethal species co-ingestion cannot be excluded
- Admit if unable to tolerate oral fluids; discharge once tolerating oral rehydration and symptoms declining
β DELAYED AMATOXIN EXCLUSION: If any doubt about species identification, onset >6 hours, or co-ingestion of other species cannot be excluded β monitor for 72 hours and treat as potential amatoxin exposure until excluded. Chlorophyllum molybdites onset is consistently <3 hours; onset >6h with subsequent false recovery must raise Tier 1 species concern.
πΎ Veterinary β Dogs
Toxicity: Severe GI. Onset within 1β2 hours.
- Signs: Rapid drooling, explosive green vomiting, bloody stools, weakness, dehydration
- Treatment: Urgent vet admission; IV fluid resuscitation (0.9% NaCl or Plasma-Lyte); Maropitant (Cerenia) 1 mg/kg SC or IV; Ondansetron 0.5 mg/kg IV; monitor glucose and electrolytes
πΎ Veterinary β Cats
Toxicity: Severe GI. Onset within 1β2 hours.
- Signs: Vomiting, profuse diarrhea, dehydration, lethargy
- Treatment: IV fluid support; Maropitant; electrolyte monitoring; supportive care; prognosis generally good with prompt treatment
Cross-Reference: North America (most common cause of mushroom poisoning by case volume in USA), Hawaii, tropical and subtropical regions worldwide.
Differential Diagnosis β Native Australian Lookalikes
| Feature | Chlorophyllum molybdites (Toxic) | Macrolepiota procera (Parasol, Edible) | Chlorophyllum hortense (Native Parasol, Edible) |
|---|---|---|---|
| Gill colour at maturity | Dull olive-green to light green | Cream-white to pale buff throughout | Cream-white to pale buff throughout |
| Spore print | Olive-green to light green | Pure white | Pure white |
| Stem pattern | Smooth, unpatterned white to browning stem | Distinctly snakeskin-patterned (flammulated) stem; double-edged movable ring | Variable patterning; ring may be movable |
Definitive Identifier: Obtain a spore print on white paper from a mature specimen. Any green spore print = Chlorophyllum molybdites. This is the only field-reliable confirmation. Do not rely on gill colour alone in young specimens (gills are white when immature). When in doubt, do not eat.
π§ͺ Meixner Test β Bedside Amatoxin Screening Tool
Protocol β Step by Step
- Compress fresh fungal cap or stalk to express tissue juice onto a surface
- Apply one drop to cheap unbleached newspaper (lignin paper) β bleached office paper will NOT work; it lacks the lignin required for the reaction
- Dry completely with air or gentle warm air β do not apply acid while wet (causes false negative)
- Add one drop concentrated HCl (10β12 M) onto the dried spot
- Observe for 1β20 minutes
Interpretation
Deep Blue / Green-Blue / Teal (immediate to 5 minutes) = Positive β High amatoxin concentration: Treat as lethal; initiate full Tier 1 amatoxin protocol immediately.
Light Blue / Olive-Green (5β20 minutes) = Positive β Trace amatoxins: Treat under full Tier 1 protocols regardless of trace result.
No change / Yellow / Light Brown (up to 20 minutes) = Negative: Amatoxins absent or below detection limit. Does NOT rule out Tier 2 gastrointestinal toxins (e.g. Chlorophyllum molybdites). Continue clinical evaluation.
Limitations: The Meixner test is a preliminary screening tool only. A negative result does not exclude all toxicity. False negatives can occur with degraded tissue, diluted samples, or incorrect paper. Never use a negative Meixner test to override clinical judgment when onset timeline is consistent with amatoxin syndrome. Confirm with Poisons Information Centre (13 11 26).
π¨ Poison Control & Clinical Triage
Australia Poisons Information Centre
24 hours β 7 days β Nationwide • State immediately: "I am a clinician treating a suspected toxic mushroom ingestion."
Request direct transfer to toxicologist for Tier 1 cases. Save all mushroom specimens (in paper or foil β never plastic); refrigerate immediately.
Request direct transfer to toxicologist for Tier 1 cases. Save all mushroom specimens (in paper or foil β never plastic); refrigerate immediately.
Clinical Triage Matrix
| Patient | Onset Window | Symptoms | Suspected Species | Triage Category | Immediate Action |
|---|---|---|---|---|---|
| Human | <1 hour (immediate) | Skin blistering, severe vomiting, immediate distress, bleeding | Podostroma cornu-damae (Tier 1) | Category 1 β Resuscitation | Continuous dermal washing; reverse isolation; secure airway; ICU admission; haematology monitoring |
| Human | >6 hours delayed | Delayed severe gastroenteritis followed by period of apparent total recovery | Amanita phalloides / Galerina marginata (Tier 1) | Category 1 β Resuscitation | Immediate ICU admission; Legalon SIL (5 mg/kg loading); NAC three-bag regimen; liver transplant evaluation; King's College Criteria monitoring |
| Human | <2 hours | Violent projectile vomiting, green/bloody diarrhea, severe cramps | Chlorophyllum molybdites (Tier 2) | Category 3 β Urgent | ED admission; aggressive IV fluid resuscitation; antiemetics (Ondansetron); electrolyte monitoring; rule out co-ingestion of Tier 1 species |
| Canine/Feline | Immediate <1 hour | Paw/oral sloughing, intense vocalization, immediate bloody emesis | Podostroma cornu-damae (Tier 1) | Critical Vet Emergency | Dermal decontamination; shock-dose fluids; ICU; haematology every 4h; supportive care |
| Canine/Feline | >6 hours delayed | Delayed haemorrhagic gastroenteritis, icterus, severe lethargy | Amanita phalloides / Galerina marginata (Tier 1) | Critical Vet Emergency | Aggressive IV fluids; multi-dose activated charcoal (1 g/kg every 4h); IV NAC; SAMe hepatic support; LFT and coagulation monitoring |
| Canine/Feline | <2 hours | Rapid drooling, explosive green vomiting, bloody stools, weakness | Chlorophyllum molybdites (Tier 2) | Urgent Vet Admission | IV fluid resuscitation; Maropitant/Ondansetron; electrolyte monitoring; prognosis good with prompt treatment |
Decontamination Protocols
Decontamination Decision Guide
1
Dermal Exposure (P. cornu-damae): Irrigate with high-volume running water for minimum 15β20 minutes. Do not scrub β prevents further toxin penetration. Remove all clothing and bag in plastic. Nitrile gloves for all handlers.
2
Ingestion <2 hours, airway secure: Single dose activated charcoal 1 g/kg. Gastric lavage only if lethal species suspected within 1 hour of ingestion and airway is secured.
3
Ingestion >6 hours (confirmed or suspected Tier 1): Do NOT induce emesis. Multi-dose activated charcoal 1 g/kg every 4 hours to interrupt enterohepatic circulation of amatoxins. Continue until clinical recovery confirmed.
4
All cases: Contact Australia Poisons Information Centre (13 11 26) immediately. Preserve all mushroom specimens in paper or foil β never plastic. Photograph specimens in situ if safe to do so. Document exact ingestion-to-symptom timeline.
5
Sample handling: Wrap physical mushroom samples in paper or foil. Refrigerate (do not freeze) to preserve microscopic structural features for poison control mycologists and forensic assessment.
Toxin Stability Reference
| Toxin | Heat Stable? | Water Soluble? | Clinical Note |
|---|---|---|---|
| Amatoxins (Ξ±-amanitin, A. phalloides, G. marginata) | Yes β fully heat stable | Partially | Cooking does NOT destroy amatoxins. Boiling water retains full toxin activity. |
| Trichothecenes (P. cornu-damae) | Yes β highly stable | Partially | Not destroyed by cooking. Dermal activity persists on dried specimens. |
| Molybdotoxin (C. molybdites) | Partially thermolabile | Yes | Thorough cooking may reduce but not eliminate GI toxicity. Raw ingestion much more severe. |
Disclaimer: This clinical reference is for educational and rapid decision-support purposes only. It does not replace clinical judgment, institutional protocols, or direct consultation with the Australia Poisons Information Centre. In any suspected mushroom toxicity, contact Australia Poisons Information Centre (13 11 26) immediately. Treatment protocols should be verified against current evidence-based clinical guidelines and confirmed with toxicology. Not intended as a foraging identification guide β mushroom identification from text descriptions alone is unreliable even for experts. Data-only guide β no photographs. Updated and reviewed β July 2026.