About This Guide
This guide covers the most clinically significant toxic mushroom species documented in Brazil: the lethal Amanita phalloides (Death Cap) in the subtropical Atlantic Forest and Pampas; the suspected-lethal Amanita campinaranae endemic to the Amazon Rainforest; and the gastrointestinal toxin producer Chlorophyllum molybdites ubiquitous across urban and Cerrado/Caatinga environments. Species data are organized by ecological biome and documented range.
Data-only reference — no photographs. Species identification for clinical management must be confirmed by a toxicologist, mycologist, or poison control specialist, not from this text alone.
Quick Reference — All Species
| Species | Tier | Toxin Class | Onset | Primary Risk |
|---|---|---|---|---|
| Amanita phalloides | Tier 1 | Amatoxins (heat-stable bicyclic octapeptides) | Biphasic/triphasic: 6–24 h | Fulminant hepatic necrosis, death |
| Amanita campinaranae | Tier 1 | Suspected amatoxins (morphology-based) | 6–12 hours | Suspected fulminant hepatic necrosis, death |
| Chlorophyllum molybdites | Tier 2 | Leucoagaricitin (heat-labile GI protein toxin) | 30 min–2.5 hours | Severe GI illness; resolves in 24–48 h |
National Emergency Numbers
Regional CIATox / CIT Centers
ONSET BRANCH — Two Primary Decision Paths
Presumptive amatoxin. Initiate full Tier 1 ICU protocol immediately. Do NOT await laboratory confirmation in Amazonian remote settings. Admit all patients for 96-hour monitoring minimum.
Likely GI irritant (Tier 2). Supportive care with IV rehydration and antiemetics. Observe minimum 6 hours. If late symptoms develop, escalate immediately to Tier 1 protocol.
Bedside Decision Matrix — All Species
| Species | Onset | Initial Symptom Pattern | Immediate Action | Disposition |
|---|---|---|---|---|
| A. phalloides — Death Cap | 6–24 h | Apparent recovery after initial GI; then rapidly rising AST/ALT, coagulopathy, encephalopathy | Admit ICU. IV silibinin + NAC + MDAC. Hepatology + transplant consult. | ICU admission. Liver transplant unit notification. |
| A. campinaranae — Amazonian Amanita | 6–12 h | Nausea, vomiting, abdominal pain followed by apparent latent period; hepatic injury expected | Treat as full amatoxin without awaiting labs. Dual large-bore IV access. Activate transfer protocol. | ICU admission. Urgent transfer if tertiary center available. |
| C. molybdites — False Parasol | 30 min–2.5 h | Profuse vomiting and diarrhea. No hepatic involvement. Resolves in 24–48 h. | IV ondansetron or metoclopramide. IV crystalloid. Electrolyte panel. Do NOT administer loperamide or diphenoxylate. | ED observation minimum 6 h; discharge with oral rehydration if stable. |
Full ICU Treatment Protocol
- Aggressive IV hydration — crystalloid resuscitation; target euvolemia with strict fluid balance monitoring
- Multidose activated charcoal (MDAC) via nasogastric tube — interrupts enterohepatic recycling of amatoxins
- IV Silibinin (Legalon SIL) — four consecutive uninterrupted 6-hour infusion blocks with zero gap between bags to maintain continuous OATP1B3 receptor blockade; any gap breaks receptor saturation
- IV N-acetylcysteine (NAC) — three-bag regimen:
- 150 mg/kg over 1 hour (loading dose)
- 50 mg/kg over 4 hours
- 100 mg/kg over 16 hours
- Then repeat at 150 mg/kg every 24 hours until INR drops below 1.5 AND transaminases clear linearly
- TGO/TGP (AST/ALT) and INR monitoring every 6 hours
- Early liver transplant unit notification — do not wait for confirmed hepatic failure to initiate contact
King's College Criteria — Non-Paracetamol (Toxic Mushroom Thresholds)
Single criterion (any one alone sufficient):
- Arterial pH below 7.3 after adequate resuscitation
Multi-factor criteria (any three of the five simultaneously):
- INR above 3.5
- Bilirubin above 300 µmol/L
- Age under 10 or over 40
- Jaundice to encephalopathy interval greater than 7 days
- Confirmed toxic mushroom ingestion
When criteria are met, immediate listing for emergency liver transplant is indicated. Do not delay notification pending additional deterioration.
Meixner Test — Bedside Amatoxin Screen
Procedure:
- Place a drop of fresh mushroom juice (or aqueous extract) on plain white newsprint or filter paper containing lignin
- Allow to dry completely at room temperature — do NOT apply heat
- Apply one drop of 10% hydrochloric acid (HCl)
- A blue coloration within 1–3 minutes indicates a positive result — presumptive amatoxin present
Limitations: Psilocybin and some other indole compounds also produce a blue color (false positive). The test cannot detect amatoxins below the colorimetric threshold.
Diagnostic Sampling
Pediatric Dosing Protocol
Pediatric Adjustments
- Activated charcoal: 1 g/kg every 4 hours via nasogastric tube
- NAC and Silibinin: weight-based dosing — consult pediatric toxicology for precise calculation
- IV fluid resuscitation: conservative at 1.0–1.5 mL/kg/hour with strict fluid balance monitoring every 2 hours — do not exceed to prevent pulmonary edema in small children
🐕 Veterinary — Dogs
Clinical signs: Vomiting, diarrhea (may be hemorrhagic), lethargy, abdominal pain, jaundice, ascites, hepatic encephalopathy, coagulopathy. Onset typically 6–24 hours after ingestion.
Treatment protocol:
- IV N-acetylcysteine: 140 mg/kg loading dose, then 70 mg/kg every 4 hours for 17 doses
- Multidose activated charcoal (MDAC) if within 2–4 hours of ingestion and patient is not vomiting uncontrollably
- Aggressive IV fluid support with crystalloids; monitor renal output
- Serial hepatic panel (ALT, AST, ALP, bilirubin) and renal panel (BUN, creatinine) every 6–12 hours
- Vitamin K1 if coagulopathy present
- Referral to veterinary internal medicine or emergency specialist if available
Prognosis: Guarded to poor without aggressive early treatment. Mortality is significant in delayed presentations. Prognosis worsens with onset of clinical jaundice and hepatic encephalopathy.
🐈 Veterinary — Cats
Clinical signs: Vomiting, diarrhea, lethargy, inappetence, icterus, hepatic encephalopathy. Cats may present with less overt GI signs than dogs early in the course.
Treatment:
- SAMe (S-adenosylmethionine) as hepatoprotectant — 20 mg/kg orally once daily
- N-acetylcysteine at weight-based dosing; consult veterinary formulary
- Thermal support — cats are prone to hypothermia in hepatic failure
- IV fluid support; cats tolerate aggressive fluid loading poorly — conservative resuscitation preferred
- Avoid drugs with high hepatic metabolism (acetaminophen absolutely contraindicated)
Prognosis: Guarded to poor. Cats are particularly susceptible to hepatotoxic injury. Early intervention is critical.
ICU Treatment Protocol
- Zero-tolerance amatoxin rules: apply full Tier 1 amatoxin protocol immediately without awaiting laboratory confirmation
- Dual large-bore IV access mandatory — establish before any other intervention
- Euvolemic targeted fluid resuscitation with CVP monitoring titrated hourly — do NOT use aggressive fluid loading; this species is under-studied and renal involvement cannot be excluded
- Activated charcoal via nasogastric tube — multidose regimen as per Tier 1 protocol above
- Serial hepatic and renal monitoring — AST, ALT, creatinine, INR every 6 hours
- Early transfer to tertiary center if available — Amazonian region has limited specialist toxicology access
🐕🐈 Veterinary — Dogs and Cats
Treat under the full amatoxin protocol as detailed above for Amanita phalloides. Given the remote Amazonian setting where access to veterinary specialists may be severely limited, prioritize aggressive supportive care, IV NAC, and MDAC. Contact the nearest veterinary emergency center by telephone for real-time dosing guidance.
Treatment Protocol
- IV Ondansetron or Metoclopramide for emesis control
- Aggressive IV crystalloid rehydration
- Electrolyte panels — monitor for hyponatremia and hypokalemia from fluid losses
- Fully resolves in 24–48 hours with supportive care — no hepatic involvement expected
- Observe minimum 6 hours; discharge when tolerating oral fluids
🐕 Veterinary — Dogs
Clinical signs: Profuse vomiting, watery to hemorrhagic diarrhea, lethargy, abdominal discomfort. Onset within 30 minutes to 2 hours of ingestion.
Treatment: IV fluids (crystalloid), antiemetics (maropitant or ondansetron), electrolyte monitoring. Do NOT administer antidiarrheal agents (loperamide).
Prognosis: Good with supportive care. Most dogs recover within 24–48 hours. Monitor for dehydration and electrolyte disturbance in small-breed dogs.
🐈 Veterinary — Cats
Clinical signs: Vomiting, diarrhea, lethargy. Cats are less likely than dogs to ingest large quantities but toxicity is confirmed.
Treatment: IV fluid support, antiemetics, monitoring. Supportive care only.
Prognosis: Good with supportive care. Full recovery expected in 24–48 hours.
Demographics
- Age and weight of each patient
- Number of people exposed from the same meal or foraging event — assume all are at risk even if asymptomatic
Location and Biome
- Specific Brazilian state and municipality
- Biome type: Atlantic Forest, Amazon, Cerrado, Caatinga, Pantanal, Pampas
- Elevation above sea level (relevant for Atlantic Forest high-altitude species)
Timeline
- Precise ingestion time (hour:minute if known)
- Precise first symptom onset time
- Time elapsed since ingestion at time of clinical presentation
Preparation Method and Detoxifying Myths
- Raw or cooked; method if cooked (boiled, fried, stewed, other)
- Any detoxifying preparation attempts — document and flag if patient or family attempted "detoxification" methods
- ⚠ Silver coin myth: Boiling mushrooms with silver objects (coins, utensils) does NOT neutralize amatoxins. Advise patients and families that this belief is pharmacologically false — amatoxins are unaffected by silver contact or heat.
Sample Preservation Protocol
- Preserve any remaining raw mushroom material refrigerated in a paper bag — never plastic, which accelerates decomposition and destroys morphological features needed for identification
- Photograph the specimen before bagging if smartphone is available
- Do not wash the specimen before preservation
Diagnostic Sampling
- Gastric aspirate ELISA: Collect via nasogastric tube within the first 6 hours for cooked specimens — amatoxins survive cooking and can be confirmed even when no physical mushroom material remains
- Urine amatoxin testing: Optimal sensitivity within 48 hours of ingestion. Sensitivity drops markedly after 72 hours due to hepatic trapping. Collect as early as possible.
Brazil-Specific Regional Access Note
- The CIATox network is well-developed in southeast Brazil (SP, RJ, MG, RS) — consult regional centers early
- The Amazonian region (AM, PA, AP) has significantly limited specialist toxicology access — treat on clinical history alone in remote settings without waiting for laboratory confirmation
- For Amazonian presentations: contact FMT-HVD Manaus: (92) 2127-3432
Scan to open this guide on any device
https://www.sporeandscout.com/guides/toxic-mushroom-clinical-reference-brazil
This QR code links to: https://www.sporeandscout.com/guides/toxic-mushroom-clinical-reference-brazil