A narrative review of toxicity after exposure to true morel (<i>Morchella</i> genus) and false morel (<i>Gyromitra</i> genus) mushroom ingestions
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The clinical presentations associated with <i>Morchella</i> spp. (true morel) and <i>Gyromitra</i> spp. (false morel) mushroom ingestions are incompletely characterized. The objective of this review is to describe the clinical presentations reported after <i>Morchella</i> spp. and <i>Gyromitra</i> spp. ingestions. This is a narrative review to identify studies reporting toxicity in humans from <i>Morchella</i> spp. and <i>Gyromitra</i> spp. The literature search was performed in two stages. First, a search of Medline, Embase, PubMed, Scopus, and Agricultural & Environmental Science electronic databases was performed. The search strategy employed a combination of controlled vocabulary terms and free-text terms. Terms such as “morel,” “true morel,” “false morel,” “morchella,” “gyromitra,” and “lorchel” were utilized in conjunction with keywords related to toxicity. Duplicate articles were removed. Second, a manual search of the references for the included articles was performed. Inclusion criteria were peer-reviewed human reports of mushroom ingestion in all languages up to 31 December 2024, with sufficient description of three components: acute ingestions to <i>Morchella</i> spp. or <i>Gyromitra</i> spp., clinical manifestations, and medical outcome. There were 84 articles that met the inclusion criteria. The articles described 201 and 52 individual <i>Gyromitra</i> spp. and <i>Morchella</i> spp. ingestions, respectively. The mortality rate in these articles was 28.9% for <i>Gyromitra</i> spp. and 7.7% for <i>Morchella</i> spp. The clinical presentation after <i>Morchella</i> spp. ingestion was primarily neurologic (65.4%), most commonly dizziness and/or unsteadiness/ataxia (51.9%), without any reported seizures, with a median onset of 12 h (IQR: 9–12 h). Gastrointestinal (50.0%) effects were less common and often early, with a median onset of 2.3 h (IQR: 1.1–9 h). Hepatic effects were uncommon (17.3%) and only present when other organ systems were involved. No fatalities from <i>Morchella</i> spp. ingestion were reported until 2024. However, three articles published in 2024 report multiple cases of critical illness and fatality after <i>Morchella</i> spp. ingestion. The clinical presentation of <i>Gyromitra</i> spp. ingestions was primarily gastrointestinal (88.1%) and often delayed with a median onset of 9 h (IQR: 6–12 h). Hepatic (53.7%) and neurologic (51.7%) effects were also commonly reported. Seizures were only reported in 13.9% of <i>Gyromitra</i> spp. ingestions and mostly in fatal cases (82.1%) later in the disease course. Hemolysis was reported in only a minority of <i>Gyromitra</i> spp. (2.5%) ingestions. <i>Morchella</i> spp. ingestions were most frequently associated with a constellation of neurologic symptoms, including dizziness, unsteadiness, and ataxia. Approximately half of the patients displayed gastrointestinal symptoms, typically within the first 6 h. The absence of gastrointestinal symptoms did not preclude the involvement of other organ systems. However, the recent critical and fatal cases of <i>Morchella</i> spp. ingestion display a pattern of severe, early vomiting and diarrhea, sometimes with shock, hemorrhagic gastrointestinal complications, and multi-system organ failure. <i>Gyromitra</i> spp. ingestions commonly displayed delayed gastrointestinal, hepatic, and/or neurologic effects. However, seizures were uncommon other than in the late stages of fatal cases with coma. This review has limitations, including reporting and publication biases. However, having a better understanding of what has been reported in the literature provides better insight into these rare toxicologic presentations. The clinical presentations following the ingestion of <i>Morchella</i> spp. and <i>Gyromitra</i> spp. mushrooms reported in the literature follow distinct patterns that differ from what is commonly reported in reference texts. <i>Morchella</i> spp. ingestions were associated with a constellation of neurological symptoms, including dizziness, unsteadiness, and ataxia, and many patients developed gastrointestinal symptoms, which typically occurred within 6 h. Several reports in 2024 described cases of critical illness, including early gastrointestinal symptoms, sometimes with shock, hemorrhagic gastrointestinal complications, and multi-system organ failure. Toxicity after <i>Gyromitra</i> spp. ingestion typically results in delayed gastrointestinal symptoms followed by hepatic and neurologic effects. Seizures were mostly reported as late findings in fatal cases after the onset of coma and multi-organ injury.
与羊肚菌属（*Morchella*，真羊肚菌）及鹿花菌属（*Gyromitra*，假羊肚菌）蘑菇摄入相关的临床表现尚未被完全阐明。本叙述性综述旨在描述羊肚菌属与鹿花菌属蘑菇摄入后报告的临床特征。本研究为叙述性综述，用于检索报道羊肚菌属与鹿花菌属蘑菇致人类中毒的相关文献。文献检索分两阶段开展：第一阶段检索Medline、Embase、PubMed、Scopus及Agricultural & Environmental Science电子数据库，检索策略结合受控词汇与自由文本词汇，采用“morel（羊肚菌）”“true morel（真羊肚菌）”“false morel（假羊肚菌）”“morchella”“gyromitra”及“lorchel（钟菌）”等术语，联合与中毒相关的关键词进行检索。去除重复文献后，第二阶段对纳入文献的参考文献进行手工检索。纳入标准为：2024年12月31日前发表的经同行评议的人类蘑菇摄入相关研究报告，且需充分涵盖以下三部分内容：羊肚菌属或鹿花菌属的急性摄入史、临床表现及转归结局。最终共有84篇文献符合纳入标准，其中分别报道了201例鹿花菌属摄入事件与52例羊肚菌属摄入事件。纳入文献显示，鹿花菌属中毒的死亡率为28.9%，羊肚菌属中毒的死亡率为7.7%。羊肚菌属摄入后的临床表现以神经系统症状为主（65.4%），最常见为头晕及/或步态不稳/共济失调（51.9%），未报告有癫痫发作，中位发病时间为12小时（四分位数间距（Interquartile Range, IQR）：9~12小时）。胃肠道症状（50.0%）相对少见，且通常发作较早，中位发病时间为2.3小时（IQR：1.1~9小时）。肝脏损害较为罕见（17.3%），仅在累及其他器官系统时出现。直至2024年，均未报道过羊肚菌属摄入导致的死亡病例。但2024年发表的3篇文献报告了多例羊肚菌属摄入后出现重症疾病与死亡的病例。鹿花菌属摄入后的临床表现以胃肠道症状为主（88.1%），通常发作较晚，中位发病时间为9小时（IQR：6~12小时）。肝脏损害（53.7%）与神经系统症状（51.7%）也较为常见。仅13.9%的鹿花菌属摄入病例报告了癫痫发作，且多数（82.1%）出现在致命病例的疾病晚期病程中。溶血仅在极少数鹿花菌属摄入病例（2.5%）中被报道。羊肚菌属摄入最常表现为一组神经系统症状群，包括头晕、步态不稳及共济失调。约半数患者会出现胃肠道症状，通常在摄入后6小时内出现。无胃肠道症状并不排除其他器官系统受累。但2024年报告的重症与致命羊肚菌属摄入病例，则表现为严重的早期呕吐与腹泻，有时伴随休克、出血性胃肠道并发症及多器官功能衰竭。鹿花菌属摄入通常表现为延迟出现的胃肠道、肝脏及/或神经系统症状。但除了伴昏迷的致命病例晚期阶段外，癫痫发作并不常见。本综述存在一定局限性，包括报告偏倚与发表偏倚。但充分梳理文献中已报道的内容，有助于更深入地认识这些罕见的中毒临床表现。文献中报道的羊肚菌属与鹿花菌属蘑菇摄入后的临床表现，呈现出与参考教材中常见描述不同的独特模式。羊肚菌属中毒以头晕、步态不稳及共济失调等神经系统症状群为主要表现，多数患者会出现通常在6小时内发作的胃肠道症状。2024年的多篇报告描述了重症病例，包括早期胃肠道症状，有时伴随休克、出血性胃肠道并发症及多器官功能衰竭。鹿花菌属中毒通常表现为延迟出现的胃肠道症状，随后出现肝脏与神经系统损害。癫痫发作大多仅在伴昏迷的致命病例晚期，即多器官损伤发作后被报告。
