There’s a darker side to mushrooms

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You had a hearty meal and then succumb to diarrhoea, vomiting and nausea. You think it is food poisoning. You might be right about the food poisoning but this time it is not because of the unicellular microbes – bacteria or virus. It could be due to a larger member of the microbial world – fungus. Yes, the mould that you see on old bread. But wait, there are even larger versions of this mould that comes with fruiting bodies. These are the mushrooms. While many look very tame and tempting, they can cause mild indigestion to organ failures or even fatality.

Mushrooms are very versatile cooking ingredient and they blend well into both traditional and western dishes. Whether they are added to an omelette, soup, pizza, stir-fried vegetables or simply fried with some batter, they produce mouth-watering dishes. They are loved for their succulent and meaty-like texture.

Living in a tropical country like Malaysia, we are blessed with a wide range of mushrooms that come in all shapes and sizes. Some are edible, some are poisonous and many even have lots of medicinal and industrial values.

What concerns a prominent mycologist in Malaysia is the lack of proper documentation of poisonous mushrooms in the country. Prof Vikineswary Sabaratnam, the Head of University of Malaya’s Mushroom Research Centre (MRC) says, “Although death caused by consuming mushrooms is not a daily tragedy, it still happens almost every year and our doctors are not able to identify it because we don’t have a compendium of poisonous mushrooms that can serve as reference for doctors during an emergency.”

A fatal harvest

Mushroom picking is not just an activity for village folks but also urbanites. Many cases were reported where the victims picked up the unsuspicious fungus from their backyards, fields, and even while jungle trekking. They spring up after a rainy day, many looking like the edible oyster mushroom or termitomyces (locally known as ‘cendawan busut’).

The common myth is all white mushrooms are edible and toxic mushrooms smell and taste horrible. The truth is even insects and animals can’t tell which mushrooms are poisonous. While there are over 2000 species of mushrooms, only fewer than 50 are poisonous. Lack of knowledge to distinguish edible and poisonous mushroom by the public who collects mushroom as food can lead to fatality in a worst case scenario.

Vikineswary says the public can be easily confused as there are many similar looking mushrooms and it requires very close and detailed examination to identify mushrooms.

“Mushrooms can also look different at different growth stages and their colours may change as well. Mushroom collectors get fooled because of this too”, says the mushroom expert.

Her advice to mushroom foragers, “if you really want to eat what you have collected, please keep some uncooked for identification purposes if something turns awry”.
Usual symptoms of mushroom poisoning are diarrhoea, vomiting, unusual sweating, tearing, salivation and dizziness. In some cases, delayed effects are seen such as liver and kidney failures. Potent mushroom toxins may cause fatality.

Partnership between medical doctors and mycologists

Since 2011, MRC has been identifying mushrooms for doctors from different states at an ad-hoc basis. These mushrooms are usually brought by the patients and given to the doctors or collected by health officers where the patients have earlier collected the mushrooms.

The standard operating procedure is for doctors to notify Department of Health in their respective state and the health officers will then send the samples to MRC. In some cases, patients even retrieve uncooked mushroom pieces from their trash bins.

The challenge for mycologists is mushrooms are highly perishable and by the time the samples reach Vikineswary’s laboratory, they are contaminated by other fungus and bacteria.

At MRC, identification is carried out through morphological and molecular systematics by looking at the nuclear ribosomal internal transcribed spacer (ITS) region.

Looking at the difficulties faced by the doctors to provide timely and proper medication and treatment to patients suffering from mushroom poisoning, Vikineswary mooted the idea of conducting hands-on workshops for medical practitioners where they will be able to do a preliminary identification of the mushroom. She believed this will enhance knowledge on public health management of mushroom poisoning.

The first such workshop will be led by Dr Phan Chia Wei and Dr Tan Yee Shin from MRC; and Datuk Dr Mohammed Alzamani Idrose and Dr Baran Palanimuthu from KL Hospital’s Emergency Department on Nov 13, 2017. This social responsibility project is supported by UMCares in University of Malaya under the National Blue Ocean Strategy (NBOS) initiatives.

Vikineswary feels strongly for the collaboration between mycologists and medical practitioners as currently a list of poisonous mushrooms in Malaysia is not available, and there is also a lack of knowledge transfer between the two expert groups. The other void in this area is comprehensive information on mushroom poisoning as a differential diagnosis in gastroenteritis.

Differential diagnosis is the process of differentiating between two or more conditions that share similar signs or symptoms. In this case, mushroom poisoning is often mistaken for common food poisoning.

The journey continues

As “mushroom poisoning” became a household name among hospitals, a Whatsapp group was created by the doctors of HKL to facilitate immediate transfer of information in cases of emergencies. Members of the groups are doctors at the emergency units at various hospitals, health officers, and mycologists from MRC, Universiti Malaysia Sabah and Universiti Malaysia Sarawak. They, too established a Facebook group called “Mushroom Poisoning”.

Over the span of her career life, Vikineswary has successfully developed experts in this field who are now with UM, UMS and UNIMAS where their expertise is put to good use across Malaysia. But she still laments that taxonomy study has become very shallow in today’s degree programme and can only be pursued at post-graduate level and not many are pursuing fundamental research.

Vikineswary also feels the various groups researching mushrooms in Malaysia are often reinventing the wheel with so much of duplication of work.

MRC’s next big step is to publish a book on mushrooms in Malaysia for quick reference by doctors at hospitals’ emergency departments. The book will list out the mushrooms with colourful pictures, their nutritional values, medicinal properties, toxins, symptoms of poisoning, SOP to medical practitioners, and tips to the public. The book is expected to be launched during the next workshop organised by MRC and HKL in March, 2018.
MRC has also taken to social media to create awareness on mushroom where the public can read more on their blog: mrcumkl.blogspot. my.