The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) said mushroom picking had started earlier than usual in 2023.

Rainy weather in several regions in August encouraged the growth of mushrooms. Growth varies yearly, depending on various things, including weather.

Since the start of August, intoxications reported to poison control centers (CAP) have increased. More than 250 cases have already been recorded, twice as many as in the same period in 2022.

There are several reasons for poisonings, including confusion of an edible species with a toxic variety or consumption of edible mushrooms in poor condition that were poorly preserved or insufficiently cooked.

It is not recommended to serve infants picked wild mushrooms but 74 young children were poisoned, including an 11-month-old child who required treatment in intensive care.

Not a new problem
Although ANSES issues recommendations yearly, cases are frequently reported to poison control centers.

Between July and December 2022, 1,923 poisonings were reported to CAPs. This was more than 1,269 cases in 2021. However, the number of serious cases was down slightly from 41 in 2021 to 37 in 2022. There were two deaths compared to four fatalities in 2021. The peak this past year was in October when more than 1,000 cases were recorded.

From all poisonings, 30 people had used recognition applications on smartphones. This is not advised due to the high risk of error.

Pick only specimens in good condition and take the entire mushroom to help with identification. Do not pick mushrooms near potentially polluted sites such as roadsides and landfills.

Store mushrooms in the fridge at a maximum of 4 degrees C (39.2 degrees F), avoid all contact with other foods, and consume within two days of picking. Ensure they are correctly cooked – 20 to 30 minutes in a pan or 15 minutes in boiling water – and don’t eat too many in one sitting.

ANSES recommends only collecting mushrooms they know, as some highly toxic ones are similar to edible species. Poisonous types can also grow where edible varieties had been picked in the past. If there is the slightest doubt, consult a specialist before consumption.

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A total of 1,923 intoxications were reported to poison control centers (CAP) during the surveillance period, between July and December. The amount is usually around 1,300 cases. Levels in 2022 were similar to those in 2019.

The monthly poisoning peak of 2022 occurred in October when more than 1,000 cases were recorded. Nearly 40 serious cases occurred, including one person needing a liver transplant and another who had kidney failure, and two people died. In 2021, 41 serious cases and four deaths were reported.

Mushroom growth varies from year to year depending on various things, including weather, according to an article in Vigil’Anses, a newsletter published by the French Agency for Food, Environmental and Occupational Health and Safety (ANSES).

Risk factors for poisoning are poor conservation, consumption of old mushrooms in poor condition, undercooked mushrooms or eating too many, and personal sensitivity, but the major risk is confusing an edible species with a toxic one.

Digging deeper into cases
A questionnaire to better understand the circumstances of intoxication was undertaken by poison control centers. It was offered to each person calling a poison control center for mushroom poisoning to assess the methods of obtaining and identifying mushrooms, plus knowledge of ANSES’s prevention messages.

Although recommendations are issued every year by ANSES, poisonings are frequently reported to poison control centers because of the consumption of raw mushrooms by young children or the use of identification applications for smartphones.

In 2022, 1,862 people were poisoned during a meal including mushrooms. The other cases include accidental ingestion by young children or vulnerable adults.

For 1,146 meals, information on the origin of mushrooms was available. More than 92 percent had been picked but some had been bought in supermarkets, markets or greengrocers or eaten in restaurants.

Picking had taken place mainly in forest areas and less frequently in a garden. A small percentage were from the roadside. Most mushrooms had been cooked before consumption but they were eaten raw in 94 meals.

Some people had tried to identify picked mushrooms before consuming them using various ways such as a book, a smartphone application, the internet or via the help of a third party such as a pharmacist or a mycologist from an association.

The most frequently identified toxic species were Satan’s (or Devil’s) bolete, yellow agarics, poisonous lepiota types or the fly agaric.

People mainly suffered from digestive symptoms including vomiting, nausea, diarrhea or abdominal pain. Neurological issues were observed in 17 percent of patients, including dizziness or headaches. Some people showed excessive sweating or a rash, as well as cardiovascular symptoms.

Wild mushroom advice
ANSES recommends that people only collect mushrooms they know as some highly toxic ones are very similar to edible species. Poisonous types can also grow where edible varieties had been picked in the past. If there is the slightest doubt, consult a specialist before consumption.

Pick only specimens in good condition and take the entire mushroom to help with identification. Do not pick mushrooms near potentially polluted sites such as roadsides and landfills.

Store mushrooms in the fridge at a maximum of 4 degrees C (39.2 degrees F), avoid all contact with other foods and consume within two days of picking. Make sure they are cooked properly – 20 to 30 minutes in a pan or 15 minutes in boiling water – and don’t eat too many in one sitting. Also, don’t give wild mushrooms to young children or use only mobile apps for identification, due to the high risk of error.

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A launch meeting for EuroCigua II was attended this past week by representatives of 11 organizations involved in food safety and public health from five European countries.

Partners include the Spanish Institute of Agrifood Research and Technology (IRTA), Canary Islands Health Service (SCS), the French Agency for Food, Environmental and Occupational Health and Safety (ANSES), German Federal Institute for Risk Assessment (BfR), Portuguese Economic and Food Safety Authority (ASAE), and Dutch National Institute for Public Health and the Environment (RIVM).

Also participating in the three-year effort are the European Food Safety Authority (EFSA), the European Center for Disease Prevention and Control (ECDC), European Environment Agency of the European Commission, the United Nations Food and Agriculture Organization (FAO) and experts from research groups in the United States and Japan.

Aims second time around
Ciguatera is a type of food poisoning associated with consumption of fishery products that contain toxins produced by a microalgae. The toxin does not affect the appearance, odor or taste of the fish and is not destroyed by cooking, refrigeration or freezing.

The role of the Canary Islands Health Service in EuroCigua II will involve determining the epidemiological characteristics of ciguatera, evaluating and characterizing ciguatoxins in fish and influence on the environment.

In recent years, 21 outbreaks have been recorded in the Canary Islands, with 125 cases. Fish species implicated were amberjack, grouper, pejerey and abade. From 2012 to 2018, four European countries reported 23 ciguatera outbreaks and 167 cases.

The objective is to improve diagnostic tools and scientific knowledge about this emerging risk, in the Canary Islands and the rest of Europe, to help authorities combat the issue. Efforts will be alongside projects such as CIGUARISK, which is a Spanish national research program. Minister of Health, Blas Trujillo, said the project would cover all aspects related to the identification, confirmation and quantification of ciguatoxins.

The meeting was organized by health officials in the Canary Islands and the Spanish Agency for Food Safety and Nutrition (AESAN).

Initial work
The first EuroCigua project, which ran from 2016 to 2021, focused on determining the risk of Ciguatera food poisoning in Europe, identifying prevention and control measures, fish species at risk and the influence of changes in the marine environment.

Results confirmed the presence of ciguatera poisoning in the European Union, and identified several species of fish with ciguatoxins in Madeira and the Canary Islands. The presence of Gambierdiscus in the Mediterranean Sea in Cyprus and Greece has also been found, as well as the first notification of several species of dinoflagellates in the Balearic Islands.

Symptoms usually develop three to six hours after eating contaminated fish but it may take up to 30 hours. Poisoning can cause gastrointestinal symptoms such as abdominal pain, nausea, vomiting, dehydration, and severe diarrhea, cardiovascular problems like an irregular pulse or low blood pressure, and neurological effects including itching, tingling, or blurred vision. Others find cold things hot and hot items feel cold.

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Recent weather conditions have favored the growth of wild mushrooms and more than 60 intoxications have been reported to poison control centers since early September. Only a few cases occurred in July and August likely because of the very hot weather and drought, according to researchers.

Poisonings have a variety of causes: some people mistook a toxic species for an edible one, sometimes it is because of a smartphone app for wild mushroom identification providing incorrect information about the mushrooms picked, or consumption of edible mushrooms that are in poor condition or have been undercooked.

A yearly problem
Between July and December 2021, there were 1,269 cases reported to poison control centers in France. The majority of the mushrooms responsible had been picked in the wild but some cases involved mushrooms purchased commercially.

Symptoms were mainly digestive with abdominal pain, nausea, vomiting and diarrhea. There were 41 severe cases including four deaths. Fifteen young children were poisoned and one of them needed a liver transplant. French authorities said picked mushrooms should not be given to young children.   

Between July and December 2020, there were 1,300 poisonings reported. Overall, 29 life-threatening cases were identified and five people died.

The French Agency for Food, Environmental and Occupational Health and Safety (ANSES), poison control centers, and the Directorate General for Health (DGS) advised people to only pick mushrooms they know very well as some poisonous fungi closely resemble edible species. If there is the slightest doubt about the identification of any picked mushrooms, the agencies said they should not be consumed until they are checked by a specialist.

People should note the time of the last meal and onset of first symptoms, and keep any leftover wild mushrooms for identification. Officials advise taking a picture of the picked mushrooms before eating to help poison control center experts decide on the correct treatment if illness occurs.

Other countries impacted
Data from Tox Info Suisse, the Swiss poisons information center, revealed 529 mushroom poisoning cases in Switzerland in 2021.

The Belgian Poison Center (Centre Antipoisons) received almost 350 calls about potential mushroom poisonings in Belgium and Luxembourg in 2021.

In Germany, an average of 10 cases of mushroom poisoning per year are reported to the German Federal Institute for Risk Assessment (BfR) by doctors, and poison centers in the federal states answer more than 3,000 related inquiries annually. 

Popular domestic edible types include the field mushroom (Agaricus campestris) and edible Russula species. Often collectors confuse edible mushrooms with the highly toxic death cap (Amanita phalloides). Toxins contained in death cap cause liver failure and even eating small amounts can be fatal. 

About five percent of all mushroom poisonings are because of consumption of the death cap mushroom, which grows from July to October, mainly in forests, but also in parks. The BfR estimates that it causes at least 80 percent of all fatal mushroom poisonings in Germany.

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Campylobacter surveillance involves Santé publique France, the National Reference Center for Campylobacter and Helicobacter, the General Directorate for Food (DGAL), the General Directorate for Concurrence, Consumption and Fraud Control (DGCCRF), the National Reference Laboratory for Campylobacter and medical and veterinary labs. 

In 2020, the CNR reported 8,884 isolates of Campylobacter and related bacteria with 7,920 identified as Campylobacter. In 2019, among 7,712 isolates of Campylobacter reported, Campylobacter jejuni was responsible for almost 85 percent followed by Campylobacter coli.

A total of 63 outbreaks due to Campylobacter were declared with 244 patients in 2020. This was similar to 2019. Consumption of poultry was the suspected source in 35 outbreaks.

Surveillance plans
While poultry present an important risk, not all infections can be linked to such products.

Monitoring of Campylobacter in poultry will continue in 2022 at the distribution stage and will make it possible to assess the impact of the process hygiene criterion. A total of 250 samples of fresh poultry meat without skin and 250 samples with skin will be studied and tested for Campylobacter.

Another surveillance plan on raw milk at production will be carried out to assess the Campylobacter risk linked to this matrix.

A study of Campylobacter contamination of bovine livers at the slaughterhouse was carried out in 2021. A look at poultry offal at the slaughterhouse and distribution stages was also done in 2021. The data for these two studies will be available later in 2022.

Past surveillance plans have included chicken, pork, beef, turkey and veal with the highest prevalence in chicken.

Genome sequencing of strains isolated from these matrices and comparison with genomic data of human strains should be a tool to support surveillance, said researchers.

In 2018, the European Commission introduced a Process Hygiene Criteria for Campylobacter on broilers requiring intervention if 1,000 Colony Forming Units per gram (CFU/g) for neck skin samples after chilling of carcasses in the processing plant is exceeded. It initially allowed 20 samples to exceed 1,000 CFU/g. This was reduced to 15 of 50 samples in 2020 and will drop to 10 in 2025.

Of the 131 French broiler slaughterhouses that transmitted results for 2020, a Campylobacter count greater than 1,000 cfu/g was reported for 28.4 percent of the 15,481 analyzes carried out.

Turmeric supplement warning
Meanwhile, the French Agency for Food, Environmental and Occupational Health & Safety (ANSES) has warned about illnesses associated with food supplements containing turmeric.

Turmeric is a plant used as a spice and can be found in a variety of supplements because of its digestive, antioxidant and anti-inflammatory properties.

Italy has recorded around 20 cases of hepatitis involving supplements containing turmeric. In France, ANSES’s nutrivigilance system has received more than 100 reports of adverse effects, including 15 reports of hepatitis, potentially related to pills containing turmeric or curcumin.

ANSES has noted the growing use of formulations that increase the bioavailability and effects of curcumin in food supplements such as those that combine it with ingredients such as piperine.

“Curcumin has very low bioavailability, i.e. it is poorly absorbed into the bloodstream and is very rapidly eliminated by the body. Manufacturers have developed various formulations to increase this bioavailability and thereby enhance the effects of curcumin,” said Fanny Huret, coordinator of the expert appraisal at ANSES.

These new formulations can pose a risk of adverse effects by increasing the bioavailability of curcumin in the body. Most labels of food supplements don’t say whether they are classic or novel formulations so consumers may unknowingly be ingesting a potentially toxic product.

ANSES advises companies selling food supplements to provide detailed data on the bioavailability of products so that a specific maximum daily intake level may be set.

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The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) identified the types of unpasteurized milk cheeses on which to target efforts.

In France, over the past decade, 34 percent, 37 percent and 60 percent of outbreaks of salmonellosis, listeriosis and E. coli  infections have been linked to raw milk cheeses.

The focus fell on soft cheeses with a surface mold such as Camembert, Brie and Crottin and short-ripened uncooked pressed cheeses like Morbier, Reblochon and Saint-Nectaire as well as soft washed-rind cheeses such as Munster and Maroilles.

In total, 46 hazard food pairs were judged as relevant by experts. They covered E. coli, Salmonella, Listeria monocytogenes, Staphylococcus aureus and histamine in cheese, butter and cream.

Supply chain approach
ANSES received the request for the study from the Directorate General for Food (DGAL) in 2019. The aim was to assess the main sources of contamination and ways to control these risks.

Methods to control microbiological risks in the main dairy sectors of cattle, sheep and goat from the rearing stage to consumption, were studied by the agency.

At farm level, measures included good animal husbandry and hygiene practices. The ANSES study said ongoing efforts in terms of hygiene during milking and the management of mastitis should be continued.

During production, risk control was also very high. The agency recommended continuing to implement good hygiene practices and to carry out self-checks to best anticipate any risk of an outbreak.

For consumers, to avoid a foodborne infection, it is essential to comply with information on the packaging or that given by the seller concerning the temperature at which raw milk cheese should be stored in the refrigerator and its use-by date.

ANSES recommends that pregnant women, immunocompromised individuals, people over the age of 65 and young children should not eat raw milk cheeses, except for hard pressed cheeses such as Gruyère and Comté.

Related outbreaks
Among 50 Salmonella outbreaks with a confirmed food source between 2008 and 2018, 18 were caused by raw milk cheeses. Five of them sickened more than 100 people.

Six of 10 E. coli outbreaks recorded by Santé publique France between 2004 and 2019 were because of raw milk cheese. These products were behind 14 of 37 Listeria outbreaks that affected 103 people between 2012 and 2018.

Types of cheeses most often linked to outbreaks were soft and uncooked pressed cheeses and were made from cow’s milk.

Information from epidemiological investigations shows some incidents are because of a lack of hygiene control on the farm or during production. For others, the causes were not identified. This indicates that, even when good hygiene practices and control measures seem to be followed by operators, contamination can occur.

Laurent Guillier, who coordinated the expert appraisal, said levels of hygiene and risk control are now high on farms and self-checks at the processing stage are able to identify problematic batches.

“For several years now, we have been seeing a strong commitment on the part of the various raw milk cheese sectors to preventing microbiological risks. However, there is still a residual risk and it is important to identify new ways of optimizing the current control measures. For example, this could involve improving epidemiological investigations, identifying poor hygiene practices at an earlier stage, or communicating more with consumers.”

The work to classify raw milk cheeses was the first stage. Efforts are continuing to evaluate effectiveness of various health measures such as sorting milk at farm level and self-checks at the production stage. The next step will be to identify priority areas to further reduce microbiological risks.

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The Actia Fastypers group was started by the French Ministry of Agriculture. It runs for five years and involves ANSES, the National Institute for Agriculture, Food, and Environment (Inrae), dairy specialist Actalia and the French Pork and Pig Institute (IFIP).

Two departments at the French Agency for Food, Environmental and Occupational Health and Safety (ANSES) are involved, one with expertise in Salmonella and Listeria and the other with knowledge on antibiotics, biocides, residues and resistance.

The initial focus is planned to be on Listeria and Salmonella in the pork and dairy sectors. Presence of Listeria and Salmonella in food processing sites poses several problems as they can survive for a long time in the environment and some strains may be resistant to treatment with disinfectants.

Partners will try to understand how these bacteria manage to adapt and persist in the environment and in food plants, and also develop tools to characterize and detect persistent bacterial strains.

The first ANSES unit will provide its expertise in the genomic characterization of strains to identify which types are associated with the characteristics studied such as persistence in the environment and virulence. The second will study adaptation and resistance of bacteria to the biocidal cleaning products used.

The goal is to develop tools that can be used routinely by food producers and manufacturers to identify the strains of bacteria present at different stages of the supply chain. Results from these analyzes can help producers make decisions to adapt the cleaning and disinfection process to characteristics of the bacterial strains likely to be found.

Decrease in hepatitis A reports
Meanwhile, data published by Sante publique France has revealed a decline in hepatitis A in 2020.

Hepatitis A is spread when someone ingests the virus through close contact with an infected person or by eating contaminated food or drink. Even microscopic amounts of contaminated foods or beverages can cause infection by the liver virus.

The number of reports fell to 411 in 2020, down from 1,277 in 2019. Officials said the drop was probably because of less international travel and measures introduced related to COVID-19 that restricted circulation of the hepatitis A virus such as better hand hygiene and closure of restaurants and schools.

The main risk factors in the two to six weeks before onset of symptoms were consumption of seafood for 28 percent of cases; a trip outside France for 21 percent of cases; and living at home with a child younger than 3 years old for 20 percent of cases.

As in previous years, jaundice was reported for the majority of patients and almost half of them were hospitalized.

Reporting rates were largely the same for women and men. The average age of cases was 35 years old but ranged from 2 to 95. The age group in which the incidence was highest was 6 to 15 years old, which reflects findings from previous years.

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In July and August, 330 cases of poisoning were reported to French poison control centers. Three of these were very serious and potentially life-threatening and three deaths have been recorded.

Weather conditions in July and August favored early picking of mushrooms, according to the French Agency for Food, Environmental and Occupational Health and Safety (ANSES).

Poisoning risks include confusing edible types with toxic species, or consumption of edible mushrooms that are in poor condition, undercooked, or have been incorrectly stored.

Five deaths in 2020; three in 2019
Results from the previous season show that between July and December, 2020, 1,300 poisonings were reported to poison control centers in the country with more than half of them in October. This was when conditions such as rain, humidity and freshness favored the growth of mushrooms and their picking.

The majority of illnesses were linked to picked mushrooms, but in 4.5 percent of cases, they had been bought in a market or shop. A few incidents were caused by confusion with an edible species related to the use of a digital recognition app available on smartphones.

People were most often poisoned during a meal but 3 percent of cases followed ingestion, by a child or a vulnerable adult, of a piece of an inedible mushroom found in the garden or schoolyard.

Although most intoxications were not serious, 29 life-threatening cases were identified and five people died.

In 2019, more than 2,000 cases were reported to poison control centers between July and December. While most were minor, there were 24 cases of high severity with life-threatening prognosis and three deaths.

Swiss and Belgian figures
Data from Tox Info Suisse, the Swiss poisons information center, revealed at least 76 mushroom poisoning cases in Switzerland in 2020 including two serious cases.

The Belgian Poison Center (Centre Antipoisons) reported almost 500 mushroom poisonings in Belgium and Luxembourg in 2020 with children slightly more affected than adults.

Symptoms are mainly digestive and include abdominal pain, nausea, vomiting, and diarrhea. The onset of illness varies and is usually within a few hours of consumption, but maybe longer and exceed 12 hours. People should note the time of the last meal and onset of first symptoms, and keep any leftover wild mushrooms for identification.

Officials advise taking a picture of the picked mushrooms before eating to help poison control center experts decide on the correct treatment if illness occurs.

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The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) said brevetoxins (BTX) were first detected in mussels in Corsica in 2018. If ingested by humans, these toxins can cause neurological, gastrointestinal or cardiovascular symptoms.

After this finding a few years ago, ANSES was asked by the Directorate General for Food (DGAL) and Directorate General for Health (DGS) to propose a guideline value to protect the health of people who eat shellfish. The agency has published an opinion and report on the subject in French.

Based on reports of food poisoning in other countries, ANSES has set a guideline value to protect consumers of products such as oysters and mussels. This value is 180 µg/kg of shellfish flesh, expressed in BTX-3 equivalents, with BTX-3 being the form of brevetoxin used as the reference.

Emerging risk in Europe
Brevetoxins can be responsible for neurotoxic shellfish poisoning (NSP) if contaminated shellfish are eaten. The most common symptoms are tingling and numbness of the face and extremities. Symptoms usually start between 1 to 24 hours after exposure and may last up to three days.

Contaminated shellfish are not detectable by taste or odor. It cannot be removed by cooking, freezing, or other storage or preparation methods.

No deaths related to these toxins have been recorded yet worldwide but several hundred cases have been reported from Florida, New Zealand and Mexico in previous studies.

They are not currently regulated in France or Europe, where they are considered emerging toxins. The origin of their emergence in France is not yet known. However, they pose a risk in Florida, Australia, New Zealand and Mexico, where they have been regulated for some time. The U.S. Australia, New Zealand and Mexico apply a threshold of 800 μg BTX-2 equivalent per kilogram of shellfish flesh.

A reporting form has been developed for the poison control centers in the toxicovigilance network to record cases associated with consumption of shellfish contaminated by marine toxins such as brevetoxins. This document will help the identification of intoxications and lead to a better estimate on the level of health concern related to brevetoxins in France.

ANSES is also looking at the exposure to brevetoxins via direct contact with contaminated water, associated with swimming, other water activities and inhalation of sea spray. Results will be available by the end of 2021.

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The European Centre for Disease Control and Prevention (ECDC), European Food Safety Authority (EFSA) and European Union Reference Laboratory (EURL) for Listeria monocytogenes, at the French Agency for Food, Environmental and Occupational Health and Safety (ANSES), began the European Listeria Typing Exercise (ELiTE) in 2010 to describe listeriosis in humans and Listeria monocytogenes in food.

Researchers found a high degree of dissemination of certain Listeria bacteria in the food chain and in people across the European Union. There was a strong link with RTE fish products in several identified clusters.

A cluster means isolates are genetically similar so likely originate from a common source. If human and food isolates are in the same cluster it is a strong indication the food may have caused the infections. However, microbiological findings alone are not enough to link food with infections, with epidemiological evidence also needed, according to the report’s authors.

Focus on fish products
Prevention and control of Listeria contamination in fish production facilities could reduce food contamination and potentially human illnesses. A review of business compliance with microbiological criteria should also be considered, particularly for fish products, according to the study.

Work covered data about public health and food from 13 and 23 EU member states, respectively, and involved three categories of RTE food: packaged hot or cold smoked or “gravad” (cured) fish, soft or semi-soft cheeses, and packed heat-treated meat products. In total, 580 human isolates and 413 food isolates were included in the research with the majority from fish samples. From the human data, at least 75 people were known to have died.

The study used molecular typing, which is a way of identifying specific strains of microorganisms, by looking at their genetic material. The method was pulsed field gel electrophoresis (PFGE), which was a well-established, standardized approach during the time period covered by the study.

PFGE is now being phased out and replaced by whole genome sequencing (WGS). ECDC and EFSA WGS databases are expected to be operational by June 2022. The project mapped clustering PFGE types with respective clonal complexes (CCs) characterized by WGS.

There were 78 separate clusters by PFGE profiles, involving 573 Listeria monocytogenes isolates. Of these, 21 included human and food Listeria monocytogenes isolates, 47 were only human, and 10 only food.

Outbreak links
In the 21 human-food clusters, almost 90 percent of food isolates were from fish products, with nearly 10 percent from delicatessen meat and 1 percent from cheese products. There were nine multi-country clusters with more than 10 cases and three involved 13, 14, and 15 countries.

The amount of Listeria in fish was generally low, but in 48 samples exceeded the microbiological limit of 100 colony forming units per gram (cfu/g). Only six meat and one cheese product had counts above 100 cfu/g.

Of 78 clusters by PFGE profiles, 57 were small, up to five Listeria monocytogenes isolates per cluster. The largest was Listeria monocytogenes clone CC8. It involved 30 human and 56 food Listeria monocytogenes isolates from 15 countries. This indicates it may be common in several countries and has potentially been circulating in RTE fish production plants, according to the study.

Experts said based on the ability of Listeria to persist in the food chain for years, this clone is likely to cause large cross-border outbreaks. It was linked to 12 infections in three countries from 2015 to 2018 and 22 infections involving five countries from 2014 to 2019.

Another clone, CC121, was linked to four clusters with very few human isolates, suggesting lower virulence of the strains and possibly requiring a higher infectious dose. There was one nine-country cluster of 30 Listeria monocytogenes food isolates and no matches with human infections.

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The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) seasonal message focused on holly, mistletoe and poinsettia blooms, berries and leaves that can be used to decorate cakes, homes and gardens. Ingestion of berries or leaves, particularly by children or pets, can cause symptoms of varying severity depending on the quantity consumed.

Poison control centers in France receive between 60 to 80 calls about children under the age of 15 who have accidentally put holly berries in their mouth. Almost 40 percent of cases occur during the winter holiday season between December and January.

In most cases, children put one or two berries in their mouth and do not develop any symptoms or only experience minor digestive problems such as nausea, vomiting and abdominal pain. However, ingesting a larger number of berries can lead to symptoms such as excessive salivation, vomiting and persistent diarrhea, drowsiness or seizures.

Holly leaves and berries are also toxic to animals like dogs and cats. If ingested they can develop diarrhea and vomiting or neurological symptoms such as drowsiness and coma after eating a large number of berries.

Calls to poison centers
Poison control centers receive around 40 calls per year concerning children who have put Mistletoe leaves or berries in their mouths. Three-quarters of these cases take place in November and January.

Most children do not develop symptoms or show only mild digestive signs after having a small amount of berries. However, cardiac rhythm disorders or a drop in blood pressure or neurological disorders such as drowsiness can be observed if many berries are ingested.

Mistletoe leaves and berries are possibly lethal if they are consumed by domestic animals or grazing herbivores such as cows, sheep or horses.

Placing a Poinsettia leaf in the mouth can cause mild digestive symptoms in children. However, for a pet, chewing several leaves or stems can have serious consequences, such as digestive problems or excessive salivation.

ANSES advised the public that if a child has placed leaves or berries of holly, mistletoe or another ornamental plant in their mouth to clean the child’s mouth with a wet cloth, do not give them anything to drink, and call a poison control center. The label should be kept or a photo of the plant taken to help with identification.

In other news
The Singapore Food Agency (SFA) and ANSES have signed a Memorandum of Understanding to promote scientific and technical cooperation between the two agencies on food safety. The MOU was signed by Lim Kok Thai, chief executive officer of SFA, and Roger Genet, director-general of ANSES.

Lim said the food system has become increasingly complex and globalized.

“SFA will continue to forge strong partnerships with our counterparts from like-minded countries to keep Singapore’s food safety regulatory framework robust and stay abreast of global food safety developments,” he said.

Potential areas of collaboration include risk assessment of chemical and microbiological food safety hazards; testing programs for chemical and microbiological food safety; safety assessments of novel foods; and emerging food safety risks.

Swedish and Norwegian advice
Meanwhile, Livsmedelsverket (Swedish Food Agency) has provided information on which fish are good to eat at Christmas and which may contain high levels of environmental toxins. The agency reported it receives a lot of questions on the topic so it published tips for the festive season.

Fish is a good and healthy food which contains important nutrients. The advice is to eat it two to three times a week and have different varieties.

However, some fish also contain high amounts of organic environmental pollutants such as dioxins and PCBs. This is influenced by where the fish comes from. For children, young people and those who want to get pregnant in the future, it is important to reduce exposure to these substances.

In the EU, there are maximum limits for the amount of dioxins and PCBs that some animal foods may contain. However, species exempt from these limits are wild-caught herring larger than 17 centimeters, salmon, char, trout and river lamprey caught in the Baltic Sea area, including Lake Vänern and Lake Vättern, and sold in the Swedish market.

Livsmedelsverket has produced a video with Sofia B Olsson, kitchen manager at a seafood restaurant in Gothenburg, about fish with high levels of environmental toxins.

Tips for leftovers
Finally, Mattilsynet (Norwegian Food Safety Authority) has published tips on preparation and storage of food at Christmas.

The most common causes of food poisoning are inadequate cooking, delayed cooling of food, storage at too high a temperature and poor cleaning, according to the agency.

Advice covers potential sources of infection, serving hot food, eating leftovers, making food the day before, refrigerator space and temperature, cross contamination and handwashing.

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The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) reported that since the start of the mushroom-picking season in early autumn, poison control centers have recorded a sharp increase in cases, particularly in recent weeks.

Poisoning risks include confusion of an edible type with a toxic species, or consumption of edible mushrooms that are in poor condition, undercooked, or have been incorrectly stored. Most cases are due to foraged mushrooms but occasionally they are because of the purchase at a market or in a shop, or consumption in a restaurant.

Latest intoxication stats
Since July 2020, poison control centers have recorded 732 cases of intoxication, including five people with serious life-threatening illnesses.

Confusion between species sometimes happens through the use of fungi recognition apps on smartphones, which incorrectly identify the foraged mushrooms, according to ANSES.

In 2019, more than 2,000 cases were reported to poison control centers between July and December. While most poisonings were minor, there were 24 cases of high severity with life-threatening prognosis and three deaths. More than half of all cases occurred in October when weather conditions combining rainfall, humidity, and cooler temperatures favored wild mushroom growth and picking.

Symptoms are mainly digestive and include abdominal pain, nausea, vomiting, and diarrhea. The onset of illness varies and is usually within a few hours of consumption, but maybe longer and exceeds 12 hours. People should note the time of the last meal and onset of first symptoms, and keep any leftover wild mushrooms for identification.

This type of poisoning can have serious health consequences such as severe digestive disorders, kidney complications, or liver damage requiring a transplant leading to hospitalization or death.

A problem elsewhere
In October this year, the Ontario Poison Centre warned the public of the dangers of mushroom foraging after an increase in calls. The rise included cases where people had to be hospitalized after consuming wild mushrooms. In September, the center received 72 calls directly related to mushroom exposures, compared to 38 in September 2019.

In the same month, officials in the Italian city of Sassari detected three cases of wild mushroom poisoning. The first involved a child who ate edible porcini mushrooms. The second intoxication was caused by consumption in excessive quantities of mushrooms from the species Leucopaxillus lepistoides. The third case occurred after eating Amanita phalloides and the patient needed hospital treatment.

Authorities in Hong Kong investigated suspected poisoning related to the consumption of wild mushrooms in September. A five-year-old boy and 47-year-old woman developed nausea, vomiting, and diarrhea for about one hour after consuming mushrooms at home. One month earlier, a 54-year-old woman reported nausea, abdominal pain, and diarrhea one hour after having cooked mushrooms at home and required hospital treatment.

In May, a number of serious poisonings occurred in Victoria, Australia due to Death Cap and Yellow-staining mushrooms. The mushroom season in South Australia coincided with more people being at home and there was an increase in calls to the poisons information hotline from those seeking help after eating wild mushrooms. In total, 21 of 30 calls in 2020 involved young children, and five were referred to the hospital.

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A European project helping to promote scientific progress on foodborne zoonoses has held its annual meeting virtually because of the coronavirus outbreak.

The second annual scientific meeting of the One Health European Joint Program (OHEJP) on foodborne zoonoses, antimicrobial resistance, and emerging threats was planned in Prague in the Czech Republic, this past week, but the COVID-19 pandemic meant the face-to-face part was cancelled.

As the 178 submitted abstracts already had been evaluated by the scientific committee, and the program was already drafted, organizers decided to host the event online with oral and poster presentations.

More than 750 participants registered for the meeting which had Stef Bronzwaer, European Food Safety Authority (EFSA) research coordinator, as a keynote speaker.

The OHEJP began in 2018 and runs through the end of 2022. It is coordinated by the French Agency for Food, Environmental and Occupational Health and Safety (ANSES) and involves 40 partners from 19 countries. Costing €90 million ($100 million), 50 percent is funded by the European Commission.

Oral presentations
Maaike van den Beld, from the National Institute for Public Health and the Environment (RIVM), spoke about improved food safety through whole genome sequencing (WGS) and data sharing.

In the Netherlands, WGS data from national lab surveillance of Listeria and Shiga toxin-producing E. coli (STEC) by RIVM is shared in a database with WGS data from food monitoring collected by Wageningen Food Safety Research as per the Dutch Food and Consumer Product Safety Authority (NVWA) demands.

In this database, 1,578 Listeria isolates were present, consisting of 217 clusters, of which 33 were of mixed origin. Overall, 95 clusters spanned more than two years. For STEC serotype O157, 190 of 205 isolates were of human origin. For serotype O26, 102 of 112 isolates were of human origin. Other STEC O-types comprise almost 1,000 isolates of which 59 percent are from humans.

Species dependent challenges exist to apply WGS and data sharing in national surveillance and source tracing. For Listeria, the time confinement for cluster detection and intervention strategies is complicated. For STEC, there is minimal overlap between human and food isolates. However, WGS surveillance and real-time data sharing enabled rapid source tracing and outbreak assessment and has led to better-targeted enforcement measures.

Claudia E. Coipan, of RIVM, used the example of an international Salmonella Enteritidis outbreak from Polish eggs to see if harmonization of molecular typing workflows was necessary.

Researchers compared the output of six different typing workflows used by European public health authorities in terms of cluster detection and concordance. They analyzed 180 isolates from confirmed and probable cases, representative of the genetic variation in the outbreak, and 22 unrelated Salmonella Enteritidis isolates. Analysis indicates the different workflows generated clusters with similar compositions.

Thomas Brauge, from ANSES, talked about the impact of two disinfectants on Listeria monocytogenes cells in biofilm on stainless steel.

Treatment with hydrogen peroxide or quaternary ammonium did not remove Listeria cells on the surfaces but changed cell viability state with the emergence of a majority of viable but non-cultivable cells (VBNC). These VBNC cells were transferred to the herring slices and returned in the viable cultivable state on agar media during commercial shelf life of the herring.

Julio Alvarez, from VISAVET, University Complutense in Madrid, spoke about how human Salmonella isolates are routinely whole genome sequenced in Minnesota to help outbreak investigation, which increases ability to link related cases but leads to a delay in serotype identification of clinical isolates, and makes establishing a relationship between cases in the first week after reporting challenging.

Researchers looked at temporal models to detect Salmonella outbreaks in the absence of serotype information. Information on patients reported to the Minnesota Department of Health in 2005 to 2018 was used. The best candidate models were able to identify more than 75 percent of known outbreaks within one week after the first cases were reported. Developed algorithms were able to identify known outbreaks over a four-year period and they also revealed possibly unsolved outbreaks.

María Ugarte-Ruiz, from the same university, covered detection and antimicrobial characterization of Salmonella in eggs from retail businesses in Madrid.

Isolation of Salmonella was carried out from eggs produced in Spain from 2003 to 2019 as part of a monitoring program. During this 19-year period, more than 200 isolates were recovered belonging mostly to serotypes Enteritidis, Infantis, Rissen, Anatum and Typhimurium. Overall, antimicrobial resistance levels were below 10 percent, except for ciprofloxacin, nalidixic acid, tetracycline and ampicillin, although amounts also vary depending on the serotype.

Idesbald Boone, from the Robert Koch Institute in Germany, found foods considered as being high risk of causing healthcare associated foodborne outbreaks being served to patients.

The survey, among 33 Italian and German healthcare facilities, explored data availability, accessibility and usefulness of patient food data in hospitals and nursing home residents. Variability was observed in the storage time of food menu data and their formats, from paper to electronic searchable databases. In Italy, outsourcing of catering was associated with a non-optimal awareness of the availability of food traceability data.

Poster presentations
Gerald Umhang, of ANSES, had a poster presenting the MEME project that started in January 2020 and has 20 partners from 15 European countries. The aim is to fill research gaps on detection and control of cystic (CE) and alveolar echinococcosis (AE). Producing epidemiological data on the presence of Echinococcus multilocularis and Echinococcus granulosus s.l. eggs in the food chain will focus on vegetables for human consumption.

As part of the project it is planned that targeted questionnaires will be developed for a sample of patients with CE in some hospitals and matched controls, to advance knowledge on food-related risk factors for human infection.

A poster from Karin Troell, of the Swedish National Veterinary Institute, described the PARADISE consortium. This project, from 2020 to 2022, will help develop methods to control foodborne parasites in the EU food chain as outbreak investigation and source attribution remain difficult.

Eleonora Ventola, from Istituto Superiore di Sanità, in Italy, had a poster looking at Yersinia enterocolitica in foods. Yersiniosis is the fourth most common foodborne zoonosis in the EU, according to the 2018 zoonoses report.

In 2019, a survey in Italy estimated contamination with pathogenic Yersinia enterocolitica in different foods, sampled at various stages of the production chain. A total of 437 samples, including pork, beef, wild boar and chicken meat, raw milk, shellfish, and fresh vegetables were analyzed.

Research found that pork products were the category most frequently contaminated by Yersinia enterocolitica. Presence of Yersinia was assessed using a Real Time-PCR targeted to the ail gene which is considered the marker of pathogenic Yersinia enterocolitica. Presence of this gene was detected in 11 samples, all from pork, beef and wild boar meat.

A study led by Jacek Sroka, of PIWET, estimated prevalence of Toxoplasma gondii infection in pigs and cattle slaughtered for human consumption in Poland. Sera of 3,111 pigs and 2,411 cattle from 16 regions were checked. Samples of the diaphragm and heart of seropositive animals were examined for Toxoplasma gondii DNA.

Seropositive results were found in 11.9 percent of pigs and 13 percent of cattle. Data analysis showed seropositivity increased with age of cattle and seropositive results were found more frequently in animals from small farms. Presence of Toxoplasma gondii antibodies in pigs and cattle and detection of parasite DNA in tissue may indicate a potential threat to consumer health.

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The French Agency for Food, Environmental and Occupational Health & Safety (ANSES) assessed the surveillance and control scheme in place between 2010 and 2014 for inorganic and organic contaminants excluding toxins, mycotoxins, marine biotoxins and plant toxins.

Checks for monitoring chemical contamination of food such as trace metal elements in milk were regarded as suitable and able to address health and regulatory issues in nearly three-quarters of cases.

However, in 16.8 percent of cases, mainly heavy metals in certain fish and seafood, mycotoxins in pulses and nuts, and acrylamide in snacks, desserts, cereals and cereal products, improvement is needed, according to ANSES. On less than 10 percent of occasions the relevance of maintaining regulations should be examined.

Best use of resources
For non-regulated substances, ANSES suggested scaling down monitoring in 66 percent of cases to concentrate efforts on 26.1 percent of the substance/foodstuff pairs that are not regulated but cause concern, such as PCBs and PCDD/Fs – dioxins, furans and chlorinated products – in eggs and egg products, or nitrate in fruit and such products.

The agency also recommended regulating chemical-food pairs such as PCBs and PCDD/Fs in meat products, plant toxins in pulses and nuts, and certain perfluorinated compounds in meat and meat products, fish and seafood, eggs and egg products, and milk and milk products.

Foodstuffs are monitored through surveillance and control plans which are governed by European regulations but a revision of the Official Controls Regulation means member states have more choice in the organization of risk-based controls.

ANSES was asked for input on developing the plans to maintain and reinforce the level of safety for consumers and optimize surveillance resources and costs. The agency acknowledged findings relate to the control system as it was five years ago so some findings may no longer be relevant.

Almost 600 recommendations
The quality of data available was an issue in some cases, according to ANSES. The data set used in the study included almost 14,800 samples from 2010, nearly 17,000 from 2011, 22,500 from 2012,  almost 23,000 in 2013 and just over 29,300 in 2014. Almost 40,000 of these were inorganic contaminants, more than 43,000 were organic contaminants, almost 11,900 were mycotoxins, 10,500 marine biotoxins and 2017 plant toxins. Samples came from border inspection and veterinary activities, farming, fishery activities, manufacturing, slaughtering and retail sale.

A working group made 576 recommendations in four categories of actions: “Maintain” which means the monitoring system is effective; “reinforce” signifies weaknesses were identified in monitoring, “create” is for substances and products where there could be legislation and “reduce” which highlights areas were regulation and surveillance could be scaled back.

It was recommended to assess the relevance of implementing rules for 32 non-regulated substance and matrix pairs such as opioid alkaloids (codeine, morphine and teabaine) in legumes, nuts and oil seeds and nitrate in vegetable products.

Other areas identified were the relevance of maintaining the regulations for 10 couples of substances and matrices including mycotoxins Fumonisin and Zearalenone in snacks, desserts and other foods and inorganic tin in fish and seafood.

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A total of 10,625 cases of unintentional poisoning because of ingestion of mushrooms were recorded by French poison control centers (PCCs), according to a study published this month.

The poisonings involved two or more people during the same meal in more than half of the cases. The peak of cases was in October although there was a monthly peak in August for two years. Intoxications occurred mostly in the west, south and east of France.

Ages of patients ranged from 9 months to 96 years old. Almost two-thirds of cases were between 30 and 69 years of age and 3.3 percent were younger than 5 years old. More than 90 percent of the people poisoned had one or more digestive symptoms, followed by general and/or neurological signs.

Almost all had been intoxicated during a meal, but 5 percent were intoxicated by what researchers determined to be ignorance of the risk, such as biting into a mushroom after picking it up. One third of children under 5 had eaten the poison mushrooms during a meal.

Severe illness and death
Mushrooms most often involved were boletus at 26.3 percent of cases, followed by agarics, clitocybes, lepiotas, amanita, chanterelles or tricholomas. In about 30 percent of cases the species was not identified.

For the eight years of study, 239 cases of high severity were identified, varying from 11 in 2016 to 44 in 2010. Twenty-two deaths were observed from zero to five each year. Deaths were due to phalloid (68.2 percent) or sudorian (31.8 percent) syndromes. Ten men and 12 women aged 38 to 88 died.

Seasonal surveillance was set up in 2010 by l’Institut de veille sanitaire (InVS, which is now Santé Publique France) following a report of poisoning caused by phalloid amanita in Pays de la Loire.  The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) has been monitoring the situation since 2016.

Surveillance from July to December consists of monitoring how many poisoning cases come from mushrooms recorded by French poison control centers, as well as the number of severe cases and deaths. The objective is to detect in real-time any increase in poisonings so health authorities can be alerted and recommendations for mushroom picking and consumption disseminated to the public.

Apart from a lower number of cases in 2016 with 877, probably linked to a relatively hot and dry summer, the annual distribution of poisoning by mushrooms varied between 1,248 cases in 2014 and 1,596 in 2017.

The rate of mushroom poisonings decreased from 2010 to 2014, then increased in 2015 before being strongly dropping in 2016. However, it went back up in 2017 as this was the year with the most cases in the period covered by the report.

Preventing poisoning
Each year, a public alert was put out by health authorities at the first peak of poisoning. A second or third alert was published when the number persisted such as in 2010 and 2015 or when cases were severe or deaths were recorded.

The number of cases tended to decline after each alert but it was not possible to tell whether that was due to the natural fall in the epidemic peak, linked to a decrease in the growth of mushrooms or if it was prevention messages from authorities being heard. The number of cases seems more linked to weather conditions favoring growth than to communication measures.

More than 1,000 mushroom poisonings are recorded every year by French poison control centers. They represent 2 percent of all poisonings and are at the same level as poisonings by plants at 3.1 percent.

In 2017 in Switzerland, 1.8 percent of poisoning cases were due to mushrooms and 2.5 percent in Sweden. In Belgium, 5.1 percent of poisonings were associated with plants and/or mushrooms while in the United Kingdom, 2.8 percent of requests for toxicological investigations in 2016 to 2017 were linked to exposure to plants and/or mushrooms.

Many factors are involved in poisonings: confusion of an edible species with a toxic one; eating edible mushrooms that are in poor condition; failure to cook species that have heat-labile toxins; too many consumed; and individuals’ sensitivity.

The researchers wrote that while surveillance is necessary to disseminate national recommendations when peaks of poisoning occur, local intermediaries such as an associations of mycologists and pharmacists are essential to help identify the mushroom and limit the number of cases. The public is advised to take a photo of mushrooms before cooking an not to give wild mushrooms to young children.

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The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) was asked by the Directorate General for Food (DGAL) in December 2018 to look at these products after an outbreak of salmonellosis in 2017 traced to their consumption. The agency’s opinion covers the hygiene, surveillance and control measures in the production chain.

ANSES stressed the importance of applying general hygiene measures to prevent product contamination, the need to strengthen environmental monitoring of production sites and recommended development by industry of a guide to good hygiene practices and HACCP principles for the sector.

Two recent outbreaks
Lactalis infant formula was linked to a Salmonella Agona outbreak in 2017 that sickened 38 babies in France, two in Spain and one in Greece. Recalled formula was distributed to more than 80 countries.

Since then, there was a Salmonella Poona outbreak linked to rice-based infant formula between August 2018 and February 2019. A total of 32 confirmed cases were reported: 30 in France and one each in Belgium and Luxembourg in infants aged 2 months to 28 months old. This incident was linked to products made at the Industrias Lacteas Asturianas SA (ILAS) factory in Anleo, a municipality in the Spanish province of Asturias and marketed by Sodilac under the Modilac brand.

The work updates expertise in 2008 and will be used as a basis for instructions on the focus points to be examined during inspections. Slightly more than 500,000 tons of milk powder were produced in France in 2018, including 125,862 tons of powdered infant formula by 40 factories.

ANSES used on scientific literature and analysis of technical documents describing measures taken by professionals to ensure the hygiene and safety of their products. Analysis of the manufacturing process made it possible to identify potential routes of contamination and the main preventive measures.

The agency said the outbreaks have shown microbiological analyzes on finished products are insufficient to control the risk. When microbial contamination is low, an “unrealistic” number of samples must be taken and analyzed to get relevant information.

Salmonella and Cronobacter main microbiological hazards
Salmonella is typically difficult to detect in dried products and requires sampling and testing methods with a high degree of sensitivity, according to EFSA and ECDC. They added sensitivity of the sampling procedures and analytical methods for this food warrant further evaluation.

Infant formula manufacturing steps generally include mixing the ingredients in liquid form, heat treatment such as pasteurization, drying and adding ingredients before final packaging. All these steps mean infant formula may be contaminated at different stages by bacteria in the plant environment.

The opinion advises infant formula producers to reconsider hazards after each formulation or process change and to account for new epidemiological data.

Salmonella spp. and Cronobacter spp. are the two main microbiological hazards. Products may be contaminated after pasteurization by bacteria in the plant or when adding ingredients.

From 2008 to 2019, 13 alerts for biological hazards, five each from Salmonella and Cronobacter and one for Staphylococcus in powdered infant formula were made on the Rapid Alert System for Food and Feed.

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In June, a 63-year-old man died after eating water hemlock — also known as water dropwort —  after confusing it with root parsley that he grew and picked in his own garden. Between 2012 and 2019, poison control centers in the country recorded 15 other cases in which water hemlock was confused with an edible plant.

The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) called for greater vigilance and issued advice on avoiding the risk of potentially deadly intoxication resulting in poisoning.

The agency said some toxic plants resemble edible plants, leading to confusion in the wild, in home gardens, or in vegetable patches. Picking plants for consumption is not without risk, according to the agency.

Common plant type confusion
In 2018, a 78-year-old man died after picking and eating monkhood leaves while out walking. He had confused the highly toxic plant with striped hemlock, which is usually eaten with salad.

Last May, the Regional Health Agency for Eastern France issued an alert after poison control centers reported 20 cases of intoxication caused by confusion between meadow saffron and wild garlic or perennial leek.

Since 2012, ANSES has registered more than 250 cases per year of mistaken identity in plants that lead to illnesses. Overall, 1,872 victims were registered between 2012 and 2018. All age groups were involved, including children younger than 6 years old.

Cases of mistaken identity concern all sorts of plants and depending on the season may involve flowers, bulbs, seeds, berries, roots or leaves.

ANSES has a list of the plants, in French, that are most frequently confused and/or cause the most severe cases. It includes bulb plants mistaken for onion, garlic or shallots, horse chestnut for chestnut, colocynth or non-edible squash for edible squash, oand cuckoo pint for sorrel or spinach.

Common symptoms are digestive disorders such as stomach pain, nausea, vomiting and diarrhea, which can be severe in the case of plants such as colocynths.

Some plants cause cardiac or neurological disorders that can prove fatal. This can occur when white hellebore is mistaken for yellow gentian, deadly nightshade for grapevine, or foxglove for comfrey.

Wild mushroom poisoning in Hong Kong
Meanwhile, research in Hong Kong has revealed 46 instances of mushroom poisoning from 2010 to the end of May this year.

The Centre for Health Protection (CHP) of the Department of Health recorded the food poisoning cases related to wild mushrooms. Most such poisoning is caused by eating toxic species mistaken as edible ones.

This past week, CHP revealed it was investigating a suspected food poisoning case related to consumption of wild mushrooms involving a 50-year-old man.

Most toxin-producing mushrooms cannot be made non-toxic by processing methods such as soaking, peeling, cooking or freezing. There is no specific treatment for mushroom poisoning. Patients with liver failure may require transplants as a result of eating poisonous mushrooms.

From 2010 to 2018, the annual number of people affected ranged from two to seven and the most cases were recorded from April to June. Of the 46 patients involved, 17 were male and 29 were female. The age range was from nine to 86 years old. Time from ingestion of the incriminating mushrooms to onset of symptoms ranged from 30 minutes to 19 hours, with a median of two hours.

Hospital treatment and one death
Common symptoms were gastrointestinal including diarrhea, vomiting, abdominal pain and nausea. Other complaints included dizziness, deranged liver function or acute liver failure, sweating, palpitation, weakness, acute kidney injury or failure, numbness, headache, hypotension, difficulty in urination, blurred vision, chest discomfort, chills and rigors, fever, increased salivation and muscle cramping.

Among 46 patients, 44 sought medical attention and 29 required hospitalization. Seven were admitted to intensive care units and two required liver transplants. One death was recorded. It was a 57-year-old man with underlying illness in 2018.

Mushrooms behind the poisonings were most commonly picked from the countryside, hillsides and along roadsides. They were also foraged in parks and residential areas.

Among 30 cases, the incriminating types of mushrooms or toxins were identified 20 times. The two most common types of mushrooms identified were Chlorophyllum molybdites, which contain gastrointestinal toxins, and amatoxin-containing mushrooms. Other mushroom species contained gastrointestinal toxins, muscarine or both. Muscarine affects the smooth muscles and sweat glands.

To prevent wild mushroom poisoning, people should not pick them for consumption in any circumstance, according to the study.

“The identification of toxic mushrooms requires the expertise of mycologists. There is no reliable method for the general public to distinguish toxic mushrooms from non-toxic ones. In fact, the vast majority (about 90 percent) of the wild mushrooms in Hong Kong are inedible or poisonous.”

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The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) looked at pinnatoxins (PnTXs), a family of marine biotoxins detected in mussels from Mediterranean lagoons.

The agency recommended the emerging biotoxins are included in monitoring of shellfish production areas and research is done to accurately estimate the exposure of shellfish consumers.

Experimental studies in mice have shown acute toxic effects that can be fatal if high doses are ingested. No cases of pinnatoxin poisoning in humans have been reported so far in France or worldwide.

ANSES identified a provisional acute benchmark value for pinnatoxin G, one of the eight toxins in the family, and the one most commonly detected in shellfish in France.

This value of 0.13 µg PnTX G per kilogram of body weight means with a default serving size of 400 gram of shellfish and a body weight of 70 kilogram, the concentration not to be exceeded in shellfish would be 23 µg PnTX G per kilogram of total meat. In cases of high consumption and/or high contamination the benchmark value could be exceeded.

Pinnatoxin concentrations detected
Pinnatoxins are produced by marine microalgae called Vulcanodinium rugosum that can accumulate in shellfish. These marine biotoxins were identified in France in 2011 in mussels from the Ingril lagoon in the Hérault region by the French Research Institute for Exploitation of the Sea (Ifremer). Since then, analyses have shown high concentrations of them for several months each year.

Concentrations varied greatly depending on the year, there was a maximum of 1,244 μg of PnTX G per kilogram of shellfish (wet weight) in 2010. In July 2015, a concentration of 1,143 μg of PnTX G per kilogram of shellfish was reported. Concentrations of PnTX G measured in mussels from Ingril are the highest reported in the world to date. Levels of up to 95 µg per kilogram of total meat have been reported in clams.

Pinnatoxins have also been detected in other regions of France and in mussels from other Mediterranean lagoons (Vic, le Prévost, Thau, Leucate) and on the Atlantic and Corsican coasts. Data on shellfish contamination has also been reported in Canada, Australia, New Zealand, and in Northern and Southern Europe.

PnTXs have a rapid mode of action, with death in mice occurring within 30 minutes of administration. Symptoms observed are neurotoxic such as paralysis and respiratory distress.

ANSES concluded there is a possible health risk associated with consumption of pinnatoxin-contaminated shellfish from Mediterranean lagoons, particularly the Ingril area. There is currently no shellfish production intended for sale from the area but the agency alerted public authorities about the need to avoid all consumption of shellfish from this area.

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From July to mid-October this year, poison control centers recorded between five and 60 cases a week but 249 poisoning cases have been recorded in recent weeks.

Seven serious cases have been noted since July 2018 and four of them were in the past few weeks.

Poisonings due to eating wild mushrooms in France are reported to the French Poison Control and Monitoring Centers (CAP-TVs).

The sharp increase prompted the French Agency for Food, Environmental and Occupational Health and Safety (ANSES) and the Directorate General for Health (DGS) to issue a warning to wild mushroom gatherers and remind them of good practices.

Although weather conditions in September and the first half of October with dry, high temperatures were not conducive to the growth of wild mushrooms, the cooler and wetter conditions of recent weeks have been more favorable, said the agencies.

ANSES and the DGS said the poisoning cases are regularly observed year after year and in most cases, poisonings result from confusion with other edible mushrooms.

Last year, 181 poisoning cases, with five of a serious nature, were recorded in two weeks of September. In 2016, 87 cases, including three serious, were recorded in October.

Poisoning can have serious health consequences such as severe digestive disorders, liver damage that may require a transplant and can be fatal. Symptoms generally appear within 12 hours of consumption and the patient’s condition may deteriorate rapidly. In the event of symptoms, it is useful to note the time of the last meal and onset of the first symptoms and to keep any leftovers from the harvest for identification.

The Centre Antipoisons in Belgium receives around 400 calls a year involving mushrooms with most between June and September. The foundation Tox Info Suisse identified almost 600 poisonings in Switzerland last year.

Mushroom poisoning worldwide

Earlier this year, more than 1,200 people fell sick, 112 were hospitalized and 19 died in Iran with a link to eating wild mushrooms.

New South Wales (NSW) Health warned against eating wild mushrooms in May after 38 poisoning hospitalizations this year, including 14 children, were reported to the NSW Poisons Information Centre. Between 2014 and 2017, there were 281 hospitalizations from mushroom poisoning in NSW and the Australian Capital Territory.

Last month, the Illinois Poison Center (IPC) also issued a warning about mushrooms.

While many types of toxic mushrooms can be found in Illinois, most are minimally to moderately toxic. In rare cases, they can be poisonous and require hospitalization.

“The Illinois Poison Center receives hundreds of calls each year about mushrooms found in lawns, neighborhood parks and forest preserves. Adults, and especially children, should be aware of the health risks associated with consuming wild mushrooms and what to do if they are ingested,” said Michael Wahl, medical director at the IPC.

One of the main concerns when consuming poisonous mushrooms is liver damage from those that contain amatoxin. Amatoxin-containing mushrooms may not produce symptoms until six to 24 hours after ingestion.

From the start of July to mid-August, 45 mushroom exposure cases (38 in humans) were managed by the medical experts at the New Jersey Poison Control Center.

Diane Calello, NJ Poison Control Center executive and medical director, said even experienced mushroom pickers can be fooled by toxic look-a-likes.

“Don’t be fooled – many edible mushrooms have toxic look-a-likes. The cooking process does not prevent the toxic health effects of some mushrooms. Depending on the type of mushroom, eating even a few bites can cause serious health concerns,” she said.

In December 2016, 14 cases of Amanita phalloides (also known as the “death cap”) poisoning were identified by the California Poison Control System (CPCS) among persons who had consumed foraged wild mushrooms. Three patients received liver transplants and while all recovered, a child had permanent neurologic impairment.

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