PORTLAND, Ore. -- One of the rarest forms of mushroom poisoning in the United States left five Oregon residents seriously ill Friday, including two who underwent liver transplants.
The case has sent doctors on an international scramble to find a treatment for the deadly toxin in the mushrooms.
The five were poisoned Oct. 22 when they ate 'death cap' mushrooms that were picked in the pristine, evergreen-lined Columbia River Gorge. The mushrooms were first stir-fried and served at a Portland dinner party, and then later served to two other victims in Hillsboro, a Portland suburb.
Preston Alexander of the Oregon Mycological Society said the toxin in the mushroom is fatal to 30 percent of the people who ingest it. A single mushroom can kill an adult, he said.
The victims felt the effects of the poisoning -- nausea, vomiting and severe diarrhea -- the following morning and were quickly hospitalized. Two of them later underwent transplant operations to replace their livers, irreparably damaged by the mushrooms. Another two were awaiting transplants.
The victims included Glenda Sabolyk, 41, of Clackamas and Andy Clark, 33, of Hillsboro, who had planned to announce their engagement soon. Sabolyk underwent a liver transplant Thursday at the University of California-San Francisco Medical Center, where Clark also was awaiting a liver transplant.
Clark's mother, Isun Pak, 52, of Hillsboro underwent a nearly nine-hour liver transplant Friday at the Veterans Administration Medical Center in Portland. A hospital spokesman said there were no major complications.
Teresa Duncan, 43, of Portland was in critical condition at Oregon Health Sciences University, awaiting a liver donor. Her husband, John E. Duncan, 43, was in serious condition at Bess Kaiser Medical Center. Doctors said he may not need a transplant.
Officials had believed until Friday the deadly mushrooms were all eaten at one gathering. But Pak's husband, releasing only his last name of Smith, said he and and his wife joined the Duncans to look for chestnuts in the gorge, picked two small containers of mushrooms and took them to the Duncans' home.
Smith was called in to work before the others ate dinner, officials said. Isun Pak took the rest of the mushrooms home with her and served them to her son and his fiancee in another stir-fry dish.
Pak apparently used an inaccurate 'rice water' test in which mushrooms are supposed to turn red if they are poisonous. Mycologists said some varieties of mushrooms require several tests to determine toxicity.
Medical investigators found a whole, uncooked mushroom -- considered the deadliest variety -- at the home where the 'death caps' were served, which enabled them to immediately determine the toxin they were dealing with.
But because that form of mushroom poisoning is rare in the United States, they had to contact doctors overseas to find answers.
Dr. Robert Norton, acting director of the Oregon Poison Control Center, said only about 20 cases of such poisoning are reported in the United States annually, most of them in California.
'We don't have much experience in this country with Amantia phalloides poisoning,' Norton said. 'It's more common in Europe. We contacted physicians and experts in Switzerland and Germany who are more familiar with Amantia poisoning.'
He said they found a doctor in Switzerland who had treated 200 patients with liver dysfunction and other symptoms of 'death cap' poisoning. But it gave them little cause for hope.
'All those people died,' Norton said.
Experimental treatments for Amantia poisoning have begun in Europe with the flowing seeds from the milky thistle weed, said Dr. Mohamud Daya, assistant professor of emergency medicine at Oregon Health Sciences University.
'European experiments with milky thistle have shown some improvement for two people with Amantia poisoning,' Daya said.
But the treatment has not been approved by the U.S. Food and Drug Administration for use in this country.
Daya said cleaning out the blood does not help with this poison because it binds to the liver.
'We find very little of the toxin in the blood,' he said.
The poison often causes kidney and pancreas damage and brain swelling, in addition to liver damage. Symptoms of the toxin aren't apparent until after it has damaged the liver.
Only five transplants have been performed in the United States to treat 'death cap' poisoning, including Sabolyk and Pak.
Dr. Emmet Keeffe, OHSU associate professor of medicine and transplantation hepatologist, said, 'Globally, 80 to 90 percent of the patients survive the transplant.'
He added that about 70 percent survive at least a year after the transplant.
The three previous liver transplants for Amantia poisoning involved a child at the University of California-Davis and a father and son at the University of California-Los Angeles, he said.
'They survived, so we're encouraged,' Keeffe said.
