Amatoxin Poisoning: An Updated Review

Amatoxin-containing mushrooms—principally from the genera Amanita, Lepiota, and Galerina—cause the majority of fatal mushroom poisonings worldwide due to their potent inhibition of RNA polymerase II and the resultant hepatocellular necrosis. Characterized by a delayed onset of symptoms, amatoxin poisoning frequently leads to acute liver and renal failure, with mortality ranging from 10% to 30% without liver transplantation. This review catalogs relevant mushroom species, explores molecular and physiological mechanisms of toxicity, delineates diagnostic tools (e.g., HPLC, urine detection, Meixner test), and outlines management strategies—including activated charcoal, penicillin, N-acetylcysteine (NAC), silymarin/silibinin (Legalon® SIL), and supportive care—with the role of liver transplantation in severe cases. Advances in rapid detection methods, like portable test strips, are also discussed. The aim is to enhance early recognition and improve treatment outcomes.