Inocybe erubescens
Inocybe erubescens (  )  [ Original photo copyright © Irene Andersson ]
Phylum: Basidiomycota
Class: Basidiomycetes
Order: Agaricales
Family: Cortinariaceae
Genus: Inocybe
Species: erubescens
Clinical Group: GROUP 2 - Neurotoxic mushroom poisoning
Solitary to gregarious in hardwood forests, parks, on pathsides and embarkments. Also found near Fagus, Quercus, Tilia, Capinus or Acer. Mostly found on nutrient rich soils from May to July. Widespread.
PILEUS (cap) 3-7 cm diameter, hemispherical to conical, becoming bell shaped to conic-convex, sometimes irregular, plane when old, with a prominent blunt umbo. Surface radially split, tomentose at center, fibrillose towards margin. Whitish, becoming dirty yellowish, with brick red areas or entirely brick red. Margin even, in-rolled, with whitish velar fibrils when young, in-curved in mature.

LAMELLAE (gills) whitish, becoming pink to olive brown. Broad, ascending, finely adnexed, white ciliate edges.

STIPE (stem) 3-10 cm in height, 0.8-2 cm thick. Cylindrical, sometimes slightly enlarged towards base. Solid, firm, becoming hollow with age. Finely longitudinally fibrillose, whitish, becoming dirty yellow with a reddish tinge, spotting brick red from base upwards.

FLESH whitish, turning faintly reddish when bruised or cut. Usually thin, thicker in center of pileus. Taste mild, fruity, rather unpleasant.

SPORE PRINT olive brown.

Spores are oval to almond shaped, smooth, light brown, thick walled and 10.8-13.8 x 6.5-8.5 μm.
Basidia clavate, 40-55 x 9-11 μm, with 2-4 sterigmata and a basal clamp.
Cheliocystidia cylindrical to clavate, thin walled, 25-67 x 9-11 μm.
First Aid
Description: First aid for poisoning by plants or mushrooms where no agreed first aid method is currently available.
In the absence of research or clinical data about first aid for poisoning caused by this species, no first aid method can currently be recommended. Seek Medical Advice without delay.
Clinical Effects & Treatment
Clinical Classification
Group 2B - Autonomic toxicity mushrooms
Clinical Effects Overview
Poisoning after ingestion of muscarinic mushrooms (encompassing numerous species, principally in the genera Inocybe, Clitocybe, Mycena), is essentially a neuro-excitatory phenomenon. Muscarine is a selective parasympathetic stimulant and causes a classic triad of symptoms ("PSL" = Perspiration, Salivation, Lachrymation). The appearance of PSL is classic for muscarine poisoning, separating it from other types of mushroom poisoning. However, other symptoms may also be present, including pupil constriction, blurred vision, urgent and/or painful micturition, nasal discharge/congestion, asthma/brochoconstriction, hypotension, bradycardia, skin flushing, watery diarrhoea, vomiting, abdominal pain/colic.

The onset of symptoms can be rapid following ingestion, from 15 mins to 2 hrs. The higher the muscarine levels, the more rapid the onset and more severe the symptoms. Duration of symptoms is also related to degree of toxicity; mild poisoning can resolve in 2 hrs, even without treatment, while severe poisoning can be symptomatic for up to 24 hrs.

An absolute lethal dose of muscarine is not established for muscarinic mushroom ingestion and the quantity of mushrooms considered hazardous will vary, depending on muscarine concentration, but in general terms, just 100-150g of some muscarinic mushrooms could contain a lethal dose.
Muscarine is not destroyed by cooking the mushrooms or by digestion, so readily reaches target organs after ingestion.

Muscarine binds to the selected acetylcholine receptors and is unaffected by anticholinesterases, so can produce hyperstimulation. Amongst those tissues affected are smooth muscle, exocrine glands and some cardiac tissue, but not skeletal muscle.
Primary Clinical Effect
The primary effect of poisoning by muscarinic mushrooms is neuro-excitation of muscarinic synapses, principally in the parasympathetic nervous system.
Treatment Overview
Initial management of ingestion of muscarinic mushrooms is, where practical, decontamination, either through lavage or use of activated charcoal. If within 15-25mins of ingestion, use of an emetic could be considered.

Cases with only mild symptoms may need no more than reassurance, but in cases with moderate to severe symptoms, atropine is indicated. If there is significant fluid loss, especially with diarrhoea, then IV fluid therapy and attention to electrolyte balance is required. Diazepam has been suggested by some authors for patients with significant anxiety or muscle spasms.

Except foor very minor poisoning, admission is advised until resolution of major symptoms.
Inocybe erubescens ( ) [ Original photo copyright © Irene Andersson ] Inocybe erubescens ( ) [ Original photo copyright © Jens V Petersen ]