Respiratory Illness Associated with Inhalation of Mushroom Spores -- Wisconsin, 1994 (2024)

During April 8-14, 1994, eight persons aged 16-19 years fromsoutheastern Wisconsin visited physicians for respiratory illnessassociated with inhalation of Lycoperdon perlatum (i.e., puffballmushrooms). On April 19, the Bureau of Public Health, WisconsinDivision of Health, was notified of these cases. This reportsummarizes the case investigations.

On April 3, the adolescents attended a party during which theyinhaled and chewed puffball mushrooms. It was unknown whether otherpersons at the party participated in this activity. No illicitdrugs were reportedly used at the party. Three persons reportednausea and vomiting within 6-12 hours after exposure. Within 3-7days after exposure, all patients developed cough, fever(temperature up to 103 F {39.4 C}), shortness of breath, myalgia,and fatigue.

Five persons required hospitalization; two were intubated. Twopatients had a history of asthma and were using steroid inhalers.Chest radiographs on all hospitalized patients indicated bilateralreticulonodular infiltrates. Two patients underwent transbronchiallung biopsy, and one had an open lung biopsy. Histopathologicexamination of the lung biopsy specimens revealed an inflammatoryprocess and the presence of yeast-like structures consistent withLycoperdon spores. Fungal cultures of the lung biopsy tissue werenegative.

All hospitalized patients received corticosteroids, and fourreceived antifungal therapy with either amphotericin B or azoledrugs. All patients recovered within 1-4 weeks with no apparentsequelae.

Reported by: TA Taft, MD, RC Cardillo, MD, D Letzer, DO, CTKaufman, DO, Milwaukee; JJ Kazmierczak, DVM, JP Davis, MD,Communicable Disease Epidemiologist, Bur of Public Health,Wisconsin Div of Health. Div of Respiratory Disease Studies,National Institute for Occupational Safety and Health; Div ofBacterial and Mycotic Diseases, National Center for InfectiousDiseases, CDC.

Editorial Note

Editorial Note: Lycoperdonosis is a rare respiratory illness causedby inhalation of spores of the mushroom Lycoperdon. Puffballs,which are found worldwide, grow in the autumn and can be ediblethen. In the spring, they desiccate and form spores that can beeasily released by agitating the mushroom (1). One puffball species(L. marginatum) can produce psychoactive effects (2).

Only three cases of lycoperdonosis have been reportedpreviously (1,3) -- two in children and one in an adolescent. Thesethree patients had inhaled large quantities of puffball spores, oneunintentionally and two deliberately (as a folk remedy to controlnosebleed). All patients had evidence of bilateral infiltrates onchest radiographs. Whether the pulmonary process results from ahypersensitivity reaction, an actual infection by the spores, orboth is unknown.

The efficacy of using antifungal agents to treatlycoperdonosis is unknown. Physicians should be aware of thisillness, especially in children and young adults presenting with acompatible clinical history and progressive respiratory symptoms.

References

1. Strand RD, Neuhauser EBD, Sornberger CF. Lycoperdonosis. N Engl J Med 1967;277:89-91.

2. Lincoff G, Mitchel DH. Toxic and hallucinogenic mushroom poisoning. Williams WK, ed. New York: Van Nostrand Reinhold Company, 1977.

3. Henriksen NT. Lycoperdonosis. Acta Paediatr Scand 1976;65:643-5.

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