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

During April 8-14, 1994, eight persons aged 16-19 years from southeastern Wisconsin visited physicians for respiratory illness associated with inhalation of Lycoperdon perlatum (i.e., puffball mushrooms). On April 19, the Bureau of Public Health, Wisconsin Division of Health, was notified of these cases. This report summarizes the case investigations.

On April 3, the adolescents attended a party during which they inhaled and chewed puffball mushrooms. It was unknown whether other persons at the party participated in this activity. No illicit drugs were reportedly used at the party. Three persons reported nausea and vomiting within 6-12 hours after exposure. Within 3-7 days 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. Two patients had a history of asthma and were using steroid inhalers. Chest radiographs on all hospitalized patients indicated bilateral reticulonodular infiltrates. Two patients underwent transbronchial lung biopsy, and one had an open lung biopsy. Histopathologic examination of the lung biopsy specimens revealed an inflammatory process and the presence of yeast-like structures consistent with Lycoperdon spores. Fungal cultures of the lung biopsy tissue were negative.

All hospitalized patients received corticosteroids, and four received antifungal therapy with either amphotericin B or azole drugs. All patients recovered within 1-4 weeks with no apparent sequelae.

Reported by: TA Taft, MD, RC Cardillo, MD, D Letzer, DO, CT Kaufman, 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 of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC.

Editorial Note

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

Only three cases of lycoperdonosis have been reported previously (1,3) -- two in children and one in an adolescent. These three patients had inhaled large quantities of puffball spores, one unintentionally and two deliberately (as a folk remedy to control nosebleed). All patients had evidence of bilateral infiltrates on chest radiographs. Whether the pulmonary process results from a hypersensitivity reaction, an actual infection by the spores, or both is unknown.

The efficacy of using antifungal agents to treat lycoperdonosis is unknown. Physicians should be aware of this illness, especially in children and young adults presenting with a compatible 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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