What is already known about this topic?:Mushroom poisoning is a major food safety threat in China. Since 2019, systematic investigations by China CDC have mapped the spatial and temporal patterns of poisoning incidents and documented the diversity of poisonous mushroom species nationwide. From 2019 to 2024, the annual number of incidents ranged from 276 to 676, and the case fatality rate ranged from 0.87% to 2.86%. What is added by this report?:In 2025, China CDC investigated 828 mushroom poisoning incidents across 27 provincial-level administrative divisions (PLADs), affecting 2,165 individuals and causing 13 deaths - a case fatality rate of 0.6%, the lowest of the past six years. In total, 138 poisonous mushroom species were identified, including 34 newly recorded in poisoning incidents in China. What are the implications for public health practice?:Prompt identification of the mushroom species, detection of toxins, and confirmation of the clinical syndrome are critical for guiding appropriate treatment and implementing effective public health interventions. Continued efforts are needed to strengthen public education and to enforce stricter market regulation of wild mushroom sales.

Aconitum poisoning is a major public health concern in East Asia, and remains difficult to diagnose when the causative toxins are not covered by routine targeted assays. In a poisoning incident that occurred in 2018, 15 individuals were affected, including five fatalities, after accidentally consuming a medicinal tincture during a shared meal. The comprehensive alkaloid profile of the tincture implicated in the poisoning was achieved through the integration of targeted analysis, molecular networking, and untargeted screening based on ultra-high performance liquid chromatography coupled to time-of-flight mass spectrometry, aiming to clarify the causative agents. Targeted quantitative analysis detected nine alkaloids derived from Aconitum plants, confirming the presence of Aconitum ingredients in the medicinal tincture. However, these alkaloids were either present at low concentrations or exhibited low toxicity, and thus were not the principal causative agents of this poisoning incident. Molecular networking revealed additional hidden diester-diterpenoid alkaloids (DDAs) and monoester-diterpenoid alkaloids (MDAs) that were undetected by targeted analysis. Untargeted screening identified 58 Aconitum alkaloids, including 15 DDAs, 17 MDAs, 17 amino-diterpenoid alkaloids (ADAs), 2 C20-diterpenoid alkaloids, and seven unclassified alkaloids. The three most abundant alkaloids were structurally identified as pseudoaconitine, 8-deacetylpseudoaconitine, and 3'-methoxyacoforestinine, and were identified as the main causative agents of this poisoning. To our knowledge, this is the first detection of these alkaloids in Aconitum poisoning in China. These findings demonstrate that integrated targeted and untargeted toxicological analysis can identify undocumented toxins in poisoning events of unknown origin and clarify the chemical etiology of unusual Aconitum poisoning.

INTRODUCTION:Diquat-induced toxic encephalopathy remains inadequately understood. METHODS:Data on patients with acute diquat poisoning were retrospectively collected from May 2017 to May 2023. The diagnosis was confirmed qualitatively by ultra-high performance liquid chromatography quadrupole-time of flight mass spectrometry. A follow-up study was designed to explore the long-term health effects of diquat poisoning. RESULTS:A total of 129 patients with acute diquat poisoning were included in this study. Thirty-four patients died (27 of whom developed toxic encephalopathy) following a median dose of diquat (200 g/L) 190 mL (IQR:100-200 mL). Forty-five patients were diagnosed with toxic encephalopathy, mainly involving the brainstem, bilateral cerebellar peduncles, and basal ganglia. The development of toxic encephalopathy was associated with a significantly higher risk of death (odds ratio = 16.5; 95%CI: 6.2-43.8; P <0.001). Twenty-five of the 95 survivors were enrolled in a follow-up study. The main persistent features were peripheral nerve injuries in 20%, suspected peripheral nerve injuries in 40%, and reduced compound muscle action potential in 84%; chronic-phase encephalopathy occurred in 28%. Transcriptomic analysis revealed significant changes in the expression profiles of neuroregulatory factors, including inhibin-βA and sonic hedgehog. DISCUSSION:Toxic encephalopathy represented an important organ injury caused by acute diquat poisoning, which was strongly associated with an increased risk of death. Peripheral nerve injuries were also common at follow-up. Several limitations should be noted, including the lack of diquat concentrations, the small sample size, the short follow-up duration, and the single-center design. CONCLUSIONS:Thirty-four of 129 (26.4%) patients died from diquat poisoning. Toxic encephalopathy was diagnosed in 45 of 129 (34.9%) patients, and its development was associated with a significantly higher risk of death. Follow-up revealed peripheral nerve injuries in 20% of patients, and chronic-phase encephalopathy in 28%.

In China, amanitin-containing mushrooms account for 55-69 % of mushroom poisoning fatalities. Due to the poor detectability of free amanitins by conventional LC-MS, we previously developed a trypsin digestion (TD)LC-MS method to detect protein-bound alpha-amanitin in mice, achieving a higher detection rate. To assess its clinical utility, we extended this method from detecting only alpha-amanitin to simultaneously detecting alpha-, (3-, and gamma-amanitin in human serum. Following validation using alpha-, (3-, and gamma-amanitin-spiked human serum, we compared two approaches on serum from patients diagnosed with amanitin poisoning (primarily by Amanita exitialis): LC-MS for free forms (99 samples from 24 patients) and TD-LC-MS for total forms (bound and free; 99 samples from 25 patients). The results demonstrated that: 1) During the clinically crucial 24-72 h post-ingestion window for diagnosis, the method significantly improved the detection rate for alpha-amanitin from 0 % (LC-MS) to 47.06-53.85 % (TD-LC-MS), with measured concentrations ranging from undetectable to 6.853 mu g/L. 2) Beyond 72 h, a period influenced by blood purification, TD-LC-MS sustained an alpha-amanitin daily detection rate of 6.25 %-16.7 % for up to 8 days while LC-MS was largely ineffective. 3) At the patient level, LC-MS detected alpha-amanitin in only one fatal case (7.153 mu g/L at 88 h post-ingestion), resulting in a patient-level detection rate of 4.17 % (1/24), while TD-LC-MS identified alpha-amanitin and/or (3-amanitin in 48 % (12/25, 10 alpha-amanitin, 1 (3-amanitin and 1 both alpha- and (3-amanitin) of patients during the 30-185 h post-ingestion. In conclusion, the TDLC-MS method dramatically improves the clinical detection of alpha-amanitin, especially within the critical diagnostic window.

What is already known about this topic?:Mushroom poisoning is a serious food safety problem in China. Since 2019, China CDC has conducted a series of investigations into mushroom poisoning outbreaks. These investigations have revealed the spatial and temporal distribution patterns of mushroom poisoning and the diversity of poisonous mushroom species in China. What is added by this report?:In 2024, China CDC investigated 599 mushroom poisoning incidents across 28 provincial-level administrative divisions (PLADs). These incidents affected 1,486 patients and resulted in 13 deaths, with a case fatality rate of 0.87%. Investigators identified 110 poisonous mushroom species causing 7 distinct clinical disease types, including 8 species newly documented as poisonous mushrooms in China. What are the implications for public health practice?:Timely species identification, toxin detection, and clinical type confirmation are crucial for effective mushroom poisoning control and proper patient treatment.

Although blood lead levels (BLLs) in children have significantly decreased compared to two decades ago, incidents of lead poisoning and elevated BLLs among children continue to occur frequently. This trend suggests that China's current hygienic regulations are not sufficiently effective in managing children's lead exposure. This study analyzed the revision processes of blood lead reference values (BLRVs) in children from various countries, the current BLLs and their changing trends in China, potential sources of lead pollution and exposure, the requirements for managing and protecting children's health, as well as the national measures and strategies for lead emission management and control. The study also explored the necessity and urgency of updating China's BLRVs in children. Based on the specific conditions in China, a proposed BLRV of 50 μg/L was deemed more reasonable and was suggested for implementation, with the potential to yield substantial economic benefits through improved IQ outcomes should the updated BLRV be adopted.

INTRODUCTION:In late August 2024, a cluster of cases of mushroom poisoning causing acute liver injury occurred in a county in Heilongjiang Province, China, resulting in two fatalities. This study aimed to identify the toxic mushroom species, quantify toxin concentrations, and characterize the clinical presentation and outcomes of the poisoning. METHODS:We conducted a retrospective analysis of epidemiological data, clinical manifestations, and management approaches. The suspected mushrooms were identified using morphological and molecular techniques. The concentrations of six amatoxins in mushroom, blood, and urine samples were measured using ultra high-performance liquid chromatography-tandem mass spectrometry. RESULTS:Eight mushroom poisoning outbreaks involving 19 individuals (11 males, eight females) from seven families were documented. Eighteen patients exhibited gastrointestinal symptoms, while one remained asymptomatic. Severe liver injury developed in 12 patients, including three who progressed to liver failure; two of these patients died, and the third recovered following liver transplantation. The causative mushroom was identified as Amanita molliuscula, which had been mistaken for the edible Agaricus bisporus. Both mushroom and biological samples tested positive for α-amanitin and β-amanitin. DISCUSSION:As far as we are aware, these are the first detailed reported outbreaks of Amanita molliuscula poisoning. The high mortality (two deaths) and need for liver transplantation in one patient underscore the severe toxicity of this species and the life-threatening nature of its poisoning. CONCLUSION:Amanita molliuscula contains α-amanitin and β-amanitin in this region of China, with hepatotoxicity as the primary clinical manifestation. Fulminant liver failure was the leading cause of death, though liver transplantation proved effective in one case. Given that toxic wild mushrooms often resemble edible varieties and cannot be reliably distinguished visually, improved public education and surveillance are crucial to mitigating the risks associated with wild mushroom consumption.

Amanita exitialis is a lethal mushroom species found in southern China. Its amatoxins can cause acute liver injury with a high case-fatality rate. However, reports combining toxin detection in clinical specimens with autopsy pathology remain limited. We conducted a retrospective analysis of A. exitialis poisoning events treated at Chuxiong Yi Autonomous Prefecture People’s Hospital from 2019 to 2024. Toxins were measured in collected mushrooms, patient blood, and urine. Clinical data included demographics, complications, laboratory parameters, and autopsy findings. Associations between a time-weighted urinary amatoxin exposure metric and laboratory indices were assessed. Ten poisoning incidents involving 27 individuals were identified, including five deaths. We collected 10 mushroom samples, 120 urine samples, and 108 blood samples. α-amanitin, β-amanitin, phallacidin, and phallisacin were detected in mushrooms and urine. The detection rates of α-AMA, β-AMA, PCD, and PSC in urine samples were 31.67%, 5.00%, 38.33%, and 49.17%, respectively. Only three blood samples tested positive for α-AMA. The time-weighted urinary amatoxin exposure metric was positively correlated with total bilirubin (TBIL), aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), creatinine (Cr), creatine kinase (CK), creatine kinase isoenzymes (CK-MB), prothrombin time (PT), activated partial thromboplastin time (APTT), and international normalized ratio (INR). Early symptoms included nausea, vomiting, diarrhea, abdominal pain, and distention; later findings involved injury to the liver, kidneys, intestines, heart, and lungs. On the fourth day following ingestion, there was a marked increase in bilirubin levels and a concurrent decrease in liver enzymes, indicating severe damage to the hepatocytes. Platelet count, white blood cell count, hemoglobin, and red blood cell count decreased over time. Autopsies demonstrated hepatic, renal, and myocardial injury, gastrointestinal mucosal exfoliation, and multiorgan hemorrhage. In summary, A. exitialis poisoning is primarily characterized by liver damage, accompanied by injuries to the kidneys, myocardium, and intestines, as well as multiorgan hemorrhaging, which may lead to blood toxicity. The detection rate of toxins in urine samples is relatively high, and early urine toxin testing can help clarify the diagnosis and guide treatment.

What is already known about this topic? Cordierites frondosus (C. frondosus) is a species of toxic mushroom known to induce symptoms of photosensitive dermatitis. What is added by this report? In the months of May and June 2023, a total of four patients in Chuxiong Yi Autonomous Prefecture, Yunnan Province, were affected by C. frondosus poisoning, occurring over two distinct incidents. The condition of two patients deteriorated after they were re-exposed to sunlight on the seventh day following the initial poisoning. Separately, an additional two patients reported experiencing a mild, needle-like sensation on areas of their skin exposed to the sun, recorded on the twelfth day subsequent to the poisoning. What are the implications for public health practice? can manifest up to a week post-sun exposure, it is weeks following poisoning.

What is already known about this topic? Mushroom poisoning poses a significant food safety concern in China, with a total of 196 species identified in poisoning incidents by the end of 2022. What is added by this report? In 2023, the China CDC conducted an investigation into 505 cases of mushroom poisoning spanning 24 provincial-level administrative divisions. This investigation resulted in 1,303 patients and 16 deaths, yielding a case fatality rate of 1.23%. A total of 97 mushrooms were identified as the cause of 6 distinct clinical disease types, with 12 species newly documented as poisonous mushrooms in China. What are the implications for public health practice? Close collaboration among CDC staff, physicians, and mycologists remains crucial for the control and prevention of mushroom poisoning in the future.

Although studies have explored the relationship between temperature and CO poisoning, the results are not consistent, and there is still a lack of early warning criteria of temperature related to CO poisoning. In order to comprehensively study the exposure-response relationship between daily average temperature and CO poisoning, and to further explore the early warning criteria of temperature related to CO poisoning, we used daily cases of CO poisoning in 31 National Injury Surveillance System (NISS) surveillance sites in seven administrative geographical regions of China and daily meteorological data obtained from the China Meteorological Science Data Sharing Service Platform from 2009 to 2019 to do the analysis. Daily meteorological data of 698 weather stations across China were interpolated at a 0.01° × 0.01°spatial resolution, which were then applied to extract the daily meteorological data of all included NISS sites. The Distributed Lag Non-linear Model (DLNM) model was applied to estimate the exposure-response associations (relative risk, RR) of daily mean temperature with CO poisoning, which was then further used to identify early warning criteria of temperature related to CO poisoning.A total of 10,618 CO poisoning cases were included in this study, with an average of 0.4 cases per day. There was generally a reverse J-shaped association between temperature and CO poisoning risk, indicating that both low and high temperature may increase the risk of CO poisoning, but low temperature usually has a longer lagged effects than high temperature. Spatialy, the exposure-response associations between temperatue and CO poisoning largely varied among regions, with greater effects of low temperatures in Southern China than in Northern China. The cumulative effects (RR, lag0-6 days) of 10 % percentile temperature ranged from 1.13 (95%CI: 1.01,1.26) in East China to 1.73 (95%CI:1.63,1.83) in South China. We also observed significant spatial variations in the early warning criteria of temperature related to CO poisoning across China. However, the patterns of high temperature effects on CO poisoning and the warning criteria of high temperature were mixed across China. In conclusions, both low temperature and high temperature may increase the risk of CO poisoning in China, and the effect of low temperature is more obvious, especially in South China, Northeast China, and North China. In addition, there is an urgent need to establish air temperature early warning and grading criteria for CO poisoning in different areas of China.

What is already known about this topic?:Mushroom poisoning incidents are one of the major causes of death by foodborne outbreaks in China. Effective detection and identification can provide the foundation for determining the cause of the incidents and the early diagnosis and treatment of patients. What is added by this report?:The surveillance data from the Public Health Emergency Management Information System, China CDC, showed that incidents with laboratory test results as the basis for determining the cause of mushroom poisoning accounted for only 14.08%. The largest number of deaths was caused by acute liver failure mushrooms, which accounted for 55.17% of the clinical types of mushroom poisoning. Amanita exitialis and Russula subnigricans were responsible for the most incidents, both of which accounted for 17.39% of all species. Amanita exitialis and Amanita fuliginea caused the largest number of poisonings and deaths, accounting for 13.32% and 18.10%, respectively. What are the implications for public health practice?:Research on the detection and identification of poisonous mushrooms needs to be strengthened. The detection capabilities of primary medical and health institutions, as well as the diagnosis and treatment of mushroom poisoning in primary hospitals, need to be improved.

A comprehensive analytical method based on liquid chromatography–tandem mass spectrometry (LC-MS/MS) was developed for the simultaneous detection of 12 mushroom toxins (ibotenic acid, muscimol, muscarine, β-amanitin, α-amanitin, desoxoviroidin, γ-amanitin, phallisacin, illudin S, phallacidin, phalloidin and illudin M) in mushrooms, serum, urine and simulated gastric fluid. The samples were extracted with water or acetonitrile solution, and the serum sample was further purified with PSA sorbent. Chromatographic separation was performed on an ACQUITY UPLC HSS T3 column with gradient elution using methanol and water containing 1 mM ammonia fluoride as a mobile phase. Mass spectrometric acquisition was performed in electrospray positive ionization mode. Good linearities (R2 > 0.994) were obtained for 12 toxins over the range of 0.05~200 µg/L. Matrix-matched calibration curves were used for quantification. The method limits of quantification were 0.01~0.2 mg/kg for mushrooms and 0.15~2.0 µg/L for three biological liquid samples. The mean recoveries of 12 target toxins (spiked at three concentration levels) ranged from 73.0% to 110.3%, with relative standard deviations not exceeding 19.4%, which meets the requirements for the determination of trace compounds in a biological matrix. This method was applied to the analysis of mushroom samples from Yunnan Province. As a result, 11 toxins, not including illudin M, were detected with a concentration range of 0.61~2143 mg/kg.

Amatoxins are responsible for most fatal mushroom poisoning cases, as it causes both hepatotoxicity and nephrotoxicity. However, studies on amatoxin nephrotoxicity are limited. Here, we investigated nephrotoxicity over 4 days and nephrotoxicity/hepatotoxicity over 14 days in mice. The organ weight ratio, serological indices, and tissue histology results indicated that a nephrotoxicity mouse model was established with two stages: (1) no apparent effects within 24 h; and (2) the appearance of adverse effects, with gradual worsening within 2 -14 days. For each stage, the kidney transcriptome revealed patterns of differential mRNA expression and significant pathway changes, and Western blot analysis verified the expression of key proteins. Amanitin-induced nephrotoxicity was directly related to RNA polymerase II because mRNA levels decreased, RNA polymerase II -related pathways were significantly enriched at the transcription level, and RNA polymerase II protein was degraded in the early poisoning stage. In the late stage, nephrotoxicity was more severe than hepatotoxicity. This is likely associated with inflammation because inflammation -related pathways were significantly enriched and NF- kappa B activation was increased in the kidney.

Lepiota brunneoincarnata is a highly toxic mushroom species known to cause acute liver failure. However, there are limited reports investigating L. brunneoincarnata causing acute hepatic and renal damage. The present article reports 2 cases of L. brunneoincarnata poisoning in a mother and son from Chuxiong City, Yunnan Province, China. Both patients presented with gastrointestinal symptoms approximately 8-9 h after ingesting the suspect mushrooms and sought medical attention 27-28 h post-ingestion, both exhibiting acute hepatic and kidney injuries. Morphological and molecular biology studies confirmed the species of the mushrooms as L. brunneoincarnata. Liquid chromatography-tandem mass spectrometry analysis revealed mean fresh-weight concentrations of 123.5 μg/g α-amanitin and 45.7 μg/g β-amanitin in the mushrooms. The patients underwent standard treatments, including multiple-dose activated charcoal, oral silibinin capsules, N-acetylcysteine, penicillin G, hemoperfusion, and plasma exchange. One patient recovered completely and was discharged after 16 days of hospitalization. The other patient exhibited gradual improvement in liver and renal function; however, renal function deteriorated 9 days after ingestion, and the patient declined renal replacement therapy and returned home 14 days post-ingestion. The patient was then re-hospitalized due to oliguria and edema in both lower extremities. Renal biopsy revealed acute tubular necrosis, inflammatory cell infiltration, minor glomerular capsular fibrosis, loss of microvilli in the renal tubular epithelial cells, and interstitial edema. The patient underwent 2 rounds of continuous renal replacement therapy, which eventually resulted in improvement, and was discharged 31 days after mushroom consumption. It is noteworthy that this patient had already progressed to chronic kidney insufficiency 11 months after intoxication.

目的 了解我国农药中毒咨询病例特征、农药中毒的毒物谱,探讨农药管理规定对农药中毒控制的影响,为农药中毒预防控制策略提供参考.方法 筛选2011-2020年全国农药中毒咨询病例数据,对时间、地区、农药中毒种类、性别和年龄情况等进行描述性分析,并分析政策对农药中毒的影响.结果 2011-2020年全国中毒咨询热线共收集农药中毒咨询病例16683例,男女性别比1.28:1,居于前5位的省份是河南(2428例,占14.55％)、河北(1 635例,占9.80％)、山东(1 435例,占8.60％)、安徽(1 304例,占7.82％)、江苏(926例,占5.55％),农药中毒病例逐年下降,每年病例最多集中在5月份.杀虫剂引起的中毒为最多,有9 469例,占总病例数的56.76％;其次为除草剂中毒,中毒病例4 371例,占26.20％;杀菌剂中毒1 609例,占9.64％.因自服、误服、意外事件和职业接触4类主要原因而中毒的病例数为15 786例.自服中毒占比最高,有7 763例,占46.53％;其次为误服,有4 438例,占26.60％;职业接触2 850例,占17.08％.不同原因中毒病例男女性别分布差异有统计学意义(P＜0.01),男性更多为职业接触,女性更多为自服.误服是6岁及以下婴幼儿最主要的中毒原因,男女性别比2.56:1;自服中毒和职业接触中毒则是18岁以上成人主要的中毒原因.结论 农药中毒流行病学特征明显,剧毒高毒农药禁限用后,病例明显减少.政策干预对农药中毒控制效果显著,针对不同人群不同地区开展针对性预防控制措施以减少农药中毒的发生.

目的 了解我国省、市、县三级疾病预防控制机构(以下简称"疾控机构")突发中毒事件卫生应急应对现状,为政策制定提供依据.方法 采取分层抽样,抽取30个省(自治区、直辖市)、29个市(州、区)和70个县的129家疾控机构参与本次调查.对疾控机构应对突发中毒事件的组织机构、工作内容和应急准备等情况开展问卷调查.结果省级、市级、县级疾控机构专设中毒卫生应急处置部门的比例分别为70.00％(21/30)、34.48％(10/29)和34.38％(22/64),开展的突发中毒事件相关监测内容前三位依次是食源性疾病(95.35％,123/129)、农药中毒(58.14％,75/129)和非职业性一氧化碳中毒(47.29％,61/129).省级、市级、县级疾控机构认为毒物检测能力不能满足工作需要的比例分别为70.00％(21/30)、65.52％(19/29)和94.29％(66/70),原因前三位依次是仪器设备不能满足工作需要(65.09％,69/106)、技术储备不足(60.38％,64/106)和专业技术人员不足(48.11％％,51/106),仅有 24.03％(31/129)的疾控机构能够向医疗机构提供毒物检测服务.动态掌握辖区内毒物危害相关信息的疾控机构仅占29.46％(38/129).结论 全国中毒卫生应急处置技术储备不足,特别是毒物检测能力亟待加强.建议各地根据当地毒物危害特点和应对短板,有针对性地开展中毒卫生应急能力建设.

目的:对国内市场上常见的防护口罩的过滤性及舒适性进行评价,为防护口罩改进提升提供依据.方法:采取线上销售平台和线下调研的抽样方法,选取国内市场上常见的77款防护口罩,参照GB 19083—2010《医用防护口罩技术要求》和GB 2626—2019《呼吸防护自吸过滤式防颗粒物呼吸器》对其过滤效率、呼吸阻力和死腔进行检测.采用SPSS 22.0软件进行统计分析.结果:防护口罩的过滤效率符合国家标准的不足75％,颗粒物防护口罩滤材的过滤效率较医用防护口罩更稳定;舒适性指标的合格率高于过滤效率,其中死腔全部合格且测试结果远低于标准要求;不同类型口罩在舒适性指标测评结果上不存在差异(P>0.05),口罩的折叠方式会影响舒适性指标测评结果(P<0.05).结论:目前国内防护口罩的过滤性及舒适性有待进一步提高,高效低阻滤材的防护口罩是今后的研发重点.