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The symptoms can be roughly divided into convulsive symptoms and gangrenous symptoms.
Convulsive symptoms include painful seizures and spasms, diarrhea, paresthesias, itching, mental effects including mania or psychosis, headaches, nausea and vomiting. Usually the gastrointestinal effects precede central nervous system effects.
Dancing mania (also known as dancing plague, choreomania, St John's Dance and, historically, St. Vitus's Dance) was a social phenomenon that occurred primarily in mainland Europe between the 14th and 17th centuries. It involved groups of people dancing erratically, sometimes thousands at a time. The mania affected men, women, and children who danced until they collapsed from exhaustion. One of the first major outbreaks was in Aachen, in the Holy Roman Empire, in 1374, and it quickly spread throughout Europe; one particularly notable outbreak occurred in Strasbourg in 1518, also in the Holy Roman Empire.
Affecting thousands of people across several centuries, dancing mania was not an isolated event, and was well documented in contemporary reports. It was nevertheless poorly understood, and remedies were based on guesswork. Generally, musicians accompanied dancers, to help ward off the mania, but this tactic sometimes backfired by encouraging more to join in. There is no consensus among modern-day scholars as to the cause of dancing mania.
The several theories proposed range from religious cults being behind the processions to people dancing to relieve themselves of stress and put the poverty of the period out of their minds. It is, however, thought to have been a mass psychogenic illness in which the occurrence of similar physical symptoms, with no known physical cause, affect a large or small group of people as a form of social influence.
Mushroom poisoning (also known as mycetism or mycetismus) refers to harmful effects from ingestion of toxic substances present in a mushroom. These symptoms can vary from slight gastrointestinal discomfort to death. The toxins present are secondary metabolites produced by the fungus. Mushroom poisoning is usually the result of ingestion of wild mushrooms after misidentification of a toxic mushroom as an edible species. The most common reason for this misidentification is close resemblance in terms of colour and general morphology of the toxic mushrooms species with edible species.
To prevent mushroom poisoning, mushroom gatherers familiarize themselves with the mushrooms they intend to collect as well as with any similar-looking toxic species. In addition, edibility of mushrooms may depend on methods of preparation for cooking. The edibility or toxicity of some species varies with geographic location.
New species of fungi are continuing to be discovered, with an estimated number of 800 new species registered annually. This, added to the fact that many investigations have recently reclassified some species of mushrooms from edible to poisonous has made older classifications insufficient at describing what now is known about the different species of fungi that are harmful to humans. Thus, contrary to what older registers state, it is now thought that of the approximately 100,000 known fungi species found worldwide, about 100 of them are poisonous to humans. However, by far the majority of mushroom poisonings are not fatal, and the majority of fatal poisonings are attributable to the "Amanita phalloides" mushroom.
A majority of these cases are due to mistaken identity. This is a common occurrence with "A. phalloides" in particular, due to its resemblance to the Asian paddy-straw mushroom, "Volvariella volvacea". Both are light-colored and covered with a universal veil when young.
"Amanita"s can be mistaken for other species, as well, in particular when immature. On at least one occasion they have been mistaken for "Coprinus comatus". In this case, the victim had some limited experience in identifying mushrooms, but did not take the time to correctly identify these particular mushrooms until after he began to experience symptoms of mushroom poisoning.
The author of "Mushrooms Demystified", David Arora cautions puffball-hunters to beware of "Amanita" "eggs", which are "Amanita"s still entirely encased in their universal veil. "Amanita"s at this stage are difficult to distinguish from puffballs. Foragers are encouraged to always cut the fruiting bodies of suspected puffballs in half, as this will reveal the outline of a developing "Amanita" should it be present within the structure.
A majority of mushroom poisonings in general are the result of small children, especially toddlers in the "grazing" stage, ingesting mushrooms found in the lawn. While this can happen with any mushroom, "Chlorophyllum molybdites" is often implicated due to its preference for growing in lawns. "C. molybdites" causes severe gastrointestinal upset but is not considered deadly poisonous.
A few poisonings are the result of misidentification while attempting to collect hallucinogenic mushrooms for recreational use. In 1981, one fatality and two hospitalizations occurred following consumption of "Galerina autumnalis", mistaken for a "Psilocybe" species. "Galerina" and "Psilocybe" species are both small, brown, and sticky, and can be found growing together. However, "Galerina" contains amatoxins, the same poison found in the deadly "Amanita" species. Another case reports kidney failure following ingestion of "Cortinarius orellanus", a mushroom containing orellanine.
It is natural that accidental ingestion of hallucinogenic species also occurs, but is rarely harmful when ingested in small quantities. Cases of serious toxicity have been reported in small children. "Amanita pantherina", while containing the same hallucinogens as "Amanita muscaria" (e.g., ibotenic acid and muscimol), has been more commonly associated with severe gastrointestinal upset than its better-known counterpart.
Although usually not fatal, "Omphalotus" spp., "Jack-o-lantern mushrooms," are another cause of sometimes significant toxicity. They are sometimes mistaken for chanterelles. Both are bright-orange and fruit at the same time of year, although "Omphalotus" grows on wood and has true gills rather than the veins of a "Cantharellus". They contain toxins known as illudins, which causes gastrointestinal symptoms.
Bioluminescent species are generally inedible and often mildly toxic.
"Clitocybe dealbata", which is occasionally mistaken for an oyster mushroom or other edible species contains muscarine.
Toxicities can also occur with collection of morels. Even true morels, if eaten raw, will cause gastrointestinal upset. Typically, morels are thoroughly cooked before eating. "Verpa bohemica", although referred to as "thimble morels" or "early morels" by some, have caused toxic effects in some individuals. "Gyromitra" spp., "false morels", are deadly poisonous if eaten raw. They contain a toxin called gyromitrin, which can cause neurotoxicity, gastrointestinal toxicity, and destruction of the blood cells. The Finns consume "Gyromitra esculenta" after parboiling, but this may not render the mushroom entirely safe, resulting in its being called the "fugu of the Finnish cuisine".
A more unusual toxin is coprine, a disulfiram-like compound that is harmless unless ingested within a few days of ingesting alcohol. It inhibits aldehyde dehydrogenase, an enzyme required for breaking down alcohol. Thus, the symptoms of toxicity are similar to being hung over—flushing, headache, nausea, palpitations, and, in severe cases, trouble breathing. "Coprinus" species, including "Coprinopsis atramentaria", contain coprine. "Coprinus comatus" does not, but it is best to avoid mixing alcohol with other members of this genus.
Recently, poisonings have also been associated with "Amanita smithiana". These poisonings may be due to orellanine, but the onset of symptoms occurs in 4 to 11 hours, which is much quicker than the 3 to 20 days normally associated with orellanine.
"Paxillus involutus" is also inedible when raw, but is eaten in Europe after pickling or parboiling. However, after the death of the German mycologist Dr Julius Schäffer, it was discovered that the mushroom contains a toxin that can stimulate the immune system to attack its own red blood cells. This reaction is rare, but can occur even after safely eating the mushroom for many years. Similarly, "Tricholoma equestre" was widely considered edible and good, until it was connected with rare cases of rhabdomyolysis.
In the fall of 2004, thirteen deaths were associated with consumption of "Pleurocybella porrigens" or "angel's wings". In general, these mushrooms are considered edible. All the victims died of an acute brain disorder, and all had pre-existing kidney disease. The exact cause of the toxicity was not known at this time and the deaths cannot be definitively attributed to mushroom consumption.
However, mushroom poisoning is not always due to mistaken identity. For example, the highly toxic ergot "Claviceps purpurea", which grows on rye, is sometimes ground up with rye, unnoticed, and later consumed. This can cause devastating, even fatal effects, which is called ergotism.
Cases of idiosyncratic or unusual reactions to fungi can also occur. Some are probably due to allergy, others to some other kind of sensitivity. It is not uncommon for an individual person to experience gastrointestinal upset associated with one particular mushroom species or genus.
The outbreaks of dancing mania varied, and several characteristics of it have been recorded. Generally occurring in times of hardship, up to tens of thousands of people would appear to dance for hours, days, weeks, and even months.
Women have often been portrayed in modern literature as the usual participants in dancing mania, although contemporary sources suggest otherwise. Whether the dancing was spontaneous, or an organised event, is also debated. What is certain, however, is that dancers seemed to be in a state of unconsciousness, and unable to control themselves.
In his research into social phenomena, author Robert Bartholomew notes that contemporary sources record that participants often did not reside where the dancing took place. Such people would travel from place to place, and others would join them along the way. With them they brought customs and behaviour that were strange to the local people. Bartholomew describes how dancers wore "strange, colorful attire" and "held wooden sticks".
Robert Marks, in his study of hypnotism, notes that some decorated their hair with garlands. However, not all outbreaks involved foreigners, and not all were particularly calm. Bartholomew notes that some "paraded around naked" and made "obscene gestures". Some even had sexual intercourse. Others acted like animals, and jumped, hopped and leaped about.
They hardly stopped, and some danced until they broke their ribs and subsequently died. Throughout, dancers screamed, laughed, or cried, and some sang. Bartholomew also notes that observers of dancing mania were sometimes treated violently if they refused to join in. Participants demonstrated odd reactions to the colour red; in "A History of Madness in Sixteenth-Century Germany", Midelfort notes they "could not perceive the color red at all", and Bartholomew reports "it was said that dancers could not stand... the color red, often becoming violent on seeing [it]".
Bartholomew also notes that dancers "could not stand pointed shoes", and that dancers enjoyed their feet being hit. Throughout, those affected by dancing mania suffered from a variety of ailments, including chest pains, convulsions, hallucinations, hyperventilation, epileptic fits, and visions. In the end, most simply dropped down, overwhelmed with exhaustion. Midelfort, however, describes how some ended up in a state of ecstasy. Typically, the mania was contagious but it often struck small groups, such as families and individuals.
The earliest symptoms of shingles, which include headache, fever, and malaise, are nonspecific, and may result in an incorrect diagnosis. These symptoms are commonly followed by sensations of burning pain, itching, hyperesthesia (oversensitivity), or paresthesia ("pins and needles": tingling, pricking, or numbness). Pain can be mild to extreme in the affected dermatome, with sensations that are often described as stinging, tingling, aching, numbing or throbbing, and can be interspersed with quick stabs of agonizing pain.
Shingles in children is often painless, but people are more likely to get shingles as they age, and the disease tends to be more severe.
In most cases after one to two days, but sometimes as long as three weeks, the initial phase is followed by the appearance of the characteristic skin rash. The pain and rash most commonly occurs on the torso, but can appear on the face, eyes or other parts of the body. At first the rash appears similar to the first appearance of hives; however, unlike hives, shingles causes skin changes limited to a dermatome, normally resulting in a stripe or belt-like pattern that is limited to one side of the body and does not cross the midline. "Zoster sine herpete" ("zoster without herpes") describes a person who has all of the symptoms of shingles except this characteristic rash.
Later the rash becomes vesicular, forming small blisters filled with a serous exudate, as the fever and general malaise continue. The painful vesicles eventually become cloudy or darkened as they fill with blood, and crust over within seven to ten days; usually the crusts fall off and the skin heals, but sometimes, after severe blistering, scarring and discolored skin remain.
Shingles may have additional symptoms, depending on the dermatome involved. The trigeminal nerve is the most commonly involved nerve, of which the ophthalmic division is the most commonly involved branch. When the virus is reactivated in this nerve branch it is termed "zoster ophthalmicus". The skin of the forehead, upper eyelid and orbit of the eye may be involved. Zoster ophthalmicus occurs in approximately 10% to 25% of cases. In some people, symptoms may include conjunctivitis, keratitis, uveitis, and optic nerve that can sometimes cause chronic ocular inflammation, loss of vision, and debilitating pain.
"Shingles oticus", also known as Ramsay Hunt syndrome type II, involves the ear. It is thought to result from the virus spreading from the facial nerve to the vestibulocochlear nerve. Symptoms include hearing loss and vertigo (rotational dizziness).
Shingles may occur in the mouth if the maxillary or mandibular division of the trigeminal nerve is affected, in which the rash may appear on the mucous membrane of the upper jaw (usually the palate, sometimes the gums of the upper teeth) or the lower jaw (tongue or gums of the lower teeth) respectively. Oral involvement may occur alone or in combination with a rash on the skin over the cutaneous distribution of the same trigeminal branch. As with shingles of the skin, the lesions tend to only involve one side, distinguishing it from other oral blistering conditions. In the mouth, shingles appears initially as 1–4 mm opaque blisters (vesicles), which break down quickly to leave ulcers that heal within 10–14 days. The prodromal pain (before the rash) may be confused with toothache. Sometimes this leads to unnecessary dental treatment. Post herpetic neuralgia uncommonly is associated with shingles in the mouth. Unusual complications may occur with intra-oral shingles that are not seen elsewhere. Due to the close relationship of blood vessels to nerves, the virus can spread to involve the blood vessels and compromise the blood supply, sometimes causing ischemic necrosis. Therefore, oral involvement rarely causes complications such as osteonecrosis, tooth loss, periodontitis (gum disease), pulp calcification, pulp necrosis, periapical lesions and tooth developmental anomalies.