FDA Investigates Multistate Outbreak of Salmonella Infections Linked to Products Reported to Contain Kratom

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NATIONAL — The U.S. Food and Drug Administration along with the Centers for Disease Control and Prevention (CDC) and state and local officials are investigating a multistate outbreak of Salmonella infections linked to products reportedly containing kratom.

According to the Food and Drug Administration, as of February 28, 2018, the CDC reports that 40 people in 27 states are infected with Salmonella.

Fourteen people have been hospitalized.

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Interviews with ill people are continuing.

So far, 17 of 24 ill people reported consuming kratom before getting sick. The outbreak strain of Salmonella has also been identified in two samples of leftover kratom powder collected from ill people in North Dakota and Utah, providing further evidence of kratom as the likely source of the outbreak.

Fast Facts

  • The FDA is advising consumers to avoid kratom and kratom-containing products. These products have been linked to a multistate outbreak of salmonellosis from a rare strain of SalmonellaMitragyna speciosa, commonly known as kratom, is a plant that grows naturally in Thailand, Malaysia, Indonesia, and Papua New Guinea.
  • As of February 28, 2018, the CDC reports that 40 people in 27 states have been reported infected with the outbreak strain of Salmonella I 4,[5],12:b:-. Fourteen people have been hospitalized.
  • During interviews conducted by health officials, ill people were asked about the foods they ate and other exposures before they became ill. As of February 28, 2018, 17 of 24 (71%) of ill people reported consuming kratom in the seven days before getting sick.
  • Health officials are collecting various leftover and unopened kratom samples to test for Salmonella contamination. The North Dakota and Utah Departments of Health collected opened, leftover kratom powder from ill people in their states. The outbreak strain of Salmonella I 4,[5],12:b:- was identified in both samples. The ill person in North Dakota purchased S.K. Herbalist brand kratom powder from the website soapkorner.com. The ill person in Utah purchased kratom powder from the website kratoma.com.
  • This investigation is ongoing. Based on the information presented above, it is likely that multiple kratom and kratom-containing brands and retailers are supplying contaminated product to the public. The FDA is continuing to work with state and local health officials and CDC to identify specific brand names and suppliers of products to learn more about the possible source and route of Salmonella contamination and will share more information as it becomes available.
  • In addition to the public health concerns raised by this outbreak, the FDA continues to warn consumers not to consume any kratom product. There is no FDA-approved use for kratom and the agency has received concerning reports about the safety of kratom, including deaths associated with its use.

What is the Problem and What is being Done About It?

The FDA, CDC, states and local health officials are investigating a multistate outbreak of salmonellosis from a rare strain of Salmonella I 4,[5],12:b:-.

The CDC reports that epidemiologic evidence collected to date indicates that products reported to be kratom or contain kratom are a likely source of this outbreak.

These products are marketed in many forms, including as leaves, pills, capsules, powder, and tea, and may not mention kratom on the labeling.

Other names for kratom that have been identified by the U.S. Drug Enforcement Administration (DEA) are: Mitragyna speciosa, mitragynine extract, biak-biak, cratom, gratom, ithang, kakuam, katawn, kedemba, ketum, krathom, krton, mambog, madat, Maeng da leaf, nauclea, Nauclea speciosa, or thang.

During interviews conducted by health officials, ill people were asked about the foods they ate and other exposures before they became ill. As of February 28, 17 of 24 (71%) of ill people reported consuming kratom before getting sick. The North Dakota and Utah Departments of Health collected leftover kratom powder from ill people in their states. The outbreak strain of Salmonella I 4,[5],12:b:- was identified in both samples. The ill person in North Dakota purchased S.K. Herbalist brand kratom powder from the website soapkorner.com. The ill person in Utah purchased kratom powder from the website kratoma.com.

This investigation is ongoing. Based on the information presented above, it is likely that multiple brands and retailers are supplying contaminated product to the public. The positive results also indicate concerns with the manufacturing practices used in production and/or handling of these products.

The FDA is continuing to work with state and local health officials and CDC to identify specific brand names or suppliers of products to learn more about the possible source and route of Salmonella contamination and will share more information as it becomes available.

As of February 28, 2018, the CDC reports that 40 people in 27 states are infected with Salmonella I 4,[5],12:b:-. The states include: AL (1), AZ (1), CA (3), CO (1), DE (1), FL (1), GA (1), KS (1), KY (1), LA (1), MA (1), MI (1), MN (1), MO (1), NC (2), ND (1), NY (2), OH (2), OK (3), OR (2) PA (2), SC (1), TN (1), UT (2), VA (2), WA (2), WI (2). Fourteen of these people have been hospitalized and no deaths have been reported. Ill people range in age from 6 to 67 years.

Illnesses started on dates ranging from October 10, 2017, to February 13, 2018. All of the cases have been confirmed to have a rare strain of Salmonella. Analysis using whole genome sequencing performed to date on isolates from ill people show most isolates are closely relatedly genetically. This means that people in this outbreak are more likely to share a common source of infection. Additionally, WGS on the isolate from the leftover product obtained by the state of North Dakota shows this isolate is highly related to most of the isolates from ill people.

Timeline

On February 12, 2018, the FDA learned of a multistate outbreak of salmonellosis from a rare strain of Salmonella.

On February 20, 2018, CDC announced that, as of February 16, 28 people in 20 states were infected, and that 11 people had been hospitalized. Eight of 11 people interviewed reported consuming kratom in pills, powder, or tea.

As of February 28, 2018, the CDC reports that 40 people in 27 states are infected with Salmonella. Fourteen people have been hospitalized.

Seventeen of 24 of ill people interviewed reported consuming kratom before getting sick.

As of February 28, 2018, the North Dakota and Utah Departments of Health collected leftover kratom powder from ill people in their states. The outbreak strain of Salmonella was identified in both samples. The ill person in North Dakota purchased S.K. Herbalist brand kratom powder from the website soapkorner.com. The ill person in Utah purchased kratom powder from the website kratoma.com.

What are the Symptoms of Salmonella Infection?

Salmonella bacteria cause the foodborne illness salmonellosis.  Most people infected with Salmonella develop diarrhea, fever, and abdominal cramps. The illness usually lasts 4 to 7 days, and most people recover without treatment. However, in the current outbreak, an unusually high rate of cases have been hospitalized for their illness.

How Soon After Exposure do Symptoms Appear?

Most people infected with Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection.

What Do Consumers Need To Do?

Consumers who have symptoms of salmonellosis should contact their health care provider. If you are diagnosed with salmonellosis, be sure to tell your health care provider about all products you may be using, including products reported to contain kratom. Consumers should be aware that some products may not list kratom on the labeling.

The FDA advises consumers to avoid kratom in any form. In addition to the public health concerns raised by this outbreak, there is strong evidence that kratom affects the same opioid brain receptors as morphine and appears to have properties that expose people who consume kratom to the risks of addiction, abuse, and dependence.

There are no FDA-approved uses for kratom, and the agency has received concerning reports about the safety of kratom, including deaths associated with its use. FDA is actively evaluating all available scientific information on this issue and continues to warn consumers not to use any products containing the botanical substance kratom or its psychoactive compounds, mitragynine and 7-hydroxymitragynine. FDA encourages more research to better understand kratom’s safety profile, including the use of kratom combined with other substances.