Kratom-Related Salmonella Outbreak Spreads to 35 States

Alicia Ault

Disclosures

March 16, 2018

At least 87 people in 35 states have become sick with salmonellosis after consuming kratom, said federal officials, who advised individuals to stop using kratom products. There have been no deaths related to the Salmonella outbreak.

The US Food and Drug Administration (FDA) said in February that consumption of kratom had been linked to 44 deaths (these deaths occurred prior to the Salmonella outbreak) and that from a scientific standpoint, the substance is an opioid, not a harmless plant.

The agency learned of a potential kratom-related outbreak of salmonellosis from a rare strain of Salmonella on February 12. By February 20, the Centers for Disease Control and Prevention (CDC) reported that 28 people in 20 states had become infected. At the time, 8 of 11 persons who were hospitalized and who were interviewed reported consuming kratom as pills, powder, or tea.

State health departments in North Dakota and Utah tested the kratom that had been used by people who become ill and discovered the rare Salmonella strain in those products.

Since that time, the FDA and states have tested multiple kratom products; 25 have tested positive for Salmonella; three of those products contained the rare strain. Twenty-two products have tested positive for a different strain or have tested positive for Salmonella. Further testing for strains of Salmonella is pending, said the FDA.

The FDA has posted a complete list of the products that have tested positive and their manufacturers of those products on their Web page devoted to the Salmonella outbreak.

As of March 14, 40 of 55 people who became sick said they had consumed kratom before becoming ill. Most said they had used a product called Maeng da red vein kratom, the FDA said.

Kratom may be marketed as leaves, pills, capsules, powder, or tea. Kratom may not be mentioned on the labeling of these products, said the FDA. It may instead be called by any number of names, including 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.

High Rate of Hospitalization

The CDC reports that Salmonella illnesses began occurring from January 21, 2017, to February 24, 2018, and that people aged 6 to 67 years have been affected. The median age of patients is 39 years; about half are male.

The agency had information on 69 of the 87 patients who have become ill. Of those, 27 (39%) were hospitalized. That is an unusually high number of hospitalizations for Salmonella-related illness, said the FDA.

The CDC said the tally could easily increase, because illnesses that have occurred after February 20 might not as yet have been reported, owing to the fact that it takes an average of 2 to 4 weeks from the time symptoms develop to the time the illness is reported. Salmonella infections give rise to diarrhea, fever, and abdominal cramps within 12 to 72 hours.

Symptoms last for 4 to 7 days and mostly resolve without treatment, but children, the elderly, and the immunocompromised are at risk for hospitalization and more serious illness.

The largest number of cases — 10 — have been reported in Washington state; the second-highest number — 6 — have been reported in California, according to the CDC.

The California Department of Public Health tested kratom-containing products manufactured by the Portland, Oregon–based company PDX Aromatics and found Salmonella, which led to a major recall of. The company, which does business under the names Kraken Kratom, Phytoextractum, and Soul Speciosa, voluntarily recalled the products on March 9.

Buyer Beware

The American Kratom Association (AKA), an organization representing kratom makers, has previously bristled at FDA actions. In November 2017, it filed a petition to overturn the agency's warnings, claiming they were not rooted in scientific evidence.

But on March 16, in response to the government's latest report, the AKA posted a warning advising consumers "to carefully select the vendors from whom they purchase kratom."

Responsible vendors protect the supply chain for the kratom plants, adhere to good manufacturing practices, follow all FDA regulations in the claims made for their products, and act responsibly when their products become a potential cause for safety concerns, said the AKA.

The group said it "supports appropriate enforcement actions by the FDA against kratom products that are adulterated or contaminated, or that make health claims in violation of the Food Drug and Cosmetic Act or the Dietary Supplement Health Education Act."

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