An investigation updat on a multistate outbreak of Salmonella infections linked to kratom supplements reports a dozen more people are sick, with seven new states involved.

This illustration shows actual kratom capsules with a faux prescription bottle. Photo illustration

The initial report  on Feb. 20 from the Centers for Disease Control and Prevention said 28 people across 20 states were confirmed with the outbreak strain of Salmonella I 4,[5],12:b.

Forty-five percent of people who are sick have been hospitalized. No deaths had been reported to CDC as of March 2.

The outbreak strain of Salmonella I 4,[5],12:b was found in leftover kratom powder collected from sick people in North Dakota and Utah. Investigation findings link the outbreak to kratom products, but the evidence collected to date has not identified a common brand or supplier of kratom.

Kratom is a plant native to southeast Asia that is consumed for its stimulant effects and as an opioid substitute. It is typically brewed in a tea, chewed, smoked or taken in capsules. Kratom may also be known as Thang, Kakuam, Thom, Ketom and Biak.

One person from each of these states has been newly reported reported sick from kratom: Delaware, Georgia, Minnesota, Missouri, Virginia, Washington and Wisconsin.

At this time, CDC recommends that people not consume kratom in any form because it could be contaminated with Salmonella. The recommendation may change as more information becomes available.

The Food and Drug Administration also warned the public in recent days about contaminants in kratom. The FDA reported its investigation is not related to the outbreak currently under investigation by the CDC.

However, the FDA reported it is aware of 44 deaths related to kratom products.

People should talk to their health care provider before taking any supplement, especially if they are in a group more likely to get a severe Salmonella infection, according to the CDC. These groups include people with weakened immune systems, including those who are receiving chemotherapy or have HIV, pregnant women, children younger than 5 and older adults.