The North Dakota Department of Health is reporting the state's first case of salmonella infection linked to the consumption of kratom, a botanical substance, which was purchased online.

There is a multi-state outbreak of salmonella infections associated with kratom. State health officials are currently warning against the consumption of kratom.

There have been 40 cases in 27 states, including the case in North Dakota, according to a news release from the state Department of Health. Of these cases, there were at least 14 hospitalizations. No deaths have been linked to the outbreak.

"The outbreak investigation is ongoing," said Laura Cronquist, an epidemiologist with the Department of Health. "Since investigators have not identified any common brands or suppliers of salmonella-contaminated kratom products, federal and state health officials recommend that people do not consume kratom in any form."

Kratom comes from a tropical tree found in Southeast Asia. The leaves are ground into a powder, which can be steeped in tea or made in capsules. The Food and Drug Administration has repeatedly warned against the use of kratom and last month linked it to 44 deaths since 2011.

The common symptoms of a salmonella infection include diarrhea, abdominal pain and fever. Symptoms typically appear within 12 to 72 hours, but can take as long as 16 days. In most cases, symptoms clear up without any treatment. However, severe cases involving complications can result in hospitalization. Severe illness is common in infants, the elderly and people with weak immune systems.

The Food and Drug Administration does not view kratom as safe and has repeatedly warned against use of the substance, which has been marketed for pain relief, depression and anxiety. Proponents say it also can be used for opioid withdrawal symptoms, though the FDA said there is no evidence to support the use of kratom as treatment for opioid addiction.

Despite the FDA's concerns, kratom has become increasingly popular in recent years, including in North Dakota.

For more information on the outbreak, visit and

(Reach Blair Emerson at 701-250-8251 or