Two Minnesotans suffered salmonella infections after taking kratom, a plant-based stimulant often used as a substitute for opioid drugs, the state Department of Health warned on Friday.

The infections are part of a larger salmonella outbreak that includes 87 cases in 35 states. Both Minnesotans suffered infections in January, and one was hospitalized after taking kratom in a powder form.

Kratom also is available as a pill or supplement for making tea, but state and federal health officials advised people to avoid all forms.

The outbreak hasn’t been isolated to a single product or version of kratom, which also is called Thang, Kakuam, Thom, Ketom or Biak, according to a state news release. Health officials in other states have identified three strains of salmonella bacteria in various types of kratom.

Kratom has emerged as a nonmedical substitute to opioids amid a surge in overdoses and deaths in the U.S. from addictions to legal opioids such as oxycodone and illicit versions such as heroin. Some have tried kratom as an alternative form of pain relief, while others have used it as an addiction substitute to wean off opioids.

The salmonella outbreak isn’t tied to any particular use of kratom, said state health department spokesman Doug Schultz, who didn’t know why the two sickened Minnesotans were taking the stimulant.

Salmonella infections commonly result in diarrhea, abdominal pain and fever. Roughly one in four infected patients are hospitalized. Minnesota’s health department receives reports each year of 700 to 975 infections, usually from eating tainted food.

Jeremy Olson