Two more people have died from fungal meningitis linked to tainted steroid injections, raising the death toll for the outbreak to 14.
The U.S. Centers for Disease Control and Prevention today reported that 169 people in 11 states have contracted fungal meningitis after receiving spinal injections of methylprednisolone acetate for back pain. One person has contracted a joint infection after receiving an injection for ankle pain.
For a map of cases by state, click here.
As many as 14,000 people may have been exposed to the suspect steroid, made by the New England Compounding Center in Framingham, Mass. Fifty sealed vials of the drug, obtained by the U.S. Food and Drug Administration, were found to contain fungus. The firm has recalled all of its products and shut down operations.
Seventy-six clinics in 23 states that received methylprednisolone acetate from the recalled lots have been instructed to notify all affected patients. The "potentially contaminated injections were given starting May 21, 2012," according to the CDC.
Forty-nine of the fungal meningitis cases -- six of them lethal -- have been reported in Tennessee. Cases have also been reported in Michigan, Virginia, Indiana, Maryland, Florida, Minnesota, North Carolina, Ohio, New Jersey and, most recently, Idaho.
For a full list of clinics receiving the recalled lots of spinal steroid injections, click here.
Meningitis affects the membranous lining of the brain and spinal cord. Early symptoms of fungal meningitis, such as headache, fever, dizziness, nausea, sensitivity to light, stiff neck, weakness or numbness, slurred speech and pain, redness or swelling at the injection site can take more than a month to appear.
The longest duration from the time of injection to the onset of symptoms in the current outbreak is 42 days, according to the CDC's Dr. Benjamin Park.
"But we want to emphasize that we don't know what the longest will be," he said, adding that patients who received injections of the recalled drug should be wary of the subtle symptoms "for months."
Fungal meningitis is diagnosed through a lumbar puncture, which draws cerebrospinal fluid from the spine that can be inspected for signs of the disease. Once detected, it can be treated with high doses of intravenous antifungal medications.
People affected by the current outbreak are being treated with two different types of antifungal medications until the type of fungus causing the infection -- aspergillus or exserohilum -- can be identified.
"These drugs are very strong and can be very difficult for patients to tolerate over time," said Dr. J. Todd Weber, incident manager of the Multistate Meningitis Outbreak at the CDC, adding that the agency is working with experts on the dose and duration of the treatments.
The CDC has confirmed one case of aspergillus meningitis and 10 cases of exserohilum meningitis. It's unclear how the fungi landed in the steroid vials.
Unlike bacterial meningitis, fungal meningitis is not transmitted from person to person and only people who received the steroid injections are thought to be at risk.
The CDC also reported the possibility of joint infections, as methylprednisolone acetate is also used to treat ankle, knee and shoulder pain. One person in Michigan developed an infection after receiving an injection of the recalled steroid in the ankle, but CDC officials are still investigating the source of the infection.
"We may see additional patients coming in with infection of the joints," said Weber, adding that symptoms of fungal joint infections include fever and swelling, redness or pain at the injection site.