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New York - Health officials have identified about 75 medical clinics across the country to help track down patients who got steroid shots linked to a deadly meningitis outbreak.
The tally from the outbreak rose to nearly 50 cases, and spread to a seventh state, the Centers for Disease Control and Prevention said Friday. The number of deaths from the rare fungal meningitis remained at five.
In all, 47 people have contracted fungal meningitis, the CDC said. Michigan became the seventh state to report cases, with four. Tennessee's cases now total 29; Virginia, six; Indiana, 3; two each in Maryland and Florida and one in North Carolina.
Three people have died in Tennessee and one in Virginia and Maryland.
Looking for a source of the outbreak, investigators have focused on a steroid made by a specialty pharmacy, New England Compounding Center in Framingham, Mass. The steroid shots were used for back pain, a highly common treatment.
Health inspectors found fungus in at least one sealed vial of the steroid at the company's facility this week and were doing tests to identify the fungus. On Friday, officials said they have found two types of fungus in nine sick patients - Aspergillus and Exserohilum.
23 states affected
The pharmacy recalled 17,676 single-dose vials of the steroid, methylprednisolone acetate, last week. Shipments went to clinics in 23 states, and on Friday, the government released a list of the 75 facilities that got doses from the recalled lots.
"All patients who may have received these medications need to be tracked down immediately," said the CDC's Dr. Benjamin Park in a statement.
At the prompting of government officials, clinics are notifying patients who got shots from the recalled lots.
"There's a massive effort to contact all the patients," said Marsha Thiel, the chief executive officer of MAPS, a company that owns surgery center clinics in Minnesota.
She added, "If there's any question at all, they're being directed to go to their physician."
39 Connecticut patients
The state Department of Public Health announced Friday that 37 of the 39 Connecticut patients who may have received injections with the recalled medication linked to a multi-state outbreak of fungal meningitis have been contacted.
The one Connecticut practice that received the medication has reached out to all 39 patients. Of those contacted, none has had symptoms or required evaluation, the public health department said in a news release. Patients are being informed of the situation, told to watch for particular symptoms and advised to contact the practice and seek treatment in the emergency room if any of these symptoms develop.
The public health department said it is working with the practice, Interventional Spine & Sports Medicine, in Middlebury, to contact the remaining patients. No other medical providers received this medication in Connecticut. This facility is one of approximately 75 facilities in 23 states that received the recalled medication.
As a precaution, the Food and Drug Administration urged physicians not to use any of New England Compounding Center products, and on Friday released a list of them that included other steroids, anesthetics and a blood pressure medicine. The company, which is now closed, said in a statement Thursday that despite the FDA warning, "there is no indication of any potential issues with other products."
There are FDA-approved versions of the steroid, sold by the brand name Depo-Medrol, in good supply. So patients who need the medicine should not encounter a shortage, the FDA said Friday.
Most of the anxiety right now, however, involves patients who got steroid shots for back pain and are worried about becoming seriously ill.
"Our phone is ringing off the hook this morning. Patients are calling. Of course, they're concerned," said Paulette Fry, practice manager at Wellspring Pain Solutions in Columbus, Ind., about 40 miles south of Indianapolis. .
Meningitis is an inflammation of the lining of the brain and spinal cord. Symptoms include severe headache, nausea, dizziness and fever.
Fungal meningitis is not contagious like the more common forms. The types of fungus linked to the outbreak are all around, but very rarely causes illness. Fungal meningitis is treated with high-dose antifungal medications, usually given intravenously in a hospital.
Day Staff Writer Judy Benson contributed to this story.
CDC list of facilities: http://www.cdc.gov/hai/outbreaks/meningitis-facilities-map.html
Recalled list: http://www.fda.gov/Drugs/DrugSafety/ucm322752.htm