NASHVILLE ? An outbreak of a rare and deadly form of meningitis has sickened 26 people in five states who received steroid injections, mostly for back pain, health officials said Wednesday. Four people have died, and more cases are expected.
Eighteen of the cases of fungal meningitis are in Tennessee, where a Nashville clinic received the largest shipment of the steroid suspected in the outbreak. The drug was made by a specialty pharmacy in Massachusetts. It issued a recall last week and has suspended operations. Investigators, however, say they are still trying to confirm the source of the infections.
Three cases have been reported in Virginia, two in Maryland, two in Florida and one in North Carolina. Two of the deaths were in Tennessee; Virginia and Maryland had one each, the Centers for Disease Control and Prevention said.
More cases are almost certain to appear in coming days, said Tennessee Department of Health Commissioner John Dreyzehner. Five new cases were confirmed over the last 24 hours in a "rapidly evolving outbreak," he said Wednesday.
The incubation period is estimated to last two to 28 days.
But federal health officials weren't clear about whether new infections were occurring. They are looking for and increasingly finding illnesses that occurred in the last two or three months.
Meningitis involves swelling of the brain. Officials say this type of meningitis is caused by a common fungus often found in leaf mold. It doesn't normally cause disease in healthy people. Fungal meningitis is not contagious like the more common viral and bacterial meningitis.
Symptoms include worsening and severe headache, nausea, dizziness and fever. Some of the patients in Tennessee also experienced slurred speech and difficulty walking and urinating, state health officials said.
Investigators have been looking into the antiseptic and anesthetic used during the injections. Neither has been ruled out, but the primary suspicion is on the steroid medication. Steroid shots are common for back pain, often given together with an anesthetic.
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