As the tally from a deadlymeningitis outbreak rose Friday, health officials identified the medicalclinics across the country that received steroid shots for back pain now linkedto the illnesses.
Authorities took the step to helpidentify everyone who may have gotten sick — or may still get sick — in theoutbreak.
"All patients who may have receivedthese medications need to be tracked down immediately," said Dr. BenjaminPark of the Centers for Disease Control and Prevention.
"It is possible that if patientswith infection are identified soon and put on appropriate antifungal therapy,lives may be saved," he said in a statement.
The CDC said the number of cases of therare fungal meningitis reached nearly 50 cases, and spread to a seventh stateFriday. The number of deaths in the outbreak remained at five.
Investigators have focused on a steroidmedication made by a specialty pharmacy in Massachusetts. All the outbreakpatients had gotten shots of the steroid for back pain, a common treatment, andinspectors found at least one sealed vial contaminated with fungus.
On Friday, officials said they havefound fungal infections in nine sick patients. They weren't able to identifywhat types of fungus in every one of those patients, but did distinguish atleast two types — Aspergillus and Exserohilum.
In all, 47 people have contracted fungalmeningitis, the CDC said. Michigan became the seventh state to report cases,with four. Tennessee's cases now total 29; Virginia, six; Indiana, 3; two eachin Maryland and Florida and one in North Carolina.
Three people have died in Tennessee andone in Virginia and Maryland.
The first known case in the meningitisoutbreak was diagnosed about two weeks ago in Tennessee, and the steroid wasrecalled last week by the pharmacy, New England Compounding Center inFramingham, Massachusetts.
About 17,700 single-dose vials of thesteroid were covered in the recall. On Friday, the government released thenames of about 75 facilities in 23 states that got recalled doses between Julyand September.
It's not clear how many were sent toclinics, how many were used, or even whether everyone who got one will getsick. Once infected, it can take as long as a month for symptoms to appear.
At the prompting of governmentofficials, clinics are notifying all the patients who got shots from therecalled lots.
"There's a massive effort tocontact all the patients," said Marsha Thiel, the chief executive officerof MAPS, a company that owns surgery center clinics in Minnesota.
She added, "If there's any questionat all, they're being directed to go to their physician."
As a precaution, the Food and DrugAdministration urged doctors not to use any of the company's products, andreleased a list Friday that included other steroids, anesthetics and a bloodpressure medicine. The company, which is now closed, said in a statementThursday that despite the FDA warning, "there is no indication of anypotential issues with other products."
The steroid is known aspreservative-free methylprednisolone acetate, which the compounding pharmacycreates by combining a powder with a liquid.
There are FDA-approved versions of thedrug, sold by the brand name Depo-Medrol, in good supply. So patients who needthe medicine should not encounter a shortage, the FDA said Friday.
Most of the anxiety now involvespatients who got steroid shots for back pain and are worried about becomingseriously ill.
"Our phone is ringing off the hookthis morning. Patients are calling. Of course, they're concerned," saidPaulette Fry, practice manager at Wellspring Pain Solutions in Columbus,Indiana, about 40 miles south of Indianapolis. She said the clinic was sendingout letters to about 300 patients who received spinal injections with the drug.
Meningitis is an inflammation of thelining of the brain and spinal cord. Symptoms include severe headache, nausea,dizziness and fever.
Fungal meningitis is not contagious likethe more common forms. The types of fungus linked to the outbreak are allaround, but very rarely causes illness. Fungal meningitis is treated withhigh-dose antifungal medications, usually given intravenously in a hospital.