NASHVILLE, Tenn. – On Wednesday, the Centers for Disease Control reported one new death in Florida in an outbreak of fungal meningitis linked to steroid shots for back pain, bringing the total number of deaths nationwide to 12.
The CDC said the total number cases rose to 137, up from 119.
Five new cases were reported in Tennessee Wednesday, which has reported 44 cases and six deaths. No new deaths were reported in Tennessee.
The outbreak of fungal meningitis has been linked to steroid shots for back pain. The medication, made by a specialty pharmacy in Massachusetts, has been recalled.
The states reporting cases include Florida, Indiana, Maryland, Michigan, Minnesota, New Jersey, North Carolina, Ohio, Tennessee and Virginia.
As many as 13,000 people received steroid shots from the New England Compounding Center of Framingham, Mass, according to The Centers for Disease Control and Prevention.
The company has recalled the fungus-contaminated steroid, which was shipped to 23 states.
On Wednesday, Massachusetts Governor Deval Patrick said NECC may have misled regulators and done work beyond the scope of its state license.
Patrick told reporters Wednesday that state and federal agencies "may have been misled by some of the information we were given."
He said the company was supposed to fill specific prescriptions for specific patients but instead made big batches of medicine and sold them out of state.
He said that was outside of its state license.
On Tuesday, Tennessee Health Commissioner Dr. John Dreyzehner reported the incubation period may be longer than originally believed, and can be anywhere from six to 42 days. He added that the average time from injection to symptoms of the disease in Tennessee patients has been 16 days.
Dreyzehner said though the period of risk is ongoing, the period of exposure is over; new cases may be identified through the end of October into early November.
The state also said the CDC has also identified a second pathogen, called exserohilum, responsible for the infection. It is a very rare fungus, that officials said many doctors may never even come into contact with. The other pathogen that was found in the first patient that died in Tennessee was identified as Aspergillus, a type of fungus.
Dr. Marion Kainer, director of health care-associated infections and antimicrobial resistance program for the state, said following the outbreak, Tennessee is now requiring providers to report cases of fungal meningitis to the state.
Clinics are now alerting state officials when patients turn up with symptoms of the disease and are informing them of patients who they think in retrospect may have had it.
The pharmacy that distributed the steroid issued a voluntary recall of all of its products Saturday, calling the move a precautionary measure. Tennessee health officials had already directed clinics and hospitals not to use any products provided by the New England Compounding Center and further urged any consumers to avoid any medications from the pharmacy.
In Tennessee, officials believe about 1,000 people could have received the contaminated medication and thus could be at risk, Dreyzehner said. Many of those received multiple injections. Officials encourage vigilance for up to three months for those that may be at risk.
Although the CDC has said the potentially contaminated injections were given starting on May 21, Dreyzehner said the earliest date that people could have received the injection in Tennessee was June 27.
(The Associated Press Contributed To This Report.)