Fungal meningitis has infected 185 Americans in 12 states, killing 14, the Centers for Disease Control and Prevention announced Friday.
The CDC's estimate was up 15 people from the day before and added another state, Texas, where one infection has been reported.
Other states with reported infections of fungal meningitis include Florida (nine cases including two deaths), Idaho (one case), Indiana (24 cases including one death), Maryland (14 cases including one death), Michigan (41 cases including three deaths), Minnesota (three cases), New Jersey (three cases), North Carolina (four cases), Ohio (three cases), Tennessee (50 cases including six deaths) and Virginia (33 cases including one death).
Up to 14,000 people may have received contaminated steroid injections from the New England Compounding Center which is considered a likely source of the outbreak, health officials said; previous estimates suggested that number was closer to 13,000 patients. The CDC reported during a press conference Oct. 11 that it has successfully tracked down nearly 12,000 of these patients -- about 90 percent -- to inform them of their risk.
The ongoing outbreak is tied to contaminated methylprednisolone acetate steroid injections. Contaminants were discovered in an unopened vial during a late September inspection at NECC's Massachusetts facility, after which three lots of single-dose vials of the steroid sent to 76 facilities in 23 U.S. states -- in total 17,676 vials -- were recalled.
States that received injections include: California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, Nevada, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, Texas and West Virginia. However, because the company is licensed in all 50 states, there is a possibility products may have shipped elsewhere.
Officials had previously said most of those at risk received epidural steroid injections to relieve back pain. On Thursday the CDC said it was alerted to one case of a person who may have developed a fungal infection after receiving a steroid injection in his or her ankle. While the case hasn't been confirmed to be caused by a fungus, the person received the same steroid injection as the confirmed fungal meningitis cases and is showing symptoms consistent with a fungal infection, including pain, redness and swelling.
Steroids can also be used to relieve pain in ankles, knees and other joints.
More details have emerged about the particular type of fungus involved in the meningitis outbreak. Laboratory tests have confirmed the presence of Exserohilum fungus in 10 people with meningitis and the Aspergillus fungus in one person with meningitis. The Aspergillus case was the first person to be linked to the outbreak in Tennessee. Up to three other cases tied to Exserohilum fungus have been confirmed in non-CDC labs, Weber added.
Exserohilum bacteria have not historically been known to cause fungal meningitis.
"This is new territory for public health and the clinical community," Dr. J. Todd Weber, incident manager of the multi-state meningitis outbreak at the CDC, warned Thursday.
More cases of the infections are expected in coming weeks. Dr. Ben Park, medical officer of the CDC's Mycotic Diseases Branch, told reporters Thursday that the median time between the steroid injection and onset of symptoms is two weeks. However, the longest delay was found to be 42 days, with Park emphasizing the CDC does not yet know what the longest time gap will be.
Weber told reporters that patients who received these injections will need to be vigilant for months afterwards to see if they've developed an infection.
"We know we are not out of the woods yet," he warned.
People who received the steroid injections in question should look for symptoms such as headaches -- which were present in nearly all cases -- and back pain and nausea, seen in about half of patients. Given the fungi involved, patients with confirmed cases should receive two strong antifungal drugs, but those recommendations may change. Even if a patient shows symptoms tied to the outbreak but tests negative for fungus, they should still be treated for fungal meningitis, Weber said. He noted the earlier doctors intervene, the greater likelihood a patient survives.
Dr. Madeleine Biondolillo, director of health care safety and quality at the Massachusetts Department of Public Health, told reporters Thursday that the New England Compounding Center violated state law that requires compounding companies to only mix drugs after receiving a patient's specific prescription.
"Certainly NECC was not operating, as far as the investigation has seen so far, in accordance with the Massachusetts licensing regulation," she said.
The NECC said in an emailed statement to the CBS Evening News,"Our intent has always been to comply with all regulations, and cooperate with all regulatory agencies."