INDIANAPOLIS - Six health care facilities in Indiana received shipments of the steroid injections that were tainted with fungal meningitis, according to the Indiana Department of Health.
The six facilities are:
"We are sending letters to all the patients that we think have been treated with this," said Dr. Drew Robertson, of Wellspring Pain Solutions in Columbus.
Some 560 Hoosiers may have contracted meningitis at the Evansville location, alone, officials said at a news conference Thursday.
No cases have been confirmed at St. Mary's Medical Center yet, but about 10 to 15 of the 250 patients contacted so far by the hospital have exhibited symptoms and have been directed to the emergency room.
Officials began making calls Wednesday to these patients, who received spinal steroid injections at a St. Mary's outpatient center with a confirmed contaminated lot of the steroid.
According to the Centers for Disease Control, "Fungal meningitis is not contagious. It is not transmitted from person to person."
This lot of steroid injections has since been recalled by the manufacturer, Framingham, Mass.-based New England Compounding Center.
Five people have died and 35 people in six states are ill. All received steroid shots for back pain.
The pharmacy issued a recall last week and has shut down operations. The steroid was sent to 75 facilities in 23 states.
Another fatality from a growing outbreak of a rare form of meningitis was reported Thursday, raising the death toll to five people, officials said.
Investigators said they are still trying to confirm the source of the infection.
Cases have been reported in Tennessee, Indiana, Virginia, Maryland, Florida and North Carolina.
Tennessee has by far the most cases with 25. Many of them were treated at the Saint Thomas Outpatient Neurosurgery Center in Nashville, which had 2,000 vials of the suspect lots, the largest number. That clinic voluntarily closed last month to deal with the investigation.
Dr. Robert Latham, chief of medicine at Saint Thomas Hospital, said a patient died there late Wednesday or early Thursday, bringing the number of deaths in Tennessee to three. Deaths were also reported in Virginia and Maryland.
More new cases are almost certain to appear in the coming days, said Tennessee Department of Health Commissioner John Dreyzehner. Five new cases were confirmed over the past 24 hours, he said Wednesday, calling the situation a "rapidly evolving outbreak."
Federal health officials weren't clear about whether new infections are occurring. They are looking for -- and increasingly finding -- illnesses that occurred in the past two or three months.
Meningitis is an inflammation of the lining of the brain and spinal cord. Symptoms include severe and worsening headache, nausea, dizziness and fever. Some of the patients also experienced slurred speech, and difficulty walking and urinating, Tennessee health officials said.
"Some are doing well and improving. Some are very ill -- very, very seriously ill and may die," Tennessee health official Dr. David Reagan said of the state's patients.
The incubation period is estimated at anywhere from two to 28 days, so some people may not have fallen ill yet, Tennessee health officials said. At three clinics in Tennessee, officials are contacting the more than 900 people who received the steroid in the past three months.
Investigators also have been looking into the antiseptic and anesthetic used during the injections. Neither has been ruled out. However, the primary suspicion is on the steroid medication. Steroid shots are common for back pain, often given together with an anesthetic.
The outbreak was discovered about two weeks ago when Vanderbilt University's Dr. April Pettit was treating a patient who was not doing well for reasons doctors did not understand.
When the lab found the fungus in the patient's spinal fluid, Pettit began asking questions and learned the patient recently had steroid injections in his spine, according to Dr. William Schaffner, who chairs Vanderbilt's Department of Preventive Medicine.
"When it became clear that the infection-control practices at the clinic were up to par, the steroid medication became implicated," Schaffner said.
Federal officials did not release condition reports or details on all the patients. Fungal meningitis is treated with high-dose antifungal medications, usually given intravenously in a hospital.