Health officials say the number of people sickened by a deadly meningitis outbreak has risen again. There are now 49 cases in seven states.

The number of deaths — five — has remained the same.

Tennessee, Virginia, Maryland, Florida, North Carolina and Indiana had previously reported cases. On Friday, Michigan joined the list, with six reported cases of fungal meningitis tied to the national outbreak. Local 4 has learned the meningitis patients are being treated at St. Joseph Mercy Hospital in Ann Arbor.

The outbreak of fungal meningitis has been tied to steroid shots used to treat back pain. The steroid was custom-made by a specialty pharmacy in Massachusetts. Health inspectors found fungus in at least one sealed vial of the steroid at the company's facility.

The steroids were delivered to four facilities in Michigan. The Michigan Department of Community Health says the number of cases is expected to increase.

The Michigan facilities which received the shipments of recalled steroids are the following:

•Michigan Neurosurgical Institutes in Grand Blanc
•Michigan Pain Specialists in Brighton
•Neuromuscular and Rehabilitation in Traverse City
•Southeast Michigan Surgical Hospital in Warren

The Michigan facilities which received the shipments are working to notify patients of the tainted steroids. The steroids were used for Michigan patients with back pain.

The company has recalled the steroid which was sent to clinics in 23 states. The government urged doctors not to use any of the company's products.

What is fungal meningitis?

Meningitis is a general term for swelling of the protective membranes that cover the brain and spine.

The swelling is typically caused by an infection of the fluid surrounding the brain and spinal cord that can be caused by bacteria, viruses, parasites or fungus, although meningitis also be caused by injury, cancer or medications.

For this type of meningitis, symptoms include worsening to severe headache, nausea, dizziness and fever, Dreyzehner said. Other symptoms can include slurred speech, unsteady gait, urinary retention, weakness and sensory deficit.

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