Tenn. meningitis outbreak tied to steroid shots An outbreak of fungal meningitis that has left two dead and 12 others infected is being investigated by Tennessee and federal health experts. Dr. David Reagan, chief medical officer for the Tennessee Department of Health, said on Tuesday that the latest two cases were confirmed in the past 24 hours. All but one of the the victims received steroid injections at St. Thomas Outpatient Neurosurgery Center between July 30 and Sept. 20, The Tennessean reported. More than 737 patients who received the shot have been notified about possible infection and examined. The clinic, the Saint Thomas Outpatient Neurosurgery Center, voluntarily shut its doors Sept. According to NBCNews.com, the patient were between 40 and 80 years old and were receiving injections as treatment for musculoskeletal disorders. The other patient was found in North Carolina but was reported to have a similar steroid procedure. Fungal meningitis is rare, but it is easier to contract in people with immune deficiencies as well as in premature babies with low birth weight. Certain diseases, medications and surgeries can put people at risk as well, according to the Centers for Disease Control and Prevention (CDC). It can be caused by a variety of fungi including Candida, Histoplasma and Coccidioides. Symptoms include nausea, vomiting, sensitivity to light and altered mental status. It can be fatal, but it is not contagious and can be treated with high dose antifungal medications. Dr. April Pettit, an infectious diseases specialist at Vanderbilt University who discovered the "index case," explained to the New York Times that her meningitis patient wasn't responding to antibiotics, the usual form of treatment, and bacteria could not be found. It wasn't until the doctors found a fungus called Aspergillus in the patient's spinal fluid that they connected the steroid injections as a possible cause. The patient later died from the disease. "I told them it was a very unusual cause of meningitis in healthy people, and that we needed to try to figure out how he got this infection," she said. Tennessee Department of Health commissioner Dr. John Dreyzehne, told The Tennessean that there is no exact known cause as of yet, but other states may have been infected. Two other Tennessee-area clinics that have purchased the "materials of concern" have been alerted, and they will notify their patients. Marion Kainer, an infectious diseases physician and epidemiologist with the Tennessee Health Department, added it's still too early to pinpoint the source. But, three lots of injectable steroid that was used at St. Thomas Outpatient Neurosurgery Center have been recalled by the manufacturer. "This is a serious illness, a serious disease," Kainer said. There is not a lot of experience treating it, but we're getting the best advice possible. Officials haven't identified the drug manufacturer or the city in North Carolina where one of the cases was reported. Reagan said that publicizing too much information at this time could negatively affect the investigation. CDC spokesman Curtis Allen said the agency is working with health departments in other states to determine whether other patients might be affected. He could not say how many people or clinics could potentially be affected nationally. In Tennessee there are about 900 people who received the injections at two clinics during the timeframe under investigation. No one from the second clinic has at this time been found to have contracted the disease, officials said. Allen cautioned that while the injectable steroids were one thing the sickened patients had in common, there could also be other things in common, such as the anesthetic or the antiseptic, and the search for a cause is ongoing. Of the 11 surviving patients in Tennessee, some are in critical condition while others are improving, Reagan said. Thus far, it has taken patients between seven days and 28 days to develop symptoms, said Health Department spokesman Woody McMillin. Officials say new cases could be identified in coming days.