Contaminated steroids from New England Compounding Pharmacy have now killed 20 people in a fungal meningitis outbreak that began earlier this month, the CDC announced in it’s weekly outbreak update.

The CDC and FDA have also confirmed the presence of the fungus Exserohilum rostratum in one of the three lots of preservative-free methylprednisolone acetate — lot #08102012 — recalled on September 28, 2012. Testing on the other two lots is ongoing.

Exserohilum rostratum has been isolated in 45 of the 47 patients with lab-confirmed fungal meningitis. As of October 18, 257 cases, including 3 peripheral joint infections, have been reported in 16 states (see cases by state on the map below).

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Tennessee continues to have the highest burden of disease, reporting 63 cases and eight deaths. Other states where deaths have occurred include Michigan with four, Florida with three, and Indiana and Virginia with two deaths each.

CDC and state health departments estimate that approximately 14,000 patients may have received injections with medication from the three implicated steroid lots, and nearly 97% of these patients have been contacted for further follow-up.The CDC has also made a patient notification letter template available for health-care providers who still need to notify patients that have been exposed to NECC medication.

The CDC’s clinical recommendations for treatment remain unchanged, as both CDC and FDA health officials suspected Exserohilum rostratum prior to laboratory confirmation.

Patients in three states — Virginia, Florida and New Jersey — have filed lawsuits against NECC.