The death toll from an unprecedented US meningitis outbreak tied to a tainted steroid jumped to 15 after another person died from a fungal form of the disease, health authorities said Saturday.
The total number of cases stood at 198 across 13 states, the Centers for Disease Control and Prevention said on its website.
That figure includes 197 cases of fungal meningitis and one case of a "peripheral joint infection," affecting joints such as the knees, hips, shoulders or elbows, the CDC said. Illinois also saw its first case included in the count.
Tennessee remains the hardest hit state with 52 cases and six deaths, followed by Michigan, with 41 cases and three deaths, and Virginia, with 34 cases and one death.
There have also been deaths in Indiana, Florida and Maryland.
Health officials say most of the 14,000 people in 23 states who may have received contaminated doses of the steroid—typically injected into the spine to treat back pain—have been notified.
But it could be weeks or even months before authorities have a final tally of the infections, due to the deadly fungal infection's long incubation period.
The rare strain of the disease, which inflames the protective membranes covering the brain and spinal cord, requires a lengthy hospital stay and intravenous anti-fungal medications. But meningitis is not contagious in this form.
The outbreak has led to calls for tighter regulation of the loosely controlled pharmaceutical compounding industry.
Critics said drug manufacturers have found a way to sidestep costly and strict oversight by classifying themselves as pharmacies, which are given freer rein to mix drug compounds for patients.
US health officials launched an investigation after the first case was discovered in September, finding fungal contaminants in steroids produced by the New England Compounding Center.
The Massachusetts-based company subsequently issued a voluntary recall of all of its products and shut down all operations.
Deborah Autor, a deputy commissioner at the US Food and Drug Administration, launched an appeal Thursday to strengthen federal regulations for pharmaceutical compounding companies like NECC.
Lawmakers have said that they plan to propose bills to increase the regulatory power of the FDA, and a senator has asked for a criminal investigation to be opened.