The death toll from a deadly meningitis outbreak in the United States blamed on a tainted drug rose to 14 Thursday as the number of cases jumped to 172 in 11 states, health officials said.
That's up from 12 deaths and 137 cases on Wednesday.
Investigators say as many as 13,000 people in 23 states may have received contaminated doses of the steroid, which is typically injected into the spine to treat back pain.
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.
Among the hardest hit states were Tennessee, with 49 cases and six deaths, Michigan, with 39 cases and three deaths, and Virginia, with 30 cases and one death.
Idaho reported its first case on Wednesday and Thursday Ohio reported two new cases after the Centers for Disease Control and Prevention posted the national tally.
Ohio said it has been able to contact 419 of the state's 422 patients who received received the possibly tainted injections.
"This outreach and contact with healthcare providers needs to continue even if the patient is feeling well during the initial conversation," said Dr. Ted Wymyslo, director of the Ohio Department of Health.
"Because of the rare nature of this infection, no one is sure of the incubation period; we don't know how long after an injection it is safe to say you won't get sick."
The rare fungal infection—which inflames the protective membranes covering the brain and spinal cord—often goes undetected until it is too late because its flu-like symptoms can be mild at first.
Treatment requires a hospital stay and intravenous anti-fungal medications. But meningitis is not contagious in this form.
US health officials launched an investigation after the first case was discovered in September and discovered 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.
A second manufacturing pharmacy owned by the same people, Ameridose and its distributor Alanaus, temporarily suspended operations on Wednesday but did not recall any products.
Massachusetts health officials said there is "no evidence to suggest that there is direct concern for compromised product manufactured or compounded by Ameridose" but that the suspension will allow for a thorough investigation.