The number of people believed to have been sickened by a contaminated drug rose to 185 Friday, but US health officials said the death toll from the rare meningitis outbreak held steady at 14.
Texas has now reported its first case, the 12th state affected by the outbreak tied to a steroid typically injected into the spine to treat back pain.
Health officials have notified most of the 14,000 people in 23 states who may have received tainted doses of the steroid. But it could be weeks or even months before authorities have a final tally of the infections, because the deadly fungal infection has such a long incubation period.
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 50 cases and six deaths, Michigan, with 41 cases and three deaths, Virginia, with 33 cases and one death and Indiana, with 24 cases and one death, according to the latest tally by the Centers for Disease Control and Prevention.
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 lengthy 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, 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.