Eighteen of the cases — and two deaths — are in Tennessee where a Nashville clinic received the largest shipment of the steroid suspected in the outbreak.
A health official says the steroid came from a specialty pharmacy in Massachusetts.
According to the Centers for Disease Control and Prevention, the other cases are in Virginia, Maryland, Florida and North Carolina. Virginia and Maryland had one death each.
The Massachusetts Department of Public Health reports they are collaborating with the CDC, FDA, and other state public health officials to identify the cause of this outbreak.
The MA DPH says there are four products common to all of these cases. One medication, Methylprednisolone Acetate, a steroid, was prepared at the New England Compounding Center, Inc, a pharmacy in Framingham. It has been recalled and quarantined as a precaution and NECC is voluntarily recalling all similar medications.
In addition, at the request of DPH, NECC has agreed to voluntarily surrender their license to operate until this investigation is complete.
The form of fungal meningitis in these patients is not transmitted from person to person.
The MA DPH says there are no known cases in the Commonwealth, however health officials said Wednesday that more new cases are almost certain to appear in the coming days.
Investigators have not ruled out contamination in other products.