OCALA, Fla. -

Four more cases of fungal meningitis, including three in Marion County, have been confirmed in Florida, according to health officials.

The Florida Department of Health on Friday confirmed the cases, which stem from the ongoing investigation of a national outbreak associated with contaminated lots of methylprednisolone acetate distributed by the New England Compounding Center in Massachusetts.

Health officials identified the Marion County victims a 69-year-old woman and a 71-year-old woman who both received treatment at the Florida Pain Clinic and a 73-year-old woman who received treatment at the Marion Pain Management Center.  A 53-year-old woman who received treatment at Pain Consultants of West Florida in Escambia County also contracted the disease.

"We care about every patient, family, and community affected by this outbreak in the aftermath of contaminated NECC steroid injections," said State Surgeon General and Secretary of Health Dr. John Armstrong. "All patient settings in Florida are free of these contaminated steroids, and we will continue to assist our federal and state counterparts to ensure that NECC products are not available in any healthcare facility and practice in Florida."

On Sept. 25, the NECC, in coordination with the Food and Drug Administration, the Massachusetts Board of Pharmacy and Centers for Disease Control and Prevention, initially recalled three lots of methylprednisolone acetate principally used for epidural back injections. These contaminated lots have been implicated in the nationwide fungal meningitis outbreak.

With FDA guidance, NECC voluntarily recalled all NECC medications on Oct. 6.

The signs and symptoms of meningitis related to epidural NECC medication injections include fever, headache, stiff neck, nausea and vomiting, sensitivity to light and altered mental status.

The fungal meningitis outbreak has resulted in at least 20 deaths and more than 240 cases across 15 states, including deaths in Marion County, Fla. A lawyer for one of the Marion County victims announced on Thursday the family was suing the pharmacy that distributed the drug.

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