At least six Michigan residents have now died as part of the outbreak of a rare form of meningitis.
The latest is a 79-year-old woman from Oakland County who is among 49 people in the state to be stricken by the illness. The spread of fungal meningitis has been linked to contaminated steroids made at an East Coast pharmacy and shipped to a handful of clinics in Michigan and across the United States.
The Michigan Department of Community Health says there have been four abscesses and a joint infection, in addition to the meningitis cases.
According to experts the most important factor determining who gets sick seems to be how much fungus was contaminating a vial of medication. The steroids were injected to relieve back and neck pain.
Including Michigan the outbreak is now blamed for 23 deaths and 284 illnesses in 16 states.
The Associated Press contributed to this report.