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A doctor inserting a syringe into a vial of liquidAs fungal meningitis deaths and cases rise across the US, the FDA has announced that two additional drugs could also be culprits in the outbreak that has already lead to 20 deaths and 254 cases across the country. The outbreak has reached a 16th state, New York, and new cases also were reported in Indiana, New Hampshire, New Jersey, Ohio and Tennessee. 14,000 people are thought to have been exposed to the contaminated steroid.

Now, the FDA is investigating three additional cases of suspected fungal meningitis or other fungal infections in patients who received other injected drugs made by New England Compounding Center (NECC).

“The sterility of any injectable drugs … produced by NECC are of significant concern,” the FDA warned.

What are the facts you need to know about this potential threat?

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What is fungal meningitis?

Fungal meningitis is a rare disease that’s usually sparked when a fungus travels though the bloodstream to the spinal cord. Like other forms of meningitis, which can also be caused by a viral or bacterial infection, the disease causes swelling and inflammation of the meninges, membranes that cover the brain and spinal cord.

What causes fungal meningitis?

The most common culprit is a fungus called Cryptococcus, with infections thought to result from inhaling soil particles contaminated with bird droppings. This form of fungal meningitis is among the leading causes of adult meningitis in Africa, according to the CDC.

Most cases in the current outbreak were caused by Exserohilum, which Tennessee state health commissioner Dr. John Dreyzehner calls “a fungus so rare that most physicians never see it in a lifetime of practicing medicine,” according to the New York Times.

What are the symptoms?

Warning signs include headache, stiff neck, lower-than-normal temperature, nausea or vomiting, sensitivity to light, and hallucinations, reports Meningitis Foundation of America, which advises anyone with these symptoms to seek immediate medical attention.

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