Journal of Medicine - The number of people infected with meningitis has risen for the fifth consecutive day since the Centers for Disease Control and Prevention began releasing figures about the deadly outbreak.

On Thursday, the CDC announced that 14 people have died in 170 cases of meningitis.

The newest victims died in Florida and Indiana, states which had already been listed as affected by the controversy.

Victims have died in six states: six in Tennessee, three in Michigan, two in Florida and one each in Maryland and Virginia.

Other states involved include Idaho, Minnesota, North Carolina, New Jersey and Ohio.

Many more people could become infected because 14,000 patients were treated with three recalled lots of steroids, says J. Todd Weber, a doctor with the CDC's Division of Healthcare Quality Promotion. So far, about 90% of the people who received the shots have been notified.

"This is new territory for public health and the clinical community," Weber said during a briefing held by the CDC, the Food and Drug Administration and the Massachusetts Department of Public Health on Thursday afternoon. "Patients and their doctors will need to be vigilant for at least several months following the injection."

He added that the first person who received an injection in a joint has begun to develop symptoms of meningitis in the ankle.

Officials had tied the outbreak of rare fungal meningitis to steroid shots for back pain. The steroid was custom-made by New England Compounding Center, a specialty pharmacy in Framingham, Mass. The steroid was recalled Sept. 26.

The government has identified about 75 facilities in 23 states that received the recalled doses. The fungus is not transmitted from person to person.

Clinicians should contact patients who received potentially contaminated injections starting May 21, the CDC has said. Once identified, patients with infections should be put on appropriate anti-fungal therapy.

Meningitis is an inflammation of the lining of the brain and spinal cord. Infected patients have developed a variety of symptoms, which set in about one to four weeks after their injections. These include fever, a new or worsening headache, nausea and problems similar to those seen in a stroke.

The FDA is now hoping to work with Congress and other regulators to come up with new rules to govern compounding pharmacies, said Deborah Autor, deputy commissioner for the FDA's Global Regulatory Operations and Policy.

"There is a lack of clarity in the law," she said. "This is the time for pharmacies and regulators to grapple with a new model and come up with a new scheme that controls the risk."