By TRAVIS LOLLER and MIKE STOBBE
Associated Press

NASHVILLE, Tenn. (AP) -- Health officials say a rare meningitis outbreak has sickened 26 people in five states who received steroid injections for back pain. Four people have died.

MORE: MTSU freshmen dies possibly from Meningitis

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 said 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.
 
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.

On Tuesday, the Tennessee Department Of Health and The CDC in Atlanta believe the source of the meningitis that killed Jacob Nunley, a Middle Tennessee State University freshman from Dyersburg, came from a steroid injection at a Nashville outpatient center.

The cause of the cluster is unknown.

Nunley, a few days from celebrating his 19th birthday, died from complications of meningitis.

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