( CNN ) -- A non-contagious , fungal form of meningitis has sickened 26 people in five states , killing four , the U.S. Centers for Disease Control and Prevention said Wednesday . Five additional cases were reported in Tennessee , health officials said Tuesday . The total number of cases in that state is 18 . Three cases have been reported in Virginia , two each in Florida and Maryland and one in North Carolina , the CDC said . Two people have died in Tennessee , one in Virginia and one in Maryland . All of those infected had received steroid injections to the spine . Tennessee : Meningitis outbreak investigated . The Tennessee victims range in age from 49 to 89 , state Health Commissioner Dr. John Dreyzehner said Wednesday . Department spokesman Woody McMillin said Tuesday 11 patients were hospitalized . `` The prime suspect for this outbreak is methylprednisolone acetate , '' Dreyzehner said Wednesday . Methylprednisolone acetate is an injectible steroid product used to treat pain and inflammation . Food and Drug Administration officials identified the manufacturer as New England Compounding Center ( NECC ) , which conducted a voluntary recall of three lots of methylprednisolone acetate 80mg/mlinjection produced at NECC . The lot numbers are # 05212012 @ 68 , # 06292012 @ 26 and # 08102012 @ 51 . The FDA continues to work with state health departments and the Massachusetts Board of Pharmacy to investigate the scope and cause of the outbreak of the fungal meningitis , according to FDA spokesperson Erica Jefferson . `` We expect to see more cases , '' Dreyzehner said , noting the infection can take up to 28 days to develop . Three pain treatment centers in Tennessee received the steroids that were part of the three recalled lots , officials said . They are the Specialty Surgery Center in Crossville , Tennessee ; the PCA Pain Care Center in Oak Ridge , Tennessee ; and the St. Thomas Outpatient Neurosurgery Center in Nashville . Biopsies from two patients are consistent with the aspergillus fungus found in another patient , according to Dreyzehner , but he was careful to note that the findings need to be confirmed by the CDC . The investigation is ongoing and evolving , he said . `` Though we are closer to identifying the cause , we have not concluded there is one factor at this time . '' The investigation is also looking at anesthetic or the antiseptic as possible causes of infection , he said . The dates of the investigation have also been widened , and now include patients treated between July 1 and September 20 . `` We are casting a wider net as a precaution , '' Dreyzehner said . The Nashville facility contacted 737 patients who had lumbar epidural steroid injections between July 30 and September 20 , health officials said previously . What is meningitis ? The facility was temporarily closed on September 20 and will remain closed until investigating authorities `` are confident the current concerns have been resolved , '' the health department said . Between 100 and 200 patients at the Crossville facility may have been exposed or put at risk because of lumbar injections during the same time period , according to McMillin . No cases have been identified from the Oak Ridge facility , Dreyzehner said . Meningitis is a general term for swelling of the protective membranes that cover the brain and spine . The swelling is typically caused by an infection of the fluid surrounding the brain and spinal cord that can be caused by bacteria , viruses , parasites or fungus , although meningitis also be caused by injury , cancer or medications . For this type of meningitis , symptoms include worsening to severe headache , nausea , dizziness and fever , Dreyzehner said . Other symptoms can include slurred speech , unsteady gait , urinary retention , weakness and sensory deficit . 6 places germs breed . CNN 's Miriam Falco , Saundra Young and Joe Sutton contributed to this report .
NEW : FDA releases lot numbers for recalled product . Title: Why do we have to wait so long between the first and second seasons of a TV show? Four people have died . `` We expect to see more cases , '' says Tennessee 's health commissioner .