medical examination
medical examinationReuters

An outbreak of a rare and deadly type of meningitis has killed four people and caused at least 30 others to fall ill in five states America, health officials said on Wednesday.

“I’m afraid we’re going to see many more cases spread across the country,” said Dr. William Schaffner, an infectious diseases expert at Vanderbilt University in Nashville, according to The New York Times.

The type of meningitis involved is not contagious like the more common forms, but is caused by a fungus often found in leaf mold, which health officials suspect may have been in steroid injections used for back pain that the individuals received.

Cases have so far appeared in Tennessee, North Carolina, Florida, Virginia and Maryland.

All the infected patients had been treated with a brand of methylprednisolone acetate produced by the New England Compounding Center in Framingham, Mass.

 Doctors are urging those who have received the treatment within the past few months to see a doctor if they develop symptoms such as severe or worsening headaches, fever, nausea, difficulty with balance, or slurred speech.

The outbreak has raised concerns about the safety of a treatment for back pain used by millions of people a year in the United States. It has also drawn attention to compounding pharmacies that are not subject to the same safety standards that the government imposes on big drug companies.

Compounding pharmacies have a history of errors. Almost one-third of pharmacies said they have had a "patient incident" involving a compounding error during the previous five years, according to a survey conducted by Pharmacy Purchasing & Products magazine, The Wall Street Journal reported.