Three cases have been reported in Virginia, two in Maryland, two in Florida, and one in North Carolina. Two of the deaths were in Tennessee; Virginia and Maryland had one each, the Centers for Disease Control and Prevention said.
More cases are almost certain, said Tennessee Department of Health Commissioner John Dreyzehner. Five more were confirmed in the last 24 hours, he said, citing a "rapidly evolving outbreak."
But federal officials were not clear about whether new infections were occurring. They are increasingly finding illnesses that occurred in the last two or three months.
Meningitis involves swelling of the brain. Officials say this type of fungal meningitis is caused by a common fungus often found in leaf mold. It does not normally cause disease in healthy people. Fungal meningitis is not contagious like the more common viral and bacterial meningitis.
At three clinics in Tennessee, officials are contacting the more than 900 people who received the steroid in the last three months.
Investigators have been looking into the antiseptic and anesthetic used during the injections. Neither has been ruled out. However, the primary suspicion is on the steroid medication. Steroid shots are common for back pain, often given together with an anesthetic.
The Food and Drug Administration identified the maker of the steroid as New England Compounding Center, a specialty pharmacy in Framingham, Mass. Last week, the company issued a recall of three lots of the steroid - methylprednisolone acetate. In a statement, the company said it had voluntarily suspended operations.