Federal health officials have expanded the recall list of potentially contaminated injectable medications suspected in a multi-state meningitis outbreak and the death of five people. More and more cases are being reported, with 47 people having contracted meningitis in seven states.

The Food and Drug Administration released a list of 34 different drugs this morning that included steroids, epidural anesthetics used to block pain during childbirth, and surgery and saline solutions that are compounded to make different medications. All of the products on the recall list were made by the New England Compound Center (NECC) in Framingham, Mass., and are administered by injection into the spine.

Tests are still underway to identify the exact type of fungus linked to the outbreak among back-pain patients who received injections of Methylprednisolone Acetate, a steroid that is injected into the spinal cord. FDA inspectors found the fungus in a sealed vial of the steroid at the New England Compounding Center earlier this week when numerous cases of meningitis in multiple states sparked health alerts and recalls. The NECC voluntarily shut down operations on Wednesday.

So far, seven states have reported meningitis cases related to the contaminated steroid, including Tennessee, Maryland, Virginia, North Carolina, Florida, and Indiana. Michigan has become the most recent state on the list, reporting four cases.

In Tennessee, the state hardest hit with the meningitis outbreak, 29 people have been diagnosed with meningitis, and three people have died. State health officials are working with clinics to contact other patients who might have been exposed to the fungus. So far, three clinics across the state are confirmed to have administered the tainted steroids to patients. Tennessee Health Commissioner Dr. John Dreyzehner said they have found no procedural problems with the clinics that administered the injections.

“These clinics and their staff are trying their level best to treat and improve the lives of patients who come to them in pain, and we respect and support their efforts,” Dreyzehner said. “Evidence indicates these clinics and clinicians had no way of knowing about the contamination at the time of the procedure. The evidence indicates this is a product issue.”

The Centers for Disease Control and FDA have asked the clinics, doctors offices and hospitals in 23 states that have received shipments of medications from NECC to stop using them immediately. Anyone who has received epidural injections since July 1 should watch for symptoms of meningitis. Health officials say the most common symptoms are worsening headache, fever, stiff neck, trouble walking or falling and progressing back pain. Many of these patients have suffered strokes.

Click for a full list of recalled drugs from the FDA.