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N.E. may have 1st cases in meningitis outbreak

New Hampshire health officials reported Saturday that four adults in the state may be infected with fungal meningitis, the first New England cases associated with a nationwide outbreak linked to contaminated steroids produced by a Framingham compounding pharmacy.

Three men and one woman, all between the ages of 40 and 60, are receiving treatment, according to a statement from the New Hampshire Department of Health and Human Services.

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“All four have received injections of the apparently tainted steroid,” said Dr. Michael O’Connell of Pain Care LLC, the company that treated each patient and that is believed to be the only facility in New Hampshire that received tainted serum. Pain Care has identified 741 patients who may have been exposed to the recalled product.

The outbreak is tied to New England Compounding Center of Framingham, which officials believe produced steroids contaminated with fungus. The compounding center voluntarily recalled all products it produced since the beginning of the year, and has laid off 40 of its roughly 50 workers in recent days.

Federal health officials reported Saturday that the number of infected patients had risen to 198 across 13 states, and the death toll related to the outbreak had risen to 15. The New Hampshire cases are not included in this tally.

The number of infected patients had risen to 198 across 13 states.

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Curtis Allen, a spokesman for the Centers for Disease Control and Prevention, said the agency has received reports of the New Hampshire cases and is investigating. He said 14,000 people across the country may have been exposed to the tainted steroids.

Dr. José Montero, public health director in New Hampshire, said officials are monitoring each of the cases there.

“They are all being clinically evaluated and they are receiving care,” Montero said. “We hope that they all have a recovery.”

O’Connell said there are no signs of life-threatening symptoms for the four people in New Hampshire at this time. One person has already been hospitalized, treated, and released, he said.

Two of the patients were injected with apparently tainted steroids at Pain Care LLC’s Merrimack Facility, O’Connell said, and two were treated in Somersworth, all within the last two months. One patient received an injection directly into the spinal canal, he said. Two others received facet joint injections, which technically are outside the spinal canal, and the other patient received a peripheral joint injection to the ankle, he said.

O’Connell said the cases related to joint injections were particularly surprising, because fungal meningitis attacks the brain and spinal cord.

“It’s surprising that one might have meningitis from an injection of the steroid outside the spinal canal,” he said.

Most shots of the contaminated steroids from New England Compounding Center were given to people with lower back pain. One patient in Michigan who received an injection for joint pain developed an infection in the ankle.

New England Compounding is already facing at least one lawsuit related to the outbreak. A Minnesota patient who received an injection of a steroid called methylprednisolone acetate filed a suit and is seeking class-action status.

In New Hampshire, it is possible that more cases will be linked to the meningitis outbreak, O’Connell and Montero said.

“I wish I could say that I don’t expect more cases, but based on what we know and we are seeing, there is a chance that we may see more,” Montero said.

O’Connell said, however, that some people who received injections of the contaminated steroids may not be severely affected.

“It appears that there’s a subset of the population of those who have been exposed who will do OK with no treatment at all and may have in fact already gone through a flu-like symptom and are now getting better on their own,” he said.

But health officials in New Hampshire are nevertheless remaining vigilant due to the breadth of the outbreak, which has called into question government oversight and licensing of compounding facilities.

“Certainly this is something that the public and the health care sector has been really worried about,” Montero said. “You don’t go to a health care facility and expect to get worse.”

Zachary T. Sampson can be reached at zachary.sampson@globe.com.

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