TALLAHASSSEE (CBSMiami/AP) — There are four new confirmed cases of fungal meningitis in the state of Florida, none of them are in South Florida.

With the additional four cases, there are now a total of 17 confirmed cases in the state connected to the use of contaminated steroids used for back pain, according to Florida health officials.

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Three of the people suffering from fungal meningitis are from Marion County and the other person is from Escambia County.

The state reported earlier this week that three people have died as a result of the fungal meningitis outbreak.

Nationwide the death toll has risen to 20 people.

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Meningitis is caused by the inflammation of protective membranes covering the brain and spinal cord.

Tainted spinal injections would directly put germs into that part of the body.

The outbreak has been linked to the maker of the steroids, New England Compounding Center of Framingham, Mass. The victims in the outbreak all received steroid shots made by the pharmacy, mostly to treat back pain. The company last month recalled three lots of the steroid made since May. It later shut down operations and recalled all the medicines it makes.

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