(CNN) -- A non-contagious, possibly fungal form of meningitis has sickened an additional five people in Tennessee, bringing the total number of reported cases to 19, state health officials said Wednesday.
Two people have died in the outbreak, Woody McMillin, a spokesman for the Tennessee Department of Health, said Tuesday.
The cases were all in patients treated with steroid injections to the spine.
The 19 cases include one person in North Carolina, according to the U.S. Centers for Disease Control and Prevention.
Victims range in age from their late 40s to early 80s, according to McMillin. Eleven patients are hospitalized.
"The prime suspect for this outbreak is methylprednisolone acetate," Tennessee Health Commissioner Dr. John Dreyzehner said Wednesday.
Methylprednisolone acetate is an injectible steroid product used to treat pain and inflammation.
Officials have identified the manufacturer, he said, but would not release the name, saying the Food and Drug Administration is investigating. Three lots of methylprednisolone acetate have been identified and recalled by the manufacturer, he said.
"We expect to see more cases," Dreyzehner said, noting the infection can take up to 28 days to develop.
Three pain treatment centers in Tennessee received the steroids that were part of the three recalled lots.
They are the Specialty Surgery Center in Crossville, Tennessee; the PCA Pain Care Center in Oak Ridge, Tennessee; and the St. Thomas Outpatient Neurosurgery Center in Nashville.
Biopsies from two patients are consistent with the aspergillus fungus found in another patient, according to Dreyzehner, but he was careful to note that the findings need to be confirmed by the CDC.
He said the investigation is ongoing and evolving. "Though we are closer to identifying the cause, we have not concluded there is one factor at this time."
The investigation is also looking at anesthetic or the antiseptic as possible causes of infection, he said.
The dates of the investigation have also been widened, and now include patients treated between July 1 and September 20. "We are casting a wider net as a precaution," Dreyzehner said.
The Nashville facility contacted 737 patients who had lumbar epidural steroid injections between July 30 and September 20, health officials said previously.
The facility was temporarily closed on September 20 and will remain closed until investigating authorities "are confident the current concerns have been resolved," the health department said.
Between 100 and 200 patients at the Crossville facility may have been exposed or put at risk because of lumbar injections during the same time period, according to McMillin.
No cases have been identified from the Oak Ridge facility, Dreyzehner said.
Meningitis is a general term for swelling of the protective membranes that cover the brain and spine.
The swelling is typically caused by an infection of the fluid surrounding the brain and spinal cord that can be caused by bacteria, viruses, parasites or fungus, although meningitis also be caused by injury, cancer or medications.
For this type of meningitis, symptoms include worsening to severe headache, nausea, dizziness and fever, Dreyzehner said. Other symptoms can include slurred speech, unsteady gait, urinary retention, weakness and sensory deficit.
CNN's Joe Sutton contributed to this report.