The Minneapolis-St. Paul area Medical Advanced Pain Specialists (MAPS) pain clinics said of its four patients showed symptoms of the disease. (Jim Mone/Associated Press)

U.S. health officials have announced another increase in the number of people affected by an outbreak of fungal meningitis as the pharmacy that distributed the steroid linked to the outbreak issued a voluntary recall of all of its products.

According to the website of the Centers for Disease Control and Prevention, the number of cases is now up to 91. On Saturday, it was at 64. The number of people who have died is seven.

The breakdown of cases is as follows:

• Florida: 4 cases.
• Indiana: 8 cases.
• Maryland: 3 cases, including 1 death.
• Michigan: 20 cases, including 2 deaths.
• Minnesota: 3 cases.
• North Carolina: 2 cases.
• Ohio: 1 case.
• Tennessee: 32 cases, including 3 deaths.
• Virginia: 18 cases, including 1 death.

In another development, the New England Compounding Center announced the recall of every one of its products late on Saturday. The company said there is no indication that any of its other products have been contaminated but it just wanted to take the action because of the risk of contamination.

The Food and Drug Administration had already warned doctors and clinics to stop using the steroid linked to the outbreak and health officials have been scrambling to notify anyone who may have received an injection of it. About 17,700 single-dose vials of the steroid were covered in the government recall.

It is not yet known exactly how many people may have been affected, though it could affect hundreds or even thousands of people who received the steroid injections for back pain from July to September.

Meningitis is caused by the inflammation of meninges, which are protective membranes covering the brain and spinal cord. Fungal meningitis is not contagious like its more common viral and bacterial counterparts.

Authorities took the step to help identify everyone who may have gotten sick — or may still get sick — in the outbreak.

All the outbreak patients had gotten shots of the steroid for back pain, a common treatment, and inspectors found at least one sealed vial contaminated with fungus.