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Compounding pharmacies mix ingredients for customized medicines that generally aren’t commercially available. They are regulated by states.

The outbreak was discovered about two weeks ago when Vanderbilt University’s Dr. April Pettit was treating a patient who was not doing well for reasons doctors did not understand.

When the lab found the fungus in the patient’s spinal fluid, Pettit began asking questions and learned the patient recently had steroid injections in his spine, according to Dr. William Schaffner, who chairs Vanderbilt’s Department of Preventive Medicine.

“When it became clear that the infection-control practices at the clinic were up to par, the steroid medication became implicated,” Schaffner said.

Federal officials did not release condition reports or details on all the patients. Fungal meningitis is treated with high-dose antifungal medications, usually given intravenously in a hospital.

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Stobbe reported from New York.