US health officials said that the death toll from a meningitis outbreak linked to tainted drugs rose to 30 as the number of cases climbed to a whopping 419.
Some 14,000 people in 23 states are at risk after having received potentially tainted doses of the steroid from the New England Compounding Center.
The steroid is typically injected into the spine to treat back pain but can also be used to treat joints and 10 of the cases reported by the Centers for Disease Control and Prevention were joint infections.
Authorities are investigating the NECC, saying its now defunct facility outside Boston made medications in unsanitary conditions with bacteria and mold so prevalent it could be seen with the naked eye.
Officials have said that due to the disease's long incubation period, it could be weeks before authorities have a final tally of the infections from the unprecedented outbreak.
NECC recalled all of its products on October 6 but the slow-moving infection can take 42 days, or even longer, to manifest symptoms.
Michigan has reported the highest number of cases -- 119 and seven deaths -- followed by the southern state of Tennessee, which has 78 cases and the highest number of fatalities at 13.
Other badly hit states include Florida, Indiana, Maryland, New Jersey and Virginia.
The outbreak has led to calls for tighter regulation of the loosely controlled pharmaceutical compounding industry. Federal investigators have launched a criminal probe into the case.
Critics say drug manufacturers have found a way to sidestep costly and strict oversight by classifying themselves as pharmacies, which are given freer rein to mix drug compounds for patients.