Another 19 people have been diagnosed with fungal meningitis linked to possibly tainted vials of a steroid medication, the U.S. Centers for Disease Control and Prevention said on Tuesday, bringing the total number of cases to 231.

The CDC said there were two additional cases of infection in joints after a steroid injection but these were not confirmed as meningitis, bringing the total of infections nationwide to 233.

The death toll from the unprecedented outbreak was unchanged at 15, the CDC said.

The new cases were in Tennessee (6), Florida (2), Indiana (2), Maryland (1), Michigan (1), New Hampshire (2), New Jersey (2), Ohio (2), and Virginia (1).

The federal Food and Drug Administration on Monday said it had widened its investigation to other drugs produced by New England Compounding Center, the specialist pharmacy at the center of the outbreak. The Massachusetts company faces multiple investigations and lawsuits over the tainted medication linked to the meningitis scare.

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