A fifth person has died in a growing outbreak of a rare form of meningitis that has sickened more than two dozen people in five US states.

Dr. Robert Latham, chief of medicine at Saint Thomas Hospital in Nashville, Tennessee, said Thursday a patient died there late Wednesday or early Thursday.

Tennessee has had three deaths. Deaths have also been reported in Virginia and Maryland.

People in all the cases received steroid injections used mostly for back pain that have been traced back to a specialty pharmacy in Massachusetts. The pharmacy issued a recall last week and has shut down operations.

The type of meningitis is not contagious. Health officials believe that more new cases are almost certain to appear in the coming days.

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