Compounding or specialty pharmacies often custom-mix medicines at levels, and in forms, that may not be available from other manufacturers. Under Massachusetts law, compounding pharmacies are only permitted to make small amounts of made-to-order prescription drugs.

The patients who developed meningitis were being treated for back pain. The Centers for Disease Control says others who received the injections in their joints are not thought to be at risk.

John Jernigan of the CDC is investigating the meningitis outbreak.

“CDC is working with state and local health departments to contact patients who may have received injections at the facilities who received the recalled lots of this medication to inform (them) that they, that they may have been exposed, to find out if they’re having symptoms, and to instruct them to seek health care should they be ill.”

Dr. Jernigan says there are many different signs of fungal meningitis.

“Fever, new or worsening headache, sometimes neck stiffness. We’ve also seen in a few patients signs and symptoms of stroke, sudden onset of slurred speech, dizziness, difficulty walking, sudden weakness.”

Health experts say they do not know how many people will actually become sick. They say it could take several months for a fungal infection to develop.

And that’s the VOA Special English Health Report. I’m Steve Ember.