NEW YORK (AP) -- Health officials say four more people have died in the national meningitis outbreak, bringing the number of deaths to 19.

The deaths are among the 247 people in 15 states sickened in the outbreak, which has been tied to steroid shots for back pain. Most have a rare fungal form of meningitis. Two have joint infections.

A specialty pharmacy in Massachusetts made the steroid, and federal officials are investigating the business.

The Centers for Disease Control and Prevention updated the count on Wednesday. There were two more deaths reported in Tennessee and one each in Florida and Virginia.

The CDC also said test results so far show infections with three kinds of fungus. Most were a form of black mold.