Eleven more people have been diagnosed with fungal meningitis after receiving an injectable steroid from one of three contaminated batches made by a Massachusetts compounding pharmacy, the US Centers for Disease Control and Prevention said Thursday. That brings the total count to 323. The number of deaths tied to the outbreak stands at 24.

Five additional patients who received steroid injections for joint pain have infections in their joints linked to New England Compounding Center in Framingham, the CDC reported.

The outbreak now includes one case in South Carolina, bringing the number of affected states to 18. In New England, only New Hampshire is on the list, with 10 cases and no deaths.

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The hardest hit states are Michigan, with 80 cases and five deaths, and Tennessee, with 70 cases and nine deaths.