A rare and deadly form of fungal meningitis has killed five and sickened 47 in seven states, with two cases reported in Florida.

The Florida Department of Health has identified eight facilities in Florida that received contaminated medication, three of them in Ocala, according to the Associated Press.

The eight facilities are: Florida Pain Clinic, Ocala; Interventional Rehab Center, Pensacola; Marion Pain Management Center, Ocala; North County Surgicenter, Palm Beach; Orlando Center for Outpatient Surgery, Orlando; Pain Consultants of West Florida, Pensacola; Surgery Center of Ocala and Surgical Park Center, Miami.

The common steroid injections, used to relieve spine and back pain, were contaminated with fungus when they were being produced at the manufacturer, said Paul Doering, a University of Florida pharmacy professor.

Health officials traced the drug back to a phramacy in Massachusetts that issued a recall last week and shut down operations.

Doering explained that the big issue with this contamination case is that the contaminated injections were prepared at a compounding pharmacy, which takes raw materials to produce injections in a sterile environment to be used in doctors’ offices.

“It’s going to raise some eyebrows as to why this compounding pharmacy found it necessary to manipulate and otherwise repackage and/or manufacture the substance,” he said.

Although the the fungal meningitis is life-threatening, it is not contagious. But Doering said it is still of concern.

Symptoms include severe and worsening headache, nausea, dizziness and fever.

“This is a major public health problem, when the pharmacies that are expected to prepare and dispense these things free of any contamination end up instead causing this type of fungal outbreak,” he said. “It’s caused the FDA to get really concerned about what goes on in a so-called compounding pharmacy.”