A 28-year-old Marion County woman has been confirmed today as Ohio’s 11th fungal meningitis case linked to contaminated steroid injections.

The Ohio Department of Health released no other information about the woman, or the conditions of the state’s 10 other victims. Nationally, the death toll rose to 21 today after an additional victim was reported in Michigan, according to the Centers for Disease Control and Prevention. So far, the CDC has reported 271 people have fungal meningitis infections in 16 states.

The Centers for Disease Control and Prevention and the Food and Drug Administration are investigating the outbreak, linked to injectable steroids prepared by the New England Compounding Center in Framingham, Mass. This week, the two agencies announced they had identified the fungus Exserohilum rostratum in unopened vials of one lot of the steroid methylprednisolone acetate, which is administered for back and joint pain. Last week, the FDA said its investigators had found the fungus growing in equipment used to prepare the steroid.

Three lots of the steroid were implicated early in the outbreak, but NECC has recalled all of its medication and ceased operations.FDA officials estimate some 14,000 people in 23 states received the injections.

Federal health officials are also investigating reports of joint infections, called septic arthritis, in people who received NECC methylprednisolone acetate injections in their knees, ankles or shoulders.

And health-care providers have been advised to notify all patients who received any injectable medication made by NECC. Providers are being asked to monitor those patients for at least several months for signs of fungal meningitis. The infection can develop slowly, and symptoms can be very subtle, experts warn.

Symptoms of fungal meningitis include fever, stiff neck and new or worsening headache.

Fungal meningitis is not spread person-to-person.