Editor's note: This article has been corrected to state the number of meningitis cases is 21 in Michigan. One joint infection has been linked to contaminated steroid shots.

Ann Arbor area hospitals are treating 19 of the 21 cases of fungal meningitis cases linked to contaminated steroid injections, health officials said Monday.

St. Joseph Mercy Ann Arbor is treating 18 of those patients, hospital spokeswoman Lauren Smoker said. One patient is receiving treatment at the University of Michigan Health System, said Pete Barkey, director of public relations.

Neither hospital received contaminated steroids that were shipped from the New England Compounding Center that is under investigation by the Centers for Disease Control and Prevention for the outbreak. However, four other Michigan facilities did - including Michigan Pain Specialists in Brighton.

Monday afternoon, Michigan health officials announced the number of fungal meningitis cases from contaminated steroid injections had risen to 21 from the 20 that had been reported over the weekend. Two of the 21 have died, including one person who died at the end of September at the University of Michigan Hospital.

An additional Michigan patient had a fungal infection in a joint from a contaminated steroid injection for pain, the Michigan Department of Community Health reported Monday.

U-M did not identify that person, but the Brighton Press & Argus and the Associated Press reported that Lillian Cary, 67, of Howell Township died Sept. 30 from fungal meningitis at the U-M Hospital.

The state said the two who died were both women. One was 56 and the other was 67 years old.

People who have fallen ill from the contaminated steroid in Michigan cases range in age from 38 to 89 years old, the Michigan Department of Community Health said.

One of those patients is Lyn Laperriere, 61, of Milan. He’s been hospitalized at St. Joseph Mercy Ann Arbor for about 12 days, and it's uncertain when he'll be discharged.

Laperriere had received an injection for his back pain Sept. 6 from his doctor at Michigan Pain Specialists in Brighton.

Around Sept. 19 he began to feel off-balance and for the next week continually had headaches, said his wife, Penny Laperriere.

By Sept. 26 the symptoms were too severe to ignore - and Lyn Laperriere went to St. Joseph Mercy Ann Arbor in an ambulance.

At first, doctors thought he had bacterial meningitis and kept him quarantined, Penny Laperriere said.

Penny Laperriere said her husband has been receiving pain treatment at the Brighton facility for some time and has no complaints about the way he’s been treated.

All of the fungal meningitis cases that have been identified in Michigan are linked to the four facilities that received shipments of the contaminated steroid from the New England Compounding Center. They are:

• Michigan Pain Specialists in Brighton
• Michigan Neurosurgical Institute of Grand Blanc
• Neuromuscular & Rehabilitation in Traverse City
• Southeast Michigan Surgical Hospital in Warren

Michigan Pain Specialists also has a location at 135 South Prospect St. in Ypsilanti.

Across nine states, 105 cases of fungal meningitis and eight deaths have been reported as of Monday evening, according to the CDC.

The CDC has expanded the notification process beyond patients who received injections for back pain to patients who received injections in other sites, including joints.

Those that received contaminated steroid injections to their joints are at risk for a fungal infection.

Only patients who received epidural shots of the contaminated steroids are at risk for meningitis.

Fungal meningitis is rare and not contagious. It causes inflammation of the protective membranes around the brain and spinal cord.

Several patients with the type of fungal meningitis associated with the outbreak have had strokes induced by the illness, according to the CDC.

The New England Compounding Center has voluntarily recalled all of its products in circulation that were distributed from its Framingham, Mass. facility. The CDC believes potentially contaminated injections were given as early as May 21.

As of Monday, most of the patients that had received an epidural injection from the four Michigan facilities had been notified, state health officials said.

After the New England Compounding Center recalled the steroid linked to the meningitis outbreak Oct. 3, the CDC launched its investigation across the country.

Michigan officials confirmed the first six cases of fungal meningitis in the state Friday. That number increased to 20 cases by Sunday afternoon.

Amy Biolchini covers Washtenaw County, health and environmental issues for AnnArbor.com. Reach her at (734) 623-2552, amybiolchini@annarbor.com or on Twitter.