OSMC Surgery Center CEO Don Hammond said two of the Elkhart clinic's patients have been hospitalized with the rare illness.

Indiana State Department of Health spokesman Ken Severson said three Indiana patients have contracted the illness after receiving spinal injections, revising an earlier report that had downgraded the number from three to two. He said a case thought to involve an out-of-state patient actually involved an Indiana resident.

Six Indiana health facilities received batches of the medication that was recently recalled by a Massachusetts manufacturer. The other clinics are in Evansville, Fort Wayne, South Bend, Terre Haute and Columbus.

Hammond said about 400 people had received the tainted injections at the clinic, which is about 15 miles east of South Bend.

So far, 35 people in six states — Tennessee, Virginia, Maryland, Florida, North Carolina and Indiana — have contracted fungal meningitis, and five of them have died, according to the Centers for Disease Control and Prevention. All had received steroid shots for back pain, a highly common treatment.

Officials at the Indiana clinics said Friday they were scrambling to call and email patients who received the tainted injections. Some of those contacted reported possible symptoms and were sent to local hospitals or doctor's offices.

Other patients who heard news reports about the outbreak were calling the clinics to find out if they were at risk.

"Our phone is ringing off the hook this morning. Patients are calling. Of course they're concerned," said Paulette Fry, practice manager at Wellspring Pain Solutions in Columbus, about 40 miles south of Indianapolis. She said the clinic was sending out a letter to about 300 patients who received spinal injections with the drug between July 1 and Sept. 28.

Dr. John Bolinger, vice president of medical affairs and chief medical officer at Union Hospital in Terre Haute, said 90 patients had been treated with the drug. All but five had been contacted by Friday afternoon, and the hospital was following up with letters. He said the injections were administered at the Wabash Valley Surgery Center between July 15 and Sept. 26.

"We removed all that medication immediately" when the hospital received a voluntary recall notice from the state health department on Sept. 26, and sent the drug to the Centers for Disease Control and Prevention for further testing.

Bolinger said the hospital is "trying to lessen the panic as much as we can" by telling people the illness is not contagious and that only the 90 patients who received the injection are at risk.

Hammond said most of the people who phoned the Elkhart clinic Thursday wanted to make sure they could continue getting back pain treatment.

Julie Lockard, marketing director at the South Bend Clinic, said three clinic employees were contacting about 50 people who had received the injections, but none had reported any symptoms.

St. Mary's Health spokeswoman Laura Forbes said the Evansville hospital had contacted or left messages for 560 patients at its Surgicare Cross Pointe facility who received injections of the steroid. She said some patients had reported symptoms, but none has been admitted.

A spokeswoman for a clinic in Fort Wayne said some of its patients had received the injections, but they were not believed to be at risk because they were injected in joints, not the spine.

Massachusetts health officials said that the pharmacy involved, the New England Compounding Center of Framingham, Mass., has recalled three lots — a total of 17,676 single-dose vials — of methylprednisolone acetate.

Meningitis is an inflammation of the lining of the brain and spinal cord. Symptoms include severe headache, nausea, dizziness and fever.