INDIANAPOLIS (AP) – Indiana has another case of fungal meningitis linked to injections of a recalled back pain medication.

State Department of Health spokesman Ken Severson said Friday that Indiana now has 53 cases of the illness that’s killed four people in the state.

State officials say clinics in six Indiana cities received tainted steroids traced to the New England Compounding Center. The Framingham, Mass., company is linked to a multistate outbreak that’s sickened 438 people in 19 states and caused 32 deaths.

The Indiana clinics that received tainted medication are located in South Bend, Elkhart, Columbus, Evansville, Fort Wayne and Terre Haute.