More than 100 Ukiah Valley Medical Center patients have been alerted that they received doses of a pain medication that has been recalled because it has led to a deadly outbreak of fungal meningitis in seven states.

No cases have been reported in California, where four hospitals have used the batch of recalled steroid medication, preservative-free methylprednisolone acetate. But the drug was administered through epidural injection to 120 patients at the Ukiah center's Outpatient Pavilion, authorities said.

Of those, 79 had received the medication in July and are likely out of what federal disease experts say is the 30-day danger-zone period, Ukiah Valley Medical Center spokesman Nick Bejarano said.

But 41 patients of the center's pain specialist, Dr. Michael Young, still fall within that danger period, Bejarano said.

All 120 patients were telephoned, a letter was sent out Thursday, and follow-up calls also will be made, Bejarano said.

The drug was not administered in Sonoma County, said the county's public health officer, Lynn Silver Chalfin.

The injections Young gave his patients were similar to those given to patients at a Tennessee medical clinic who developed meningitis-like symptoms, Heather Van Housen, Ukiah Valley Medical Center's patient care executive, told the patients in a letter.

Anyone experiencing "unusual symptoms" within one to four weeks should seek medical care, she said.

"Although we don't anticipate any reactions to the injections, there are some symptoms you should be aware of," she said in the letter. "A stiffening of the neck or a different kind of headache than you've previously experienced, fever, stiffness, sensitivity to light or stroke-like symptoms."

The drug often was used to treat back pain and pain and swelling associated with arthritis and other joint diseases.

Investigators have focused on a steroid custom-made by a specialty pharmacy, New England Compounding Center, in Framingham, Mass. Health inspectors found fungus in at least one sealed vial of the steroid at the company's facility this week.

The pharmacy recalled 17,676 single-dose vials of the steroid. Shipments went to clinics in 23 states.

The tally of deaths from the rare form of meningitis was at five on Friday, but a seventh state, Michigan, was added to the list of those affected, with four cases, said the Centers for Disease Control and Prevention.

Tennessee's cases now total 29; Virginia, six; Indiana, 3; two each in Maryland and Florida and one in North Carolina.

The Centers for Disease Control and Prevention said the other doses in California were received by Cypress Surgery Center in Visalia, Encino Outpatient Surgical Center, and Universal Pain Management in Palmdale.

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

The type of fungal meningitis involved is not contagious like the more common forms.

This report includes information from Associated Press.

You can reach Staff Writer Jeremy Hay at 521-5212 or or on Twitter @jeremyhay.