NASHVILLE, Tenn. (AP) — Tennessee health officials are once again alerting patients who received tainted steroid shots after finding that some have infections at the injection site that could lead to fungal meningitis.

Tennessee Health Commissioner John Dreyzehner said Thursday that since Thanksgiving, officials have identified 22 new cases of these localized infections and one case of meningitis without such an infection.

Dreyzehner said the infections are under the skin, so patients do not see them. Symptoms include increased pain at the injection site, numbness and possible loss of bowel and bladder control.

Tennessee has identified 75 of these infections. In all, 107 Tennessee patients have developed either meningitis or local infections or both. Nationally, at least 560 people have been sickened and 36 have died in the outbreak. Thirteen deaths were in Tennessee.