An 87-year-old Washtenaw County woman who died Dec. 30 is the 14th Michigan resident to die in a nationwide outbreak of fungal meningitis associated with injectable steroid shots, state officials confirmed Thursday.

The woman is the third Washtenaw County resident to die in the outbreak, which has been linked to steroids manufactured by a Massachusetts company and contaminated with fungus. Three of the 14 Michigan residents who died received their injections at Indiana facilities.

Nationwide, 656 people have been sickened in the outbreak, including 39 deaths across 19 states, according to the most recent data available from the Centers for Disease Control and Prevention.

The state of Massachusetts is working to revoke the license of the New England Compounding Center, which authorities claimed violated the terms of its license by mass producing medications and distributing them across the country.

Three Michigan facilities received shipments of the contaminated steroids, which were used to treat back and joint pain. The closest facility to Ann Arbor is Michigan Pain Specialists in Brighton, which has said more than 800 of its patients could be at risk in the outbreak.

St. Joseph Mercy Hospital in Superior Township has become one of the leading treatment facilities in the fungal meningitis outbreak in Michigan, and has reported 173 of the state’s 233 confirmed cases to date.

Eight patients who received shots of the contaminated steroid and sought treatment at St. Joseph Mercy Ann Arbor have died from the illness, said Laura Blodgett, spokeswoman for the hospital.

The most recent death of a fungal meningitis patient occurred Dec. 30 at the hospital, which officials confirmed Thursday, Blodgett said. She could not confirm that the patient who died is the 87-year-old Washtenaw County resident.

Currently, there are 18 fungal meningitis patients at St. Joseph Mercy Ann Arbor, Blodgett said. Several dozen patients who were initially notified of their involvement in the outbreak are now actively seeking treatment at the hospital, Blodgett said.

The University of Michigan Health System has been tracking 16 patients to see if they will be developing any symptoms in connection with the outbreak, hospital officials said.

Meningitis is an inflammation of the lining of the brain and spinal cord. Unlike the viral or bacterial forms of the illness, fungal meningitis is not contagious.

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