ST. PAUL, Minn. — Four patients of Minnesota pain clinics that used a steroid linked to a fungal meningitis outbreak showed symptoms of the disease and were told to be tested, the group's CEO said Friday.

Marsha Thiel, the chief executive officer of Medical Advanced Pain Specialists, said the clinics are working with health authorities to track down about 700 patients who were given injections of the steroid for back or neck pain. MAPS has several locations in the Minneapolis-St. Paul area and owns the Minnesota Surgery Center clinics, where the now-recalled product from a Massachusetts specialty pharmacy was also used.

"There's a massive effort to contact all the patients," Thiel said.

She added, "If there's any question at all, they're being directed to go to their physician."

The steroid has been linked to 35 cases of a rare type of fungal meningitis in six states. Five people have died.

Thiel said the Minnesota clinics received the steroid on July 3 and stopped using it Sept. 26. She said the clinics got two lots of the product, and used the first on 100 patients and the second on approximately 600.

"This just happened to be our supplier and we happened to get the lots that are in question," Thiel said.

The meningitis in question is not transmissible from person to person. The Minnesota Health Department said symptoms of infection typically show up within one to four weeks of an injection, but could start sooner or develop later.