Maryland is working with federal health officials and authorities in Pennsylvania and Delaware to investigate a cluster of infections at a cosmetic surgery center in Baltimore County, Maryland officials said Tuesday.

One woman died after contracting a severe bacterial infection following liposuction at the Monarch Med Spa in Timonium, Md. Two others who also had liposuction at the center also contracted infections and were hospitalized. The facility has been closed since Sept. 18.

No additional Maryland cases have been reported. Delaware health officials have confirmed one infection by a resident at one of the Monarch locations in Pennsylvania. Maryland officials are working with experts at the Centers for Disease Control and Prevention to do additional tests as part of the investigation.

Cosmetic surgery centers in Maryland are not licensed by the state. The state is seeking public comment on potential approaches to oversight of these facilities.

The women in Maryland contracted invasive streptococcal infections known as Group A Streptococcus. Most GAS infections are relatively mild illnesses, such as strep throat. But occasionally these bacteria can cause severe and even life-threatening diseases when they infect parts of the body where bacteria usually are not found, such as blood, muscle or the lungs. These infections are known as “invasive GAS disease.” About 10 to 15 percent of patients with the disease die of it.

One of the most severe, but least common, forms of the disease is necrotizing fasciitis, sometimes described as “flesh-eating bacteria” disease. Health officials have declined to give specifics about the Maryland patients’ infections.

Over the past five years, an average of 189 cases of invasive GAS were reported annually in Maryland. About 9,000 to 11,500 cases of invasive GAS disease occur each year in the United States, resulting in 1,000 to 1,800 deaths annually.