At least five people are confirmed dead and several injured in a massive pile-up of 40 to 50 cars and trucks on Missouri’s Interstate 57 highway.

       The casualties could rise as rescue crews work to assess the damage and injuries, with a mobile morgue set up near the Mississippi County crash site.

       Mississippi County EMS director Zach Bolden said conditions were foggy when emergency crews responded to the pile-up of between 40 to 50 vehicles, according to 23WIFR.

       Drone footage of the scene showed multiple large semi-trailers and small cars strewn across the highway in flames and smoke.

       Early indications point to one of the drivers slamming on the breaks and causing a chain reaction to follow, Mr Bolden said.

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       He added that emergency responders were among the injured taken to local hospitals. Several of the injured were treated on the scene. Coroner Terry Parker confirmed at least five deaths.

       The collision occurred about 12 noon local at the 10- to 12-mile markers in both north and southbound directions.

       The I-57 remained closed from the Missouri-Illinois border at the Mississippi River to the I-55 in Sikeston, according to the Missouri Department of Transportation.