(CNN) -- A grand jury in Ohio has indicted suspected serial stabber Elias Abuelazam on charges of attempted murder and assault in an attack on a church janitor in Toledo.
Abuelazam is suspected of stabbing 18 victims in Michigan, Virginia and Ohio. Five people were killed in the attacks, which took place from May through August.
The indictment in Ohio on Friday relates to an August 7 attack in which a 59-year-old man who was taking a smoke break from his job as a church custodian was seriously wounded, police said.
"A suspect approached him asking for directions and started stabbing him for no apparent reason," Toledo Police Sgt. Bill Wauford said after the attack.
The man suffered a punctured lung and was hospitalized for four weeks, including 15 days in an induced coma, the Toledo Blade newspaper reported.
Abuelazam was arrested August 11 at Atlanta, Georgia's Hartsfield-Jackson International Airport while trying to board a flight to Israel, where his mother lives, police said.
In addition to the Ohio stabbing, Abuelazam is believed responsible for three attacks in Leesburg, Virginia, and the stabbing deaths of five people and the wounding of nine others in Flint, Michigan, authorities have said.
He is being held in Michigan on charges of murder and assault with intent to commit murder.
In Session's Chris Perry contributed to this report.