She came into the emergency department with a fever and pain in her head and abdomen. Track marks lined her arms from injecting heroin. Following a series of tests, doctors diagnosed her as having a collection of pus within her spine. She was given antibiotics and transferred to another hospital for possible surgical intervention. But no surgery was needed. And, a few days later, all the patient’s symptoms resolved. Someone in the hospital overheard the patient remark to a friend, “I think I had a bad case of cotton fever.” What is cotton fever?
What is Cotton Fever?
Cotton is used with many injectable drugs of abuse to filter out any impurities, including additives and bacteria. Once a drug has been prepared for injection, cotton is placed in the solution as a kind of strainer. Users then stick a syringe into the cotton ball, draw up the solution, and inject it.
IV drug users who work with cotton filters can develop cotton fever shortly after injection of a drug like heroin. Cotton fever is a self-limiting condition associated with sudden onset fever and what is known as “leukocytosis” or an increase in white blood cells in the bloodstream. White blood cells are part of the body’s defense against bacteria, viruses, and other invaders, and an increase in white blood cells often signals some type of inflammation somewhere in the body. Cotton fever in many cases, however, is not associated with a bacterial infection.
What Causes Cotton Fever?
The simple answer is, we don’t really know. Very little research has been done on this phenomenon. Nonetheless, three hypotheses exist.
One theory is that the components of the cotton used during IV drug injection may cause fever. Interestingly, cotton has been used to induce fevers in animals being used to study the effectiveness of antipyretics (i.e. medications that work to reduce fever). A second theory is that those who develop cotton fever may have antibodies to cotton circulating in their bloodstream. The issue with this theory is that researchers have not been able to prove that these antibodies exist. The third and most plausible theory is that cotton fever is a response to bacteria often found in cotton known as Enterobacter agglomerans. It should be noted, however, that only the researchers studying one individual IV drug user were able to find Enterobacter agglomerans in both the user’s bloodstream and the ball of cotton he used to shoot heroin.
What are the Signs and Symptoms of Cotton Fever?
Maybe you know someone who is an IV drug user or perhaps you yourself are dealing with addiction. What are the signs and symptoms of cotton fever that you should be aware of so that you can get help?
As stated above, most individuals suffering from cotton fever will simply run a temperature. Other symptoms associated with cotton fever include difficulty breathing, headache, abdominal pain, nausea and vomiting.
Here’s the main thing you need to remember. If you recently injected yourself with an illicit substance and you have symptoms of fever, headache, or pain, you need to get to the hospital because cotton fever is the least of your worries.
When a patient who is an IV drug user presents to the hospital with a fever, the top diagnosis that healthcare providers think of for the patient is something called
“infective endocarditis.” Infective endocarditis is an infection of the heart that can lead to heart attack, heart failure, and stroke. Without treatment, infective endocarditis “is almost inevitably fatal.”
Clearly, infective endocarditis is a far more serious condition than cotton fever. For this reason, any IV drug user having a fever needs to be examined by a healthcare provider to make sure that he or she does not have infective endocarditis or any other life-threatening infection.
Getting Help
It bears repeating that cotton fever is a benign and self-limiting condition. If you or someone you know is injecting heroin or other illicit substances, you are at risk for more serious medical conditions than cotton fever:
- As mentioned above, IV drug users are at higher risk for developing infective endocarditis, a condition which can damage the heart, brain, and other major organs and lead to death.
- Most individuals think that IV drug users can contract diseases like hepatitis C only through the sharing of needles. In fact, sharing cookers and/or cotton can also spread this life-threatening infection. The same goes for the spread of HIV.
IV drug abuse is dangerous and can lead to various life-threatening conditions. If you or someone you know is struggling with addiction, please know you don’t have to fight alone. Your road to recovery is a phone call away.
