Cotton fever

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Cotton fever is a condition that is often associated with intravenous drug use, specifically with the use of cotton to filter drugs like heroin.[1] It has been established that the condition derives from an endotoxin released by the bacteria Pantoea agglomerans which colonizes cotton plants, not from the cotton itself.[2] A condition very similar to cotton fever was described in the early 1940s among cotton-farm workers. The term cotton fever was coined in 1975 after the syndrome was recognized in intravenous drug users. However, some sources have attributed the symptoms of cotton fever with sepsis occasioned by unsafe and unsanitary drug injection practices. This is borne out by the fact that cotton fever symptoms have occurred among all intravenous drug users, with various filter materials utilized.

Signs and symptoms[edit]

Signs and symptoms of cotton fever usually appear within 22 minutes after injection, but may come on gradually over the course of a few hours.[medical citation needed] In addition to fever, they may include headaches, malaise, chills, nausea, extreme joint and muscle pain, a sudden onset of dull, sharp, piercing or burning back and kidney pain, tremors, anxiety, shortness of breath, and tachycardia. The fever itself usually reaches 38.5–40.3 °C (101.3–104.5 °F) during the full onset.[citation needed] Extreme chills and uncontrollable shivering are common. The symptoms of cotton fever resemble those of sepsis and patients can be initially misdiagnosed upon admission to a hospital.


Cotton fever rarely requires medical treatment but is sometimes warranted if the high fever does not break within a few hours of the onset. It will usually resolve itself within a day. Soaking in a warm bath along with a fever reducer can alleviate symptoms. Extreme cases (particularly severe or long-lasting) can be treated with antibiotics.

See also[edit]


  1. ^ Harrison D. W.; Walls R. M. (1990). "'Cotton Fever': a benign febrile syndrome in intravenous drug abusers". Journal of Emergency Medicine: 135–139. 
  2. ^ Ferguson R.; Feeney C.; Chirurgi V. A. (1993). "Enterobacter agglomerans--associated with cotton fever". Archives of Internal Medicine: 2381–2382. 
  • "Cotton fever": A benign febrile syndrome in intravenous drug abusers; The Journal of Emergency Medicine, Volume 8, Issue 2, Pages 135-139; David W. Harrison, Ron M. Walls


  • Shragg Thomas. "Cotton fever" in narcotic addicts;". Journal of the American College of Emergency Physicians. 7 (7): 279–280. doi:10.1016/s0361-1124(78)80339-6. 


  • Shooting up: The interface of microbial infections and drug abuse; 2011, Journal of Medical Microbiology; Kaushik K.S., Kapila K., Praharaj A.K.


External links[edit]



  1. ^ Harrison, DW; Walls, RM (1990). ""Cotton fever": a benign febrile syndrome in intravenous drug abusers.". The Journal of emergency medicine. 8 (2): 135–9. doi:10.1016/0736-4679(90)90222-h. PMID 2362114. 
  2. ^ a b Shragg, Thomas (July 1978). ""Cotton fever" in narcotic addicts". Journal of the American College of Emergency Physicians. 7 (7): 279–280. doi:10.1016/S0361-1124(78)80339-6. 
  3. ^ Kaushik, K. S.; Kapila, K.; Praharaj, A. K. (9 March 2011). "Shooting up: the interface of microbial infections and drug abuse". Journal of Medical Microbiology. 60 (4): 408–422. doi:10.1099/jmm.0.027540-0. 
  4. ^ Harrison, David W.; Walls, Ron M. (March 1990). ""Cotton fever": A benign febrile syndrome in intravenous drug abusers". The Journal of Emergency Medicine. 8 (2): 135–139. doi:10.1016/0736-4679(90)90222-H.