What Is Cotton Fever? | Causes, Symptoms & Treatment for IV Drug Users

Cotton fever is a condition often experienced by individuals who inject drugs, named after the cotton filters used during the injection process. These filters can sometimes introduce bacteria or other contaminants into the bloodstream, leading to a range of uncomfortable and potentially serious symptoms. Understanding the causes, symptoms, and treatments of cotton fever is crucial for those at risk and their caregivers, as early intervention can significantly improve outcomes.

What Is Cotton Fever?

Cotton fever is an illness that occurs when bacteria-contaminated cotton fibers are introduced into the bloodstream during intravenous drug use. This condition often results in symptoms like high fever, rapid heart rate, and general weakness. Although most cases resolve within 12 hours, the discomfort and potential complications highlight the dangers of using non-sterile materials for drug injection. In severe cases, untreated infections can lead to more serious health issues, emphasizing the need for medical attention and safer injection practices. 

The bacteria commonly responsible for cotton fever are typically found on cotton plants and can survive on cotton filters. When these bacteria enter the bloodstream, they trigger an immune response, leading to the symptoms of fever and malaise. While cotton fever is usually self-limiting, repeated episodes can cause significant distress and potentially lead to more serious infections if not addressed properly. This underscores the importance of using sterile equipment and seeking medical help if symptoms persist or worsen.

What Are Intravenous (IV) Drugs?

Intravenous (IV) drugs are substances that are injected directly into the veins using a syringe. This method of drug administration delivers the substance quickly into the bloodstream, resulting in rapid onset of effects. Commonly abused IV drugs include heroin, methamphetamine, and various prescription opioids. While this route can enhance the drug’s impact, it also significantly increases the risk of infections, overdoses, and other serious health complications.

Administering a substance through this method leads to the fastest effects, but it has the potential to introduce toxins directly into the bloodstream that other routes of administration don’t carry. Drugs like heroin and cocaine, which are often injected, can have an unknown purity level, potentially exposing individuals to foreign compounds that could be hazardous to their health or life.

The recreational use of IV drugs carries extreme risks, such as overdose and relapse, and can become deadly. Thus, having an IV substance use disorder is considered to be one of the most serious forms of illicit substance abuse.

What Are The Potential Complications of Using IV Drugs?

Using IV drugs can result in numerous potential complications and risks. One common complication is cotton fever, which, although temporary, can be uncomfortable. However, there are far more serious consequences that can arise from IV drug use. One significant risk is the considerable reduction in life expectancy, with the average lifespan being shortened by over 18 years for those who use heroin intravenously. 

Additionally, the use of contaminated needles increases the chances of contracting bloodborne diseases, such as HIV or hepatitis, which can have severe and potentially fatal implications. The negative health effects of IV substance use are substantial and should not be underestimated. Nonetheless, it is important to remember that it is never too late to seek help and start on the path to recovery. 

What Causes Cotton Fever?

Cotton fever is primarily caused by using contaminated cotton in drug injections. When bacteria from the cotton or the drug solution enter the bloodstream, it can lead to an infection, causing the symptoms associated with cotton fever. This condition is more common among individuals who inject drugs using non-sterile techniques or equipment.

The exact cause of cotton fever is still under investigation, but several theories exist:

  • Immune Response to Cotton: The immune system reacts to foreign particles in the bloodstream, and cotton is detected as a foreign substance. This immune response can lead to a fever.
  • Pharmacologic Reaction: Cotton particles may react with chemicals in the drugs, causing a chemical reaction that triggers fever and other symptoms.
  • Bacterial Contamination (Endotoxin Theory): Certain bacteria, such as Enterobacter agglomerans (E. agglomerans), can survive on cotton fibers. When these bacteria are injected into the bloodstream, they may release endotoxins that trigger an immune response, resulting in fever.
  • Contaminated Cotton: Using cotton filters that contain bacteria or other pathogens can directly introduce these harmful elements into the bloodstream.
  • Non-Sterile Injection Practices: Sharing needles or using unclean equipment can increase the risk of introducing bacteria and cotton fibers into the bloodstream.

Regardless of the exact cause, cotton fever is a serious condition requiring appropriate attention. It highlights the dangers associated with intravenous drug use and the need for sterile injection practices to minimize risks.

What Are the Symptoms of Cotton Fever?

Like other conditions, there are different symptoms that may manifest at different times. Because this is a condition that has not been studied extensively, there is not a hard-and-fast list of symptoms. Importantly, not everyone is going to develop all of the symptoms below, and some symptoms are more serious than others.

Some of the most common symptoms of cotton fever include:

  • A high fever
  • Abdominal pain, aches, and cramps
  • A severe, pounding headache
  • Shakes and chill that may persist for hours
  • Intermittent and recurrent chest pain
  • An elevated heart rate (tachycardia) and respiratory rate, along with other altered vital signs

Typically, cotton fever is diagnosed using a combination of a history and physical exam. If someone uses IV drugs and develops the symptoms above shortly thereafter, they can be diagnosed with cotton fever. Even though there are other conditions that may demonstrate a lot of the symptoms listed above, there are not a lot of conditions that cause the same symptoms immediately after using IV drugs.

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Diagnosis Cotton Fever

Diagnosing cotton fever typically involves a medical evaluation based on symptoms (mentioned above) and the patient’s history of drug use. Medical professionals may perform blood tests to check for bacterial infections and rule out other potential causes of the symptoms. A prompt and accurate diagnosis is crucial for effective treatment.

How Is Cotton Fever Treated?

If someone develops the symptoms above, several treatment options are available. This condition is generally self-limited, meaning that it will generally resolve itself without any extensive intervention.

As a result, cotton fever treatment usually focuses on treating the symptoms above. Making the person more comfortable as the symptoms dissipate can maximize the chances of fully recovering.

Generally, the condition goes away in about 12 hours. Antibiotics are usually unnecessary to address the fever, and an infection might not even be present. Keep in mind that the symptoms are a manifestation of the immune response, regardless of whether bacteria are present in the bloodstream.

Some of the most popular treatment options include:

  • Over-the-counter anti-inflammatory medications, which can be used to address the fever
  • Cool rags and cloth, which can be used to make someone more comfortable as the fever goes away
  • Over-the-counter medications, which can be used to treat headaches
  • Water and electrolytes, which can be used to keep someone hydrated as a combat fever
  • Allowing the body to recover by getting plenty of rest

Everyone needs to be monitored as cotton fever runs its course. Remember that this condition manifests shortly after using IV drugs, and other complications might develop that could warrant intervention.

When to Seek Medical Help

It is not unusual for someone to develop cotton fever after using IV drugs. IV drug use is a severe form of substance abuse that has to be addressed. Even though cotton fever is generally self-limiting, other complications might develop that could be more severe. That is why it is important to generate a comprehensive plan, which includes helping someone get sober and stay sober.

If you or someone you know exhibits symptoms of cotton fever after injecting drugs, it’s important to seek medical attention immediately. Symptoms such as high fever, rapid heart rate, chills, and severe discomfort are clear indicators that medical help is needed. Early treatment can prevent complications and ensure a quicker recovery.

Delaying treatment can lead to more serious health issues, including severe infections or sepsis, which can be life-threatening. It’s crucial not to ignore symptoms, even if they initially seem mild. Seeking prompt medical attention can significantly reduce the risk of long-term damage and improve overall outcomes.

In addition to addressing the immediate symptoms, medical professionals can provide guidance on safer injection practices to prevent future occurrences. They can also offer resources and support for those struggling with substance use, helping to address the root cause of the problem and promoting healthier, safer behaviors.

Mental Health Treatment is Necessary

Drug injection can cause a variety of medical complications, but it is also important to address the underlying reason why someone might be using IV drugs. That means mental health treatment that focuses on the treatment of substance abuse and addiction.

It is important for anyone using IV drugs to start by going through the detox process in the presence of medical professionals. The withdrawal symptoms should be treated with supportive care, which can make it easier for someone to remove all traces of drugs from the bloodstream.

Then, individuals who use IV drugs need to work with treatment professionals who can help them develop coping skills to prevent future relapse. For example, it might be prudent to attend group therapy sessions where individuals can learn from the stories of others. They might generate ideas for how they can change their behavioral patterns to prevent IV drug use in the future.

Seeking Treatment for Cotton Fever

Understanding and addressing cotton fever is important for those who inject drugs. Recognizing the symptoms, seeking timely treatment, and adopting preventative measures can help manage and reduce the risk of this condition. If you or a loved one is experiencing symptoms of cotton fever or struggling with drug use, contact our team at Riverside Recovery of Tampa today to learn more about our comprehensive treatment programs