What is Cotton Fever? Causes, Symptoms, and Treatment

Cotton fever is a condition that primarily affects individuals who inject drugs. While not widely discussed outside of harm reduction and medical communities, it can cause significant distress and discomfort. Although generally not life-threatening, it mimics severe infections and can be concerning for those who experience it.

Understanding the causes, symptoms, treatment, and prevention methods for cotton fever is essential, especially for individuals at risk and healthcare professionals who provide care for people with substance use disorders.

What Causes Cotton Fever?

Cotton fever is typically caused by the introduction of bacteria or bacterial endotoxins into the bloodstream during intravenous (IV) drug use. The most widely accepted explanation is that certain bacteria, particularly the Enterobacter species, are present in cotton fibers used to filter substances before injection. These bacteria release endotoxins that, when introduced into the bloodstream, trigger an immune response. This response leads to fever, chills, and other flu-like symptoms associated with cotton fever.

Another possible cause of cotton fever is an immune system overreaction to non-bacterial contaminants in reused cotton filters. Some individuals may experience an inflammatory response to residual chemicals or tiny cotton fibers that enter the bloodstream, resulting in similar symptoms. However, research supports the bacterial endotoxin theory as the primary cause of cotton fever.

How Do People Get Cotton Fever?

Cotton fever occurs when individuals use cotton as a filtration medium while preparing injectable drugs. Cotton is often used to remove impurities, but it can also harbor bacteria if it has been previously used, stored improperly, or exposed to contaminants. Here are some common ways people get cotton fever:

• Reusing old cotton filters: Individuals may reuse cotton filters to extract residual drug substances, unknowingly introducing bacteria into their bloodstream.
• Using non-sterile cotton sources: Some individuals may use cotton from non-medical sources, such as cigarette filters or cotton balls, which may not be sterile.
• Poor injection practices: Injecting with unclean hands, using non-sterile equipment, or failing to clean the injection site can increase the likelihood of bacterial contamination.
• Using shared drug preparation equipment: Sharing cotton, needles, or other drug paraphernalia with others increases the risk of infection, including cotton fever and other serious diseases (such as HIV and hepatitis C).

Understanding these risk factors can help individuals adopt harm reduction strategies to minimize the risk of cotton fever and other injection-related complications.

Common Symptoms of Cotton Fever

Cotton fever symptoms usually begin within 20 minutes to a few hours after injection. The symptoms resemble those of a bacterial infection and can be quite severe. Common symptoms include:

• High fever: Individuals may experience a sudden and intense fever, sometimes exceeding 101°F (38.5°C).
• Chills and shivering: A person may feel extremely cold and shake uncontrollably due to the fever.
• Severe body aches and joint pain: Muscle and joint pain can be intense, similar to flu symptoms.
• Headache: A pounding or persistent headache is common.
• Rapid heart rate (tachycardia): The heart may beat faster than normal due to the immune response.
• Shortness of breath: Some individuals report difficulty breathing or feeling out of breath.
• Nausea and vomiting: The immune response may trigger gastrointestinal discomfort and nausea.
• Fatigue and malaise: People often feel drained and extremely weak for several hours.

These symptoms can be distressing, but they typically resolve on their own within a day or so. However, persistent or worsening symptoms may indicate a more severe infection (such as sepsis) which requires immediate medical attention.

How Long Does Cotton Fever Last?

Cotton fever is usually self-limiting, meaning it resolves without medical intervention in most cases. Symptoms generally last between 6 to 24 hours, with most individuals recovering within 12 hours. However, factors such as overall health, immune response, and repeated exposure to contaminants can influence how long symptoms persist.

While the fever and chills may subside within a day, some residual fatigue, muscle aches, and general discomfort may linger for an additional day or two. If symptoms extend beyond 24 hours, it may be a sign of a more serious infection (such as sepsis or endocarditis) and medical attention should be sought immediately.

Is Cotton Fever Dangerous?

While cotton fever itself is not typically life-threatening, it can be extremely uncomfortable and distressing. Because its symptoms closely mimic those of serious infections such as bacteremia (bacteria in the blood), endocarditis (heart valve infection), and sepsis (a life-threatening systemic infection), it is important not to dismiss the symptoms entirely.

Complications may arise if cotton fever persists. This may include:

• Dehydration: Persistent fever and vomiting can lead to dehydration if fluid intake is not maintained.
• Misdiagnosis or delayed treatment: Since cotton fever symptoms resemble serious infections, individuals may delay seeking treatment for a potentially dangerous condition.
• Repeated exposure to bacteria: Those who frequently experience cotton fever may be at greater risk of developing chronic infections or immune system complications.

Individuals who frequently experience cotton fever should consider addressing their injection practices and exploring harm reduction strategies or treatment for substance use disorders.

Diagnosing Cotton Fever: What to Expect

There is no specific test for cotton fever, but doctors may conduct several tests to rule out serious infections. A diagnosis is typically based on:

• Medical history and symptom review: A healthcare provider will ask about recent drug use and symptom onset.
• Blood tests: These may be ordered to check for signs of bacterial infection or inflammation.
• Urinalysis and imaging tests: If symptoms are severe or prolonged, additional tests may be conducted to rule out complications (such as kidney or lung infections).

If symptoms improve within 12 to 24 hours without intervention, cotton fever is the likely cause. However, persistent symptoms warrant further medical evaluation.

Treatment Options for Cotton Fever

Cotton fever is usually treated symptomatically, meaning the goal is to alleviate symptoms rather than target a specific pathogen. Common treatment approaches include:

• Over-the-counter fever reducers: Acetaminophen (Tylenol) or ibuprofen (Advil) can help reduce fever and relieve body aches.
• Fluids and hydration: Drinking plenty of water or electrolyte-replenishing beverages can help prevent dehydration.
• Rest: The body needs time to recover, so resting in a comfortable environment is essential.

In rare cases where symptoms persist or complications arise, antibiotics may be prescribed if a secondary bacterial infection is suspected.

Home Remedies and Self-Care for Cotton Fever?

Individuals experiencing mild cases of cotton fever can take the following steps to manage symptoms at home:

• Take a lukewarm bath to reduce fever and soothe muscle aches
• Use cold compresses on the forehead or neck to help lower body temperature
• Stay hydrated by drinking clear fluids and electrolyte solutions.
• Get plenty of rest and avoid strenuous activities

Preventing Cotton Fever: Harm Reduction Strategies

To reduce the risk of cotton fever, individuals who inject drugs should adopt harm reduction strategies, such as:

• Using new, sterile cotton filters for every injection.
• Avoiding the reuse of cotton or sharing injection equipment.
• Practicing good hygiene, such as washing hands and cleaning the injection site before use.

When to Seek Medical Attention for Cotton Fever?

It is crucial to seek medical attention if you suspect you have cotton fever, especially if symptoms worsen or fail to improve. While mild cases may resolve on their own within several hours, certain warning signs indicate the need for urgent medical care.

Seek immediate medical attention if:

• Symptoms persist beyond 24 hours: Cotton fever symptoms typically subside within a day. If a person continues to experience a high fever, chills, or body aches beyond this period, it may indicate a more serious infection.
• You experience severe chest pain, difficulty breathing, or confusion: These symptoms could suggest a more severe systemic infection such as sepsis, which requires emergency medical treatment.
• Signs of a more serious infection: If you notice redness, swelling, or warmth at the injection site, these may be indications of an abscess, endocarditis, or another serious complication. This also includes symptoms such as developing a rash, persistent vomiting, or an unusually high fever,
• You have a history of weakened immunity: Individuals with underlying health conditions (such as HIV, hepatitis, or diabetes) may be at higher risk for complications and should not delay seeking medical attention.
• Your fever is extremely high: If your body temperature rises above 103°F (39.4°C), it could be a sign of a more dangerous infection requiring professional treatment.

Ignoring these warning signs can lead to life-threatening complications. If in doubt, seek medical care promptly to ensure proper diagnosis and treatment.

Getting Help for Substance Use and Related Health Risks at Agape Detox

Agape Detox provides comprehensive treatment for individuals struggling with substance use disorders. Our programs include:

• Medically supervised detox to manage withdrawal symptoms safely
• Evidence-based therapies to address underlying addiction
• Aftercare planning to support long-term recovery

If you or a loved one is struggling with substance use, contact Agape Detox today to learn more about our compassionate and effective treatment programs.