Cotton Fever: What is it? And What to do if you get it.

Cotton fever is a term that may be unfamiliar to many, but for individuals who use intravenous drugs (drugs injected directly into the bloodstream), it’s a well-known and dreaded condition. Often characterized by a sudden onset of fever, chills, body aches, and flu-like symptoms, cotton fever can be alarming. While the symptoms can be intense, they usually resolve on their own within 24 hours.

Despite its name, cotton fever isn’t caused by cotton itself but is linked to the use of cotton filters when preparing injectable drugs. Understanding what cotton fever is, its causes, symptoms, and treatment options can help individuals manage this condition effectively and avoid unnecessary panic. In this post, we’ll break down what cotton fever is, how it happens, and the best ways to treat it.

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What is Cotton Fever and how do you get it?

Cotton fever is an illness that occurs primarily in individuals who use intravenous drugs, particularly heroin or other opioids. It is believed to result from bacterial contamination of the cotton used to filter the drug into the needle. The most commonly accepted theory is that the fever and flu-like symptoms are triggered by Enterobacter agglomerans (now known as Pantoea agglomerans), a type of bacteria commonly found in cotton plants. When drug users filter their substances through cotton before injection, trace amounts of bacteria or endotoxins may enter the bloodstream, leading to an immune system response that mimics an infection.

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What causes Cotton Fever

There are several theories about what specifically causes cotton fever, but the most widely accepted explanation involves bacterial contamination and endotoxins.

1. Bacteria from Cotton
   
   • The most common bacterial culprit is Enterobacter agglomerans (now known as Pantoea agglomerans), a microorganism commonly found in cotton plants.
2. Endotoxins from Bacteria
   
   • Even if the bacteria themselves are not alive, their cell walls can contain endotoxins—harmful compounds that provoke an inflammatory reaction in the body. 
3. Reusing Cotton Filters
   
   • Some individuals may reuse cotton filters multiple times, believing they can extract leftover drug residue. However, reusing cotton increases the likelihood of bacterial contamination, making cotton fever more likely.
4. Contaminated Water or Drug Preparation Equipment
   
   • In some cases, cotton fever may not be caused by the cotton itself but rather by using non-sterile water, syringes, or preparation surfaces. Any of these can introduce bacteria or toxins into the bloodstream, leading to similar symptoms.

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What are the symptoms of cotton fever?

Symptoms of cotton fever typically appear within 20-30 minutes after injection and can include:

• Rapid onset of fever and chills
• Intense body aches and muscle pain
• Headache
• Nausea
• Elevated heart rate
• Sweating
• Fatigue and general discomfort

While cotton fever is generally not life-threatening, the symptoms can have a rapid onset while being severe and frightening. Understanding its causes can help individuals recognize the risks and take precautions to avoid experiencing it.

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How to prevent Cotton Fever

While cotton fever is not life-threatening, it can be extremely uncomfortable and frightening. The best way to avoid experiencing it is through harm reduction practices that minimize the risk of bacterial contamination. Here are the most effective ways to prevent cotton fever:

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Use Sterile, Single-Use Filters

• Avoid using cotton balls, cigarette filters, or Q-tips, as they may contain bacteria.
• If possible, use medical-grade micron filters designed to remove impurities without introducing contaminants.

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Do Not Reuse Cotton Filters

• Many people reuse cotton filters to extract leftover drug residue, but this increases the risk of bacterial contamination.
• Always use a fresh, sterile filter for each injection.

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Use Clean, Sterile Injection Equipment

• Always use a new syringe and needle if possible.
• If reusing, ensure all equipment is properly cleaned and sterilized.
• Avoid sharing needles, which can introduce bacteria and increase the risk of infections.

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Use Sterile Water for Mixing

• Avoid using tap water, bottled water, or other non-sterile sources, as they may contain bacteria.
• If sterile water is not available, boil water and let it cool before use.

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Keep Hands and Injection Sites Clean

• Wash your hands with soap and water before preparing an injection.
• Use an alcohol swab to clean both the injection site and any equipment before use.

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Store Cotton and Equipment Properly

• If you must store cotton filters, keep them dry and in a clean, sealed container.
• Avoid using old, damp, or moldy cotton, as it can harbor bacteria.

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Recognize Early Signs of Infection

• If you develop fever, chills, or flu-like symptoms, monitor your condition closely.
• Seek medical attention if symptoms last longer than 24 hours, worsen, or include chest pain, confusion, or an infected injection site.

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How Long Does Cotton Fever Last?

Cotton fever typically lasts between 6 to 24 hours, with the most intense symptoms occurring within the first few hours after injection. In most cases, the body naturally fights off the reaction, and symptoms gradually subside within a day. However, some individuals may experience lingering fatigue or mild discomfort for up to 48 hours.

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The exact duration varies based on factors such as:

• The individual’s immune response
• The amount and type of bacteria or endotoxins introduced
• Overall health and hydration levels

If symptoms persist beyond 24 hours or worsen, it’s important to seek medical attention to rule out more serious conditions like sepsis, endocarditis, or an abscess, which require urgent treatment.

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What Should You Expect if You Get Cotton Fever?

When cotton fever sets in, symptoms appear rapidly—often within 20-30 minutes of injection. The condition closely mimics a severe flu or bacterial infection, with common symptoms including:

• Sudden high fever (often 101°F or higher)
• Intense chills and uncontrollable shivering
• Severe muscle and body aches
• Sweating and hot flashes
• Rapid heartbeat (tachycardia)
• Nausea and vomiting
• Extreme fatigue and weakness

These symptoms can be alarming, but they usually peak within a few hours and then gradually improve. It is rare for cotton fever to lead to serious complications on its own, but if symptoms persist beyond a day, are unusually severe, or include confusion, chest pain, or difficulty breathing, medical help is necessary.

Most people find that resting, staying hydrated, and managing fever symptoms help ease discomfort while the body recovers. In the next section, we’ll discuss the best ways to treat cotton fever and alleviate symptoms as quickly as possible.

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Are there home remedies for Cotton Fever?

Yes, there are several home remedies that can help ease the symptoms of cotton fever while your body naturally recovers. Since cotton fever is typically not life-threatening and resolves on its own within 6 to 24 hours, the focus of treatment is on symptom management and hydration. Here are some ways to relieve discomfort at home:

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Stay Hydrated

Fever and sweating can quickly lead to dehydration, which can worsen symptoms. Drink plenty of water, electrolyte drinks (like Gatorade or Pedialyte), or herbal teas to replenish lost fluids and help your body recover faster. Avoid alcohol and caffeine, as they can contribute to dehydration.

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Rest as Much as Possible

Cotton fever can leave you feeling exhausted and weak. Lie down in a comfortable, quiet space and allow your body to rest. Overexerting yourself can prolong recovery time and make symptoms feel worse.

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Use Over-the-Counter Medications (if available and safe for you)

• Acetaminophen (Tylenol): Helps reduce fever and body aches.
• Ibuprofen (Advil, Motrin): Reduces fever, inflammation, and pain.
• Aspirin: Can help with fever, but should be avoided if you have stomach issues or take blood thinners.
  *Avoid taking too many medications at once, and do not mix substances that could interact negatively with any drugs in your system.

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Apply Warm or Cool Compresses

If you're feeling chilled, use a warm blanket or heating pad to regulate your body temperature. If your fever is high and causing discomfort, a cool, damp washcloth on your forehead, neck, or wrists can provide relief.

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Take a Lukewarm Shower or Bath

A lukewarm bath (not too hot or too cold) can help bring down your fever and relax tense muscles. Avoid extreme temperatures, as sudden cooling or heating can cause more discomfort.

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Eat Light, Nutritious Foods

If you're feeling nauseous, try eating small portions of bland foods like toast, crackers, soup, or rice. Avoid heavy, greasy, or spicy foods that may worsen nausea.

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Monitor Your Symptoms

Although cotton fever is usually mild and self-limiting, pay attention to any warning signs of a more serious infection, such as:

• Fever lasting more than 24 hours
• Chest pain or difficulty breathing
• Confusion or disorientation
• Skin infections or abscesses at the injection site
• Persistent vomiting or dehydration symptoms (dizziness, dark urine, dry mouth)

If you experience any of these symptoms, seek medical attention immediately, as they could indicate sepsis or another life-threatening condition.

‍Seek Medical Help if..

• Your fever persists for more than 24 hours
• You experience severe chest pain, difficulty breathing, or confusion
• You notice redness, swelling, or pus at an injection site (signs of an infection)
• Symptoms are getting worse instead of improving

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Cotton Fever Medical Treatments

While cotton fever is generally not life-threatening and often resolves on its own within 6 to 24 hours, there are times when medical treatment may be necessary—especially if symptoms persist, worsen, or mimic more serious infections like sepsis or endocarditis. If you seek medical care, doctors will focus on treating fever, dehydration, and ruling out life-threatening conditions.

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IV Fluids for Hydration

One of the most common hospital treatments for cotton fever is intravenous (IV) fluids. Since fever and sweating can lead to dehydration, medical professionals may administer saline or electrolyte solutions to help rehydrate your body quickly and stabilize your condition.

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Fever and Pain Management

Doctors may give acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) to reduce fever and alleviate muscle aches and chills. If symptoms are severe, they may use stronger fever-reducing medications.

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Antibiotics (Only If a Serious Infection Is Suspected)

Since cotton fever is not typically caused by an active bacterial infection, antibiotics are not always necessary. However, if a doctor suspects a systemic infection, sepsis, or an abscess at an injection site, they may prescribe IV or oral antibiotics like:

• Ceftriaxone
• Vancomycin
• Ampicillin or other broad-spectrum antibiotics

Antibiotics are only used if lab tests (such as blood cultures) indicate a serious bacterial infection. Otherwise, they are not prescribed for typical cotton fever cases.

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Blood Tests and Medical Evaluation

Because cotton fever symptoms resemble more dangerous conditions like sepsis, endocarditis, or bloodstream infections, doctors may run diagnostic tests, including:

• Complete Blood Count (CBC): Checks for elevated white blood cells, which can indicate an infection.
• Blood Cultures: Identifies bacterial infections in the bloodstream.
• Urinalysis: Checks for signs of infection or dehydration.
• Echocardiogram (if endocarditis is suspected): Evaluates heart function to rule out serious complications from IV drug use.

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Hospitalization (Only in Severe Cases)

In rare cases where symptoms persist beyond 24-48 hours, or if a person shows signs of sepsis, heart infection (endocarditis), or abscess formation, hospitalization may be necessary for IV antibiotics, monitoring, and further treatment.

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What to do if you think you have Cotton Fever

If you believe you have cotton fever, stay calm—while the symptoms can be intense, they are usually temporary. The best course of action is to rest, stay hydrated, and manage your fever with over-the-counter medication like acetaminophen or ibuprofen. Most cases resolve within 6 to 24 hours without medical intervention.

However, if your symptoms last longer than 24 hours, worsen, or include severe chest pain, difficulty breathing, confusion, or signs of an infected injection site, seek immediate medical attention to rule out serious conditions like sepsis or endocarditis.

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Conclusion

Cotton fever is an unpleasant but typically short-lived condition that occurs when bacteria or endotoxins enter the bloodstream during injection. While it mimics the symptoms of a severe flu, it is not usually dangerous and often resolves on its own.

By practicing harm reduction strategies—such as using sterile filters, clean injection equipment, and proper hygiene—you can significantly reduce the risk of cotton fever. If symptoms do occur, focus on hydration, rest, and fever management while monitoring for any signs of complications.

For those who regularly experience cotton fever or other injection-related health issues, seeking medical guidance, harm reduction resources, or support for substance use can be beneficial in improving overall well-being.