Cotton fever

A condition 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.

Signs and symptoms of cotton fever usually appear within 20 minutes after injection, but may come on gradually over the course of a few hours. 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. 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 may bear resemblance to other bodily infections such as the flu; a culture would be required to determine whether a particular patient has been infected by the specific bacteria (Pantoea agglomerans) that causes true cotton fever. Confusion continues to exist as outdated or inaccurate definitions of the condition, including its causes, remain widespread, especially among intravenous drug users, who are likely to self-diagnose based on local common knowledge.

Contrary to popular belief, cotton fever does not result directly from the introduction of cotton fibers or other particulate matter into the bloodstream.[3] This misconception may arise from the increased infection rate as particles can introduce bacteria directly into the bloodstream; cotton fever is simply a specific one of them. Cotton fever, or more specifically its symptoms, can also occur from injecting old blood back into the bloodstream. Though doing so doesn’t result in true cotton fever caused by enterobacter agglomerans, it results in presentation of cotton fever’s symptoms; fever, severe chills, myalgia, spasmodic muscles especially those of the neck and back, tachycardia, profuse hidrosis, shortness of breath, lethargy, and fatigue. I/V injection of old blood cells can introduce myriad bacterium and/or microbes into one’s bloodstream as old blood, I.e. that left behind in a used hypodermic, acts just as a Petri dish for culturing such micro-organisms. A blood smear and/or culture must be performed, however, to determine the specific sickness-causing organism.

Injection of old blood intravenously can cause much more severe, even potentially lethal ailments such as endocarditis, or myocarditis, than true cotton fever, albeit the initial presentation of symptoms can be identical to those of cotton fever. [4]

Cotton fever has specific symptoms that differentiate it from other ailments: fever, chills, and shortness of breath. In Europe, cotton fever is commonly called "the shakes"--a reference to another common symptom of cotton fever. Those with this ailment often experience violent shaking or shivering.

These symptoms normally occur immediately following an injection, but there are reports of lags up to an hour in length.

Under most circumstances, cotton fever is quite benign. Although it is possible for it to turn into something much more serious like a pneumonia. Normally however, the symptoms of cotton fever disappear after a few hours or less, e.g. symptoms usually occur immediately following an injection, but there are reports of lags up to an hour in length.

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.

• Intravenous marijuana syndrome

• 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.
• 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.

• Heroin Helper "Cotton Fever" Article for IV Drug Users