Cotton fever is an acute, febrile illness occurring shortly after the intravenous injection of a substance. It is a syndrome associated with using cotton or other fibrous materials as makeshift filters during the preparation of injectable drugs. The condition is characterized by a sudden onset of intense flu-like symptoms. This reaction is a systemic inflammatory response triggered by contaminants, not the drug itself, inadvertently introduced into the bloodstream.
The Source of Contamination
The primary cause of cotton fever is not the cotton fibers themselves, but rather the biological contaminants residing on the plant material or the surrounding preparation environment. The most significant culprits are bacterial products known as endotoxins, which are fragments of the outer membrane of certain gram-negative bacteria. A common source is the bacterium Pantoea agglomerans, naturally found in cotton plants.
When preparing the substance for injection, the cotton filter, surrounding water, and paraphernalia can harbor these bacteria and their endotoxins. Importantly, these endotoxins are heat-stable, meaning they are not destroyed by the heating process sometimes used to dissolve the injectable substance. This heat resistance allows the toxins to pass through the filter and into the prepared solution, ready to be injected directly into the bloodstream.
Once introduced, these foreign substances are rapidly recognized by the immune system, triggering an immediate and widespread inflammatory reaction, characterized by the rapid release of chemical messengers called cytokines. This overwhelming immune response to the toxin, rather than a live bacterial infection, causes the dramatic and acute symptoms of cotton fever. This mechanism explains the rapid onset and equally rapid resolution of the syndrome, distinguishing it from a true, slower-developing infection.
Identifying the Acute Symptoms
The hallmark of cotton fever is the rapid onset of symptoms, typically occurring within minutes to an hour following the injection. This presentation differentiates it from most bacterial infections, which usually take days to manifest. The condition is defined by a sudden and severe spike in body temperature, with a high fever that can reach 101.3 to 104.5 °F.
Accompanying the high fever are profound chills and shivering, known as rigors. Individuals also commonly experience intense muscle aches (myalgia) and joint pain, similar to a severe flu. Other common complaints include a headache, malaise, and sometimes nausea or vomiting. The symptoms can be distressing due to their severity and sudden appearance, often leading to anxiety and a rapid heart rate.
Treatment and Expected Recovery
Anyone experiencing symptoms of cotton fever should seek medical evaluation immediately. Though cotton fever is typically a self-limiting condition, its symptoms closely mimic those of more serious, life-threatening conditions like sepsis or endocarditis, which require urgent treatment. Medical professionals will focus on ruling out these dangerous systemic infections through observation and diagnostic testing.
Treatment is primarily supportive, aimed at managing the distressing symptoms while the body clears the endotoxins. This care often involves ensuring the individual is well-hydrated, sometimes with intravenous fluids, and administering over-the-counter fever reducers and pain relievers. Acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used to reduce the fever and alleviate muscle aches.
The prognosis for cotton fever is generally very good. Symptoms typically begin to subside within six to twelve hours, with most individuals fully recovering within 24 hours. Antibiotics are usually unnecessary because the syndrome is a reaction to a toxin rather than a multiplying infection. However, if symptoms persist beyond a day or if a secondary bacterial infection is suspected, doctors may prescribe antibiotics as a precaution.