Cotton fever is a term used to describe a sudden, acute illness characterized by a high fever and flu-like symptoms that occurs shortly after an intravenous injection. The reaction is a rapid, temporary response by the body’s immune system to contaminants introduced during this process. While the symptoms can be intense and alarming, the illness is typically self-limiting and resolves within a day.
The Role of Endotoxins and Bacterial Contamination
The cause of the illness is the presence of bacterial byproducts on the cotton material. Cotton plants in their natural environment are colonized by various microorganisms, including the Gram-negative bacterium Pantoea agglomerans, which was previously known as Enterobacter agglomerans. This organism is a common environmental bacterium found abundantly on cotton fibers and dust globally.
When cotton is used as a filter, especially if it is damp or reused, it provides a favorable environment for this bacteria to thrive. The pyrogenic, or fever-inducing, agent is a component of the bacterial cell wall known as endotoxin, specifically a lipopolysaccharide (LPS). Endotoxin is released into the liquid solution when the bacteria die or when the drug solution is heated during preparation.
The immune system recognizes these LPS molecules as foreign threats, triggering a massive, systemic inflammatory response. This reaction is the body’s attempt to neutralize the perceived infection, even though the primary cause is a cellular component rather than a living, replicating organism.
The inflammatory cascade involves the activation of immune cells, such as macrophages, which release chemical messengers called cytokines. These cytokines then travel to the brain, where they interact with the hypothalamus to reset the body’s internal thermostat to a higher temperature. This rapid elevation in body temperature is the fever, accompanied by the intense chills and rigors as the body attempts to generate heat to meet the new, higher set point.
This process is distinct from a true bacterial infection where viable, living bacteria multiply in the bloodstream, a condition known as bacteremia or sepsis. In cotton fever, the reaction is solely to the endotoxin, which is why the symptoms are so rapid in onset and typically resolve quickly once the body processes the toxin. The amount of endotoxin introduced directly correlates to the intensity of the patient’s symptoms.
Identifying the Acute Symptoms
The hallmark of cotton fever is the extremely rapid onset of symptoms, typically beginning within 15 to 30 minutes following the injection. The initial sensation is often a sudden, intense feeling of coldness, leading to severe chills and uncontrollable shivering, known as rigors.
This is quickly followed by a significant elevation in body temperature, with the fever often peaking in the range of 101.3°F to 104.5°F (38.5°C to 40.3°C). Patients also experience extreme muscle aches, or myalgia, and joint pain. Other common symptoms include headache, nausea, and sometimes vomiting.
The systemic inflammatory response can also cause the heart rate to increase, a condition called tachycardia, and may lead to excessive sweating. The symptoms usually peak within a few hours and then gradually subside, with most cases resolving completely within 6 to 12 hours, though they can occasionally last up to 24 hours.
Immediate Management and Prognosis
Management focuses on supportive care while the body clears the endotoxin. The initial steps involve resting completely and maintaining adequate hydration, often with water or electrolyte-rich fluids, to counteract fluid loss from fever and sweating.
Over-the-counter fever-reducing medications, such as acetaminophen or ibuprofen, can be used to manage the fever and alleviate the severe muscle and body aches. There are no known long-term effects associated with the condition itself.
It is important to understand that the symptoms of cotton fever closely mimic those of a much more serious condition: sepsis, a life-threatening systemic infection. If symptoms persist beyond 12 to 24 hours, worsen significantly, or include signs like confusion, difficulty breathing, or persistent low blood pressure, immediate medical attention is necessary. These prolonged or severe symptoms may indicate a true bloodstream infection or another serious complication that requires urgent medical diagnosis and treatment, which may include intravenous fluids and antibiotics.