"Cotton Fever" in Intravenous Drug Users

HARM REDUCTION November-December 1997

"Cotton Fever" is a fever that is sometimes experienced by intravenous drug users. Questions about this condition were posted recently on the Internet. The fever is believed to be associated with an organism called enterobacter agglomerans that colonize cotton and cotton plants. Cotton is used by many heroin users to filter the drug as it is drawn into the syringe from the "cooker." According to a report in the Journal of Emergency Medicine, "Trivial illness accounts for 16% to 26% of such fevers." However, serious illness such as pneumonia must be considered in fevered addicts (D.W. Harrison and R.M. Walls, "`Cotton Fever': a benign febrile syndrome in intravenous drug abusers," Journal of Emergency Medicine, March-April 1990, pp. 135-139; R. Ferguson, C. Feeney, and V.A. Chirurgi, "Enterobacter agglomerans -- associated with cotton fever," Archives of Internal Medicine, October 25, 1993, pp. 2381-2382).