How do you get Cotton fever?

[Freebird1327]

I use a small piece of cotton ball to filter my H before i inject, and one night i started feeling very sick and ran a fever. it lasted all night and seemed to pass by the next morning. it felt horrible. was this cotton fever? and is there another way or material i can use to filter my H?

 

[Swimmingdancer]

"Cotton fever" can be due to a number of things. It's basically the body's immune reaction to something it doesn't like being injected, presumably due to bacteria, debris or other contamination. The name comes from the fact that a kind of bacteria that can live on cotton cause this type of reaction, but there are other things that can cause it as well (as people who don't use cotton can get it too).

One way to tell whether or not you likely have cotton fever is that it comes on suddenly not very long after the injection (usually within half an hour I think) and it is normally better by the next day. Whereas a normal infection would come on gradually, would probably be accompanied by some signs at the injection site, and would not resolve that quickly on its own.

The best kind of filter is a micron filter, also called a wheel filter or syringe filter. You can buy them online but depending on where you live you may be able to get them at a needle exchange. The second best option would be a Sterifilt filter (or similar), which is also designed specially for injecting drugs and can be found at some needle exchanges or online. The third best option in my opinion would be a clean cigarette filter made for hand-rolling cigarettes, but people are divided about whether cigarette filters or cotton is better.

 

[RedRum OG]

^ basically sums it up

Tl;dr you let a wet cotton sit, bacteria grows, you shoot up bacteria, bad feels are imminent

If you're going to milk cottons and shoot, make sure you let the cotton sit on an open, clean, area to dry as quickly as possible. Never store wet cottons in baggies or anything that will keep them wet unless you plan on milking them right away

It doesn't really sound like you had the fever though, you used a fresh cotton right? Straight off the clean q-tip or something. Maybe you just were dope sick or had a regular old sickness

 

[Jean-Paul]

ugh dirty washes
i came across an old spoon the other day with an old cotton in it and it felt really good to just be able throw it away.
even though the junk voice inside me said don't you want to save that cotton in case
no. i didn't.

 

[thesameoldfears]

I've only ever gotten cotton fever when I used all my old cottons and mashed them up and did a cotton shot. This is stupid and if you insist on doing so, make sure to let the cottons dry in an open area or freeze them. But again....not reccommended!

When I got cotton fever I could tell right after my shot something was up. The headache came on first, then the chills - I wa uncontrollably shaking for hours. Next was a HIGH fever (mine got past 105 degrees F). It was not a subtle thing. It sounds like you might have had a more mild version, like some cut or something got into your shot.

You should look into micron/wheel filters. They definitely lessen the risk of cotton fever significantly.

 

[Crashing]

Cotton fever is just a bacterial infection. There is a bacteria in cotton and when you rip cotton apart to use a small piece, or maybe inject a tiny fiber that slips into the rig, a high concentration of the bacteria goes into your body and produces the sickness. It is rare but can happen with brand new cottons. Make sure you're drawing up against the grain so the fibers aren't sticking up towards the needle, or ball it up tightly first (clean fingers of course).

I like cigarette filters better, but don't tear them. You have to cut off a small piece with scissors and draw against the grain. You also wanna apply a little pressure on the cotton when drawing, but not too much or too little.

 

[Swimmingdancer]

Cotton fever is just a bacterial infection. There is a bacteria in cotton and when you rip cotton apart to use a small piece, or maybe inject a tiny fiber that slips into the rig, a high concentration of the bacteria goes into your body and produces the sickness. It is rare but can happen with brand new cottons. Make sure you're drawing up against the grain so the fibers aren't sticking up towards the needle, or ball it up tightly first (clean fingers of course).

I like cigarette filters better, but don't tear them. You have to cut off a small piece with scissors and draw against the grain. You also wanna apply a little pressure on the cotton when drawing, but not too much or too little.

"Cotton fever" is not the same as an infection. Cotton fever is a street term for an immune reaction - normally one of the symptoms is fever - that occurs soon after the injection of a drug. White blood cell count will be raised and things like abdominal pain, headache and generally feeling sick are common. Researchers have theorized that cotton fever is normally due either to a hypersensitivity to materials found in cotton or other contaminants, or sometimes a reaction to an endotoxin produced by the Enterobacter agglomerans bacteria that frequently colonizes cotton plants. When it is due to bacteria it is not because there is a high concentration of bacteria in your blood, it is actually a low concentration of bacteria, it is just that the endotoxin it produces causes a dramatic immune response (the bacteria itself is considered to generally have a low level of pathogenicity). It is not like a normal infection. In general, however, people with cotton fever do not have any infection (blood cultures usually turn up no bacteria), they have a self-limiting immune response and do not usually require medical treatment.

Obviously if one's symptoms do not improve within 24 hrs, or did not come on rapidly and occur soon after the injection, they should seek medical treatment as it may not actually be cotton fever in that case. Or if the cotton fever is extremely severe it's best to seek medical treatment if in doubt.

Also to some of the above posters you can definitely get cotton fever without reusing old cottons.

 

[tentram]

There are two distinct types of 'cotton fever' as swimmindancer has elaborated on quite extensively.

They are a) particulate matter infection and b) bacterial contamination.

Both of which can be eliminated at about a 95%+ rate by using a .22 micron filter as a minmum size throughout the IV prepsration.

 

[Crashing]

I thought the particulate matter was the original theory but then it was found out that the particle getting into the bloodstream actually just results in a high amount of bacteria to seep in which causes the fever. I read that on HeroinHelper but maybe you have a more reputable or up to date source. They make it seem like the particulate matter theory was a misunderstanding.

 

[Swimmingdancer]

What I am saying is that from what I've read and heard on the subject there are likely to be multiple causes for cotton fever and also - my main point - that it is not considered a true infection per se but an acute sepsis-mimicking condition, a sort of disproportionate immune response. There is at least one case report where "cotton fever" has been attributed to an endotoxin produced by Enterobacter agglomerans as I mentioned above, but there are case reports where there was no evidence that this was the case (negative blood tests etc). After that one case was deemed to be caused by the specific endotoxin the report theorized that this could be the cause in all cases and that some hospitals must have just missed the endotoxin because endotoxin might be harder to detect than the levels of bacteria needed to cause sepsis (infection). That is the reference Heroin Helper used to draw his own conclusions from. I wasn't saying it's caused simply by injecting a physical strand of cotton fiber (I am inclined to agree with Heroin Helper's assumption that it's possible that injecting a piece of cotton might just be a delivery system for the bacteria endotoxin. Regardless, injecting fibers or particles is unwise due to risk of embolism etc).

I think the problems are that since cotton fever usually resolves on its own and is experienced by IV drug users who rarely want to seek medical help if not necessary for obvious reasons, and that if/when they do it's very possible that the cases are not being reported and not much testing is being done. Doctors might just send someone home with some antibiotics. So the phenomenon has been poorly studied and there aren't a lot of good sources on the topic.

However, people have had this reaction from injecting drugs that were not filtered with cotton, which is why I think it's likely that it can happen due to things other than the endotoxin of the bacteria that can live on cotton. So my broad statement is that it is due to contamination of some kind (which we can assume because injecting the same drugs under sterile conditions in a medical setting has never been reported to cause this kind of reaction to my knowledge). But it's possible that all the cases could be due to an endotoxin of some type (maybe more kinds than just the one from Enterobacter agglomerans).

I was just trying to clarify that it's not correct to say "cotton fever is just a bacterial infection". Saying it's likely due to a mild case of endotoxemia or due to injecting lipopolysaccharides would be more correct if we are going to go on the assumption that that is the sole cause. You wouldn't even necessarily have to inject any whole bacteria and the bacteria would not have to be alive. This is different from a bacterial infection.

(EDIT: Sorry this is so long! and getting out of BDD territory! Just trying to be clear)

 

[Crashing]

This might be a stretch, but maybe certain batches of dope have a small amount of detergent-cut, like boric acid, which kill the bacteria on the cotton which releases a bunch of the endotoxin which is then part of the solution.

 

[Swimmingdancer]

^Who knows, could be possible, but something like that wouldn't be necessary as the bacteria can apparently shed the endotoxin spontaneously, and it also wouldn't explain the cases of people getting it from injecting pills, injecting marijuana (IV marijuana can cause a more severe reaction though), cotton workers inhaling cotton dust, etc.

 

[Crashing]

Well, it could if they were using public tap water which is full of detergents also.. Inhaling cotton dust seems a little easier to explain.

But yeah, city water + cotton may shed more endotoxins than when using sterile water.

 

[Swimmingdancer]

^Not sure. But I should have noted this bacteria can be present on plants, wood, fruit, feces, etc, not just cotton. It's very hard to find published case reports that don't involve cotton as I don't know how to search for them. But people on this forum have said they got it when not using cotton and even when using sterile water. But cotton fever is not really that common and I'm sure it's more common if you reuse old cottons (just as a regular bacterial infection would be). The case reports I've seen all state that it is a benign self-limiting syndrome aside from the IV marijuana and IV mushroom ones and the one in a pregnant woman.

 

[BlueHues]

I always though it was particulate matter, but I've read that it could be bacteria or even a disease that cotton plants get that causes it....

That being said, I've had cotton fever 5-6 times in 15+ years of IV drug use, and not once was it because of mashing up old cottons and doing a "rinse"(which Ive done hundreds of times), not to say that that kind of behavior isn't risky, it's definitely is, but that's not necessarily what causes cotton fever....

For me, it was completely random....I used fresh cottons(not sterile) and used clean water like I normally do, and 20-45 minutes later I started getting shaky and sweating and it got worse from there.....

violent shaking and sweating are really the main thing to look for with cotton fever, not feeling a little shitty and feverish....Once you've had it once, it's un-mistakable! The shaking is scary! It causes my teeth to chatter uncontrollably! You feel like you're gonna die...

One time, everybody I knew that used this particular heroin from this particular dealer got cotton fever, so it was definitely from the heroin not the cotton in that case...

Twice, my girlfriend and I got it at the same time, using different cottons(from the same source), syringes, mixers etc....so, IMO it can be caused by a few different things.

Endocarditis, which is an infection of the of the heart, typically the valves AFAIK, is much more of a reason to be vigilant about using clean injection equipment, IMO/IME..It can be bacterial or fungal.....Bacterial endocarditis is much more common.....It takes up to six weeks for symptoms to appear and usually presents as just a fever...It requires weeks of hospitalization with IV anti-biotics to treat and sometimes even surgery....I know someone who died from fungal endocarditis from Iving using puddle water, they just couldnt wait to get regular water and they didn't care at the time...


I personally have never known anyone who's had health complications from using new syringes everytime, clean cotton filters and a clean receptacle to mix their drugs....although, it can be easier said than done if you're using IV drugs every day...Inevitably you'll find yourself in situations that make it difficult to take every precaution....

Beyond anything else, having your own clean syringes, filter and mixer with you always should be your top priority IMO!....In other words, share nothing!

Cotton fever sucks, thats for sure, but it's not nearly as bad as some of the other consequences of IV drug use.