Infections and Drug Use: Cotton Fever & Infective Endocarditis

Cotton Fever

Cotton Fever is an illness that happens to some people after they inject drugs. It’s caused when bacteria, from reused cottons/filters or needles, is injected into the body. 

Symptoms of the illness include fever, headache, nausea, chills, and muscle and joint pain. There is no cure, treatment, or vaccine for cotton fever itself, however the disease is generally not serious, and the symptoms can be treated with fever reducer (like aspirin) as appropriate.

It's caused when bacteria is injected into the body.

Cotton fever cannot be passed from person to person. The only way to be infected is by using unsterile syringes or cottons/filters. Individuals at risk for cotton fever can protect themselves by using sterile syringes and cottons/filters every time. Learn more about preventing Cotton Fever and other Skin and Soft Tissue Infections (SSTIs) from the National Harm Reduction Coalition.

Infective Endocarditis

Infective endocarditis (IE) is a disease that attacks the heart. When someone is infected with endocarditis, clumps of bacteria form in the heart, and can then break loose and travel to different parts of the body. This can lead to many varied symptoms, including fatigue, aching joints and muscles, swelling in the feet and legs, and blood in the urine, among others.

IE generally occurs when bacteria or fungi enter the bloodstream and spread to the heart. 

Exposure to this type of bacteria can be caused by certain dental procedures or oral activity, infection, catheters, needles used for tattoos or piercings, and injection drug use.

Most individuals infected with endocarditis do not know right away that they are infected, but if left untreated, endocarditis can quickly lead to life-threatening complications. It is important for those at risk for endocarditis to seek medical attention if they start noticing unexplained symptoms associated with the disease. Treatment for infective endocarditis includes antibiotics and sometimes surgery.

IE cannot be passed from person to person – it is caused by unsterile needles or injection paraphernalia, which includes syringes, cookers, cottons, and water. Individuals who inject drugs have more than 6 times the odds of infective endocarditis than those who do not inject, and these odds jump to 4 times for those who inject at least daily.

For those at risk of infective endocarditis, take these steps to prevent infection:

  • Use sterile needles and injection paraphernalia every time. These can often be obtained from a local syringe services program or harm reduction center.
  • Avoid injecting drugs. The bacteria that cause IE are much less likely to cause harm if they do not enter the bloodstream directly. This means that drug use behaviors that don’t involve injection, such as smoking or snorting, are a much lower risk for IE.

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