Cotton fever resulting in Enterobacter asburiae endocarditis

Francis, Munib; Chin, Justin; Lomiguen, Christine M; Glaser, Allison

doi:10.1016/j.idcr.2019.e00688

Cited by 6 publications

(6 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…P. agglomerans is also associated with “cotton fever,” a benign febrile response to endotoxin production following introduction of cotton to the bloodstream [ 3 ]. This can occur when cotton is used to filter substances prior to intravenous injection.…”

Section: Introductionmentioning

confidence: 99%

Successful Treatment of Pantoea agglomerans Bacteremia Using Oral Antibiotics

Penner

Romans

Tah

et al. 2022

Case Reports in Infectious Diseases

View full text Add to dashboard Cite

A 30-year-old female with a medical history of gastrointestinal reflux and intravenous methamphetamine use was admitted to the hospital with complaints of fever and chills. Pantoae agglomerans was isolated in one out of two blood cultures. Although information was limited about the duration and efficacy of oral antibiotics to treat this type of infection, the patient recovered with oral antibiotic treatment following a short course of intravenous antibiotics.

show abstract

Section: Introductionmentioning

confidence: 99%

Successful Treatment of Pantoea agglomerans Bacteremia Using Oral Antibiotics

Penner

Romans

Tah

et al. 2022

Case Reports in Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…The retained particles are often stored and re-injected after extraction [ 19 ]. The intravenous administration of cotton contaminants causes a sepsis-like syndrome with transient, acute-onset fever, and leukocytosis [ 2 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Studies related to pneumoconiosis from cotton exposure were excluded. As a result, we found only 13 case reports, one case series, and a single cross-sectional study (Table 4 ) [ 2 - 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…The theory endorsed by most evidence hypothesizes that a gram-negative bacilli Enterobacter agglomerans , a prevalent colonizer in cotton, releases an endotoxin resulting in the sequelae of symptoms [ 12 ]. Contrarily, bacteremia with E. agglomerans is not present in affected patients but has been reported in rare cases [ 2 , 6 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition to fever, other symptoms include rigors, headache, nausea, vomiting, and myalgia. This may be mistaken for a sepsis-like clinical presentation, resulting in a redundant diagnostic workup, overuse of hospital resources, and prescription of unnecessary treatments [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. We aim to raise more awareness about this disease in the healthcare community by presenting a case of cotton fever in a patient with recent intravenous (IV) methamphetamine use.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Just a Bad Case of Cotton Fever: A Case Report and Literature Review

Geedipally¹,

Karki²,

Shirke³

et al. 2022

Cureus

View full text Add to dashboard Cite

Fever is one of the most commonly seen presentations in intravenous drug abusers. "Cotton Fever" is a benign condition, unrecognized among the medical community. It is characterized by a systemic inflammatory response syndrome occurring within minutes of intravenous (IV) drug use. Patients present to tertiary-level care settings with fever, chills, gastrointestinal symptoms, shortness of breath, and chest pain. We present the case of a 46-year-old Caucasian male who presented with lightheadedness, chest pain, and gastrointestinal symptoms after using IV methamphetamine. On physical examination, he was disoriented, tachycardic, and had a fever of 102.8⁰F. He did not have any Osler nodes, Janeway lesions, or splinter hemorrhages. Diagnostics showed leukopenia with neutropenia, lactic acidosis, and elevated creatine kinase. Blood cultures did not grow any organisms. The patient was admitted to the intensive care unit and treated with IV fluids and broad-spectrum antibiotics. His condition improved rapidly and the patient left against medical advice (AMA).The toxic appearance of patients presenting with cotton fever often causes panic among clinicians, resulting in an extensive diagnostic workup, exhaustion of hospital resources, and overprescription of antibiotics. Due to the lack of knowledge about this condition among healthcare practitioners and the tendency of these patients to leave AMA, an appropriate management strategy remains unrecognized. Our case aims to bring awareness about this condition to help guide patient-directed care, reduce the use of healthcare resources, and establish prevention strategies in the community.

show abstract

A case report of Enterobacter cloacae endocarditis in a patient with a history of cotton fever

Tarabanis

Zhang

Grossman

et al. 2022

European Heart Journal - Case Reports

View full text Add to dashboard Cite

Background Cotton fever is a self-limited, febrile syndrome occurring after the injection of trace amounts of drugs, in particular heroin, extracted from reused cotton filters. It is characterized by non-specific findings, such as fever, tachycardia and leucocytosis. The leading pathophysiologic explanation suggests it is the result of direct inoculation of the bloodstream with endotoxins from Gram-negative bacilli of the genus Enterobacter, known to colonize all parts of the cotton plant. Only one prior case report has suggested cotton fever as a potential risk factor of infective endocarditis. Case summary We describe a case of a 57-year-old patient with a history of intravenous heroin use complicated by self-reported episodes of cotton fever. His presentation was notable for Enterobacter cloacae infective endocarditis with bilateral septic pulmonary emboli. Transthoracic echocardiography findings included new tricuspid regurgitation and two mobile echodensities on the right atrial implantable cardioverter defibrillator (ICD) lead. Despite broad antibiotic coverage and extraction of the ICD leads, the patient passed away from septic shock. Discussion The present case report is only the second published report of endocarditis in a patient with a history of cotton fever. In both cases, bacteria of the Enterobacter genus were isolated in patients’ blood cultures. This evidence supports the endotoxin theory as the leading pathophysiologic explanation for cotton fever and suggests cotton fever as a risk factor for Gram-negative infective endocarditis. In the inpatient setting it informs proper antibiotic coverage, whereas in the outpatient setting it supports harm reduction interventions in the form of sterile cotton balls.

show abstract

Cotton fever resulting in Enterobacter asburiae endocarditis

Abstract: HighlightsCotton fever is a self-limited phenomenon that occurs in IV drug users.Colloquially known to IV drug users, cotton shooting can cause cotton fever.Enterobacter asburiae endocarditis is a rare complication of cotton fever.

Cited by 6 publications

References 14 publications

Successful Treatment of Pantoea agglomerans Bacteremia Using Oral Antibiotics

Successful Treatment of Pantoea agglomerans Bacteremia Using Oral Antibiotics

Just a Bad Case of Cotton Fever: A Case Report and Literature Review

A case report of Enterobacter cloacae endocarditis in a patient with a history of cotton fever

Contact Info

Product

Resources

About