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Enterobacter agglomerans--associated cotton fever

R Ferguson1, C Feeney, V A Chirurgi

  • 1Department of Medicine, Highland General Hospital, Oakland, Calif.

Archives of Internal Medicine
|October 25, 1993
PubMed
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Cotton fever, a febrile illness in intravenous drug users, is likely caused by Enterobacter agglomerans. This bacterium was found in a patient's blood and the cotton used to filter heroin, confirming its role.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Toxicology

Background:

  • Cotton fever is a recognized syndrome among intravenous drug users, characterized by fever and elevated white blood cell counts.
  • The etiology of cotton fever has remained largely unknown, despite its association with the use of cotton as a filter for illicit substances.
  • Enterobacter agglomerans is known to colonize cotton and cotton plants extensively.

Observation:

  • A case study involving an intravenous narcotic abuser presenting with symptoms consistent with cotton fever is detailed.
  • Enterobacter agglomerans was successfully isolated from the patient's bloodstream.
  • The same bacterial species was subsequently identified in the cotton material used by the patient to filter heroin prior to injection.

Findings:

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  • The findings strongly suggest that Enterobacter agglomerans is the probable causative agent of cotton fever.
  • The dual isolation of E. agglomerans from both the patient's blood and the contaminated cotton filter provides direct evidence linking the bacterium to the syndrome.
  • This case provides a specific etiological link for cotton fever.

    • Implications:

    • Blood cultures are recommended for patients presenting with classic cotton fever symptoms to identify potential pathogens.
    • Empiric antibiotic therapy should be initiated promptly in suspected cases of cotton fever.
    • Understanding the specific etiology (Enterobacter agglomerans) can guide targeted treatment and potentially inform harm reduction strategies for intravenous drug users.