{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T19:30:21Z","timestamp":1776799821754,"version":"3.51.2"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2022,6,30]],"date-time":"2022-06-30T00:00:00Z","timestamp":1656547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,7,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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 (IE).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>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 IE 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>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\u2019 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 IE. 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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytac258","type":"journal-article","created":{"date-parts":[[2022,6,30]],"date-time":"2022-06-30T16:44:06Z","timestamp":1656607446000},"source":"Crossref","is-referenced-by-count":2,"title":["A case report of <i>Enterobacter cloacae<\/i> endocarditis in a patient with a history of cotton fever"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7563-2430","authenticated-orcid":false,"given":"Constantine","family":"Tarabanis","sequence":"first","affiliation":[{"name":"Department of Medicine, NYU Langone Health , 550 1st Avenue , New York, NY 10016, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruina","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Medicine, NYU Langone Health , 550 1st Avenue , New York, NY 10016, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelsey","family":"Grossman","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Veterans Affairs New York Harbor Healthcare System , New York, NY 10016 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Kaul","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases & Immunology, Department of Medicine, NYU Langone Health , New York, NY 10016 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey D","family":"Lorin","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Veterans Affairs New York Harbor Healthcare System , New York, NY 10016 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,6,30]]},"reference":[{"key":"2022071316383542100_ytac258-B1","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/0736-4679(90)90222-H","article-title":"\u2018Cotton fever\u2019: a benign febrile syndrome in intravenous drug abusers","volume":"8","author":"Harrison","year":"1990","journal-title":"J Emerg Med"},{"key":"2022071316383542100_ytac258-B2","doi-asserted-by":"crossref","first-page":"2381","DOI":"10.1001\/archinte.1993.00410200109014","article-title":"Enterobacter agglomerans-associated cotton fever","volume":"153","author":"Ferguson","year":"1993","journal-title":"Arch Intern Med"},{"key":"2022071316383542100_ytac258-B3","doi-asserted-by":"crossref","first-page":"e00688","DOI":"10.1016\/j.idcr.2019.e00688","article-title":"Cotton fever resulting in Enterobacter asburiae endocarditis","volume":"19","author":"Francis","year":"2019","journal-title":"IDCases"},{"key":"2022071316383542100_ytac258-B4","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1080\/10826084.2020.1720247","article-title":"Correlates of self-reported cotton fever experience among people who inject opioids","volume":"55","author":"Mezaache","year":"2020","journal-title":"Subst Use Misuse"},{"key":"2022071316383542100_ytac258-B5","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/S0361-1124(78)80339-6","article-title":"\u2018Cotton fever\u2019 in narcotic addicts","volume":"7","author":"Shragg","year":"1978","journal-title":"J Am Coll Emerg Physicians"},{"key":"2022071316383542100_ytac258-B6","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1007\/s11606-015-3424-1","article-title":"Cotton fever: does the patient know best?","volume":"31","author":"Xie","year":"2016","journal-title":"J Gen Intern Med"},{"key":"2022071316383542100_ytac258-B7","first-page":"798","article-title":"Medical complications following intravenous heroin","volume":"32","author":"Thomson","year":"1975","journal-title":"Ariz Med"},{"key":"2022071316383542100_ytac258-B8","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1097\/IPC.0b013e318157d287","article-title":"The other \u2018cotton fever\u2019","volume":"16","author":"Ramik","year":"2008","journal-title":"Infect Dis Clin Pract"},{"key":"2022071316383542100_ytac258-B9","doi-asserted-by":"crossref","first-page":"e385","DOI":"10.1016\/j.jemermed.2012.11.090","article-title":"Cotton fever: an evanescent process mimicking sepsis in an intravenous drug abuser","volume":"44","author":"Torka","year":"2013","journal-title":"J Emerg Med Elsevier Ltd"},{"key":"2022071316383542100_ytac258-B10","first-page":"283","article-title":"Cotton fever and pregnancy. A confusing clinical problem","volume":"2","author":"Wright","year":"1980","journal-title":"Diagn Gynecol Obs"},{"key":"2022071316383542100_ytac258-B11","doi-asserted-by":"crossref","first-page":"276","DOI":"10.3122\/jabfm.2016.02.150267","article-title":"Cotton fever: a condition self-diagnosed by IV drug users","volume":"29","author":"Zerr","year":"2016","journal-title":"J Am Board Fam Med"},{"key":"2022071316383542100_ytac258-B12","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1097\/01.ccm.0000510413.44343.45","article-title":"Cotton fever the great imitator","volume":"44","author":"Holland","year":"2016","journal-title":"Crit Care Med"},{"key":"2022071316383542100_ytac258-B13","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1002\/ajim.4700120607","article-title":"The role of endotoxin for reactions after exposure to cotton dust","volume":"12","author":"Rylander","year":"1987","journal-title":"Am J Ind Med"},{"key":"2022071316383542100_ytac258-B14","doi-asserted-by":"crossref","first-page":"829","DOI":"10.7326\/0003-4819-147-12-200712180-00002","article-title":"Non-HACEK gram-negative bacillus endocarditis","volume":"147","author":"Morpeth","year":"2007","journal-title":"Ann Intern Med"},{"key":"2022071316383542100_ytac258-B15","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1007\/s10156-012-0376-9","article-title":"An unusual etiology of infective endocarditis: Enterobacter cloacae","volume":"18","author":"Moon","year":"2012","journal-title":"J Infect Chemother"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytac258\/44345362\/ytac258.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/6\/7\/ytac258\/44855971\/ytac258.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/6\/7\/ytac258\/44855971\/ytac258.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,13]],"date-time":"2022-07-13T16:39:57Z","timestamp":1657730397000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytac258\/6623551"}},"subtitle":[],"editor":[{"given":"Romain","family":"Didier","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Yehia","family":"Saleh","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Jan","family":"Henzel","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Carla","family":"Sousa","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Linh","family":"Ngo","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Nida","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,6,30]]},"references-count":15,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2022,7,6]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytac258","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,7,1]]},"published":{"date-parts":[[2022,6,30]]},"article-number":"ytac258"}}