The bacteria that causes Lyme disease is only transmitted through the bites of infected blacklegged ticks (also called deer ticks). The tiny blacklegged tick nymphs cause most cases of infection. The black legged nymph season takes place in early summer, coinciding with peak outdoor human activities (sports, hiking, etc.). Since blacklegged nymphs are very small, move slowly, and tend to cause little itch or irritation compared to other Virginia ticks, most people never realize they have been bitten unless the tick attaches to a part of the body that is in plain sight. Lyme disease is not transmitted person-to-person.

Most patients (about 75%) will see the development of a red rash called an erythema migrans (“EM” or “bull’s-eye” rash) around a tick bite site within days or weeks of the tick bite. This rash expands (up to 12 inches in diameter) and often clears around the center. The rash does not itch or hurt, so it may not be noticed if it is on a person’s back-side or scalp. The initial illness may cause fatigue, fever, headache, muscle and joint pains, and swollen lymph nodes.

If untreated or improperly treated in the early stage of illness, some patients may develop one or several of the following symptoms: multiple EM rashes on their body, intermittent arthritis (pain and swelling) in their large joints (e.g., knees), facial palsy, heart palpitations, severe headaches/neck stiffness (due to inflammation of spinal cord), or neurological problems (shooting pains or numbness and tingling in hands and feet, or memory problems) months to years after the initial illness. Pain and swelling in large joints will occur in about 60% of untreated patients and neurological symptoms occur in about 5% of untreated patients. Arthritis and neurological problems may last for years after the infection.

The diagnosis of Lyme disease is based primarily on signs and symptoms of illness. Laboratory tests for Lyme disease antibody may be done on a patient’s blood to confirm the diagnosis, but if blood is collected too early in the course of illness, an infected person may not yield an antibody response. If laboratory confirmation is desired, re-testing may be necessary.

When Lyme disease is detected early and treated with an appropriate antibiotic (e.g., doxycycline), treatment is typically effective. A prophylactic treatment (meaning offering medication prior to symptom onset to prevent illness) may be appropriate in some cases.

Bacteria in the spotted fever rickettsioses group are spread to people through the bite of an infected tick or mite; Rickettsia rickettsii is transmitted from the bite of an infected American Dog tick (Dermacentor variabilis), Brown Dog Tick (Rhipicephalus sanguineus), and Rocky Mountain wood tick (Dermacentor andersoni; this tick is not found in Virginia).

Rocky Mountain spotted fever(RMSF) is characterized by a sudden onset of moderate to high fever, severe headache, fatigue, deep muscle pain, chills and rash. The rash typically begins on the legs or arms, may include the soles of the feet or palms of the hands, and may spread rapidly to the trunk or rest of the body.  If left untreated Rocky Mountain spotted fever can be fatal.

SFR can be diagnosed through laboratory tests of blood or skin.  Antibodies to the infectious agent typically do not become detectable until seven to ten days after onset of illness, therefore testing for the agent’s DNA via PCR is the best diagnostic laboratory test in the early stages of illness. If PCR is not preformed, the pairing of an acute and convalescent serum sample taken seven or so days apart can be an effective means of diagnosing RMSF.

Rickettsial infections can be treated with certain antibiotics in both children and adults.  Prompt treatment may decrease the chance of developing serious illness.

The bacteria are transmitted to humans from the bite of an infected lone star or blacklegged tick.

Ehrlichiosis cases range from mild to moderately severe, with a few cases causing life-threatening or fatal illness. Infected individuals that experience symptoms may expect a fever and one or more of the following; headache, chills, discomfort, muscle pain, nausea, vomiting, diarrhea, confusion, and a rash or red eyes that begin about one to two weeks after the bite of an infected tick. Ehrlichiosis causes rash in about 30% of infected adults and 60% of infected children. Severe cases may cause difficult breathing, neurologic problems, and bleeding disorders. Symptoms and biological markers of Ehrlichiosis may be similar to those of Anaplasmosis and RMSF,  causing those illnesses to also be considered as well in the diagnosis.

There are multiple ways to test for ehrlichiosis, one of which is a method called indirect immunofluorescence IgG assay that detects Ehrlichia-specific markers. This test involves a blood sample taken as early as possible and a second blood sample taken 2 to 4 weeks later to compare immunological response. The best laboratory method to assist in diagnosis of Ehrlichia is a multiplex PCR, which can detect the DNA of multiple pathogens at one time.

Prompt treatment (in the first five days of illness) with an appropriate antibiotic will minimize the chances of a severe illness development.

People become ill with anaplasmosis from the bite of an infected blacklegged tick (Ixodes scapularis). Ticks acquire the bacteria from feeding on infected wildlife.

Symptoms will typically begin within 1-2 weeks after the bite of an infected tick. Early signs usually present as an acute onset of fever, headaches, body aches, nausea, vomiting, and in rare cases, a rash. Also characteristic of the illness are signs such as leukopenia (low white blood cell count), thrombocytopenia (low platelet levels), elevated liver enzymes, and anemia.

Testing for anaplasmosis usually consists of serological testing for antibodies present in the blood, however, Anaplasma is serologically cross-reactive with Ehrlichia which can result in confusing results. To determine a current, ongoing infection, it may be necessary to provide an acute serum sample paired with a second sample taken about a week or so after the first. This paired sample method allows us to observe a change in the amount of antibody present in the blood when comparing the first and second serum samples. However, the preferred method of testing is a multiplex PCR.

Treatment with an appropriate antibiotic is effective for anaplasmosis cases.

People become infected with Babesia from the bite of an infected blacklegged tick (Ixodes scapularis). Ticks acquire the parasites from feeding on infected wildlife.

Most individuals who become infected with Babesia do not exhibit symptoms of disease. Others will develop flu-like, non-specific symptoms such as fever, chills, sweats, headache, body aches, nausea, loss of appetite, and fatigue. Babesia is well known for infecting red blood cells and can cause a specific form of anemia called hemolytic anemia that can result in jaundice (yellowing of the skin) and dark urine. Other characteristic signs of babesiosis include a low and unstable blood pressure, low platelet count, disseminated intravascular coagulopathy (DIC – which can lead to blood clots and bleeding), malfunction of vital organs, and in severe cases death may result.

Lab testing for babesiosis involves the identification of the Babesia parasite in a blood smear under the microscope or detection of the organism’s DNA in whole blood using PCR methods.

Treatment of babesiosis usually involves the combination of two prescription medications: an antibiotic and an antiparasitic, taken together over a 7-10 day period. In more severe cases, additional supportive care may be necessary.

Bacteria in the spotted fever rickettsioses group are spread to people through the bite of an infected tick or mite; Rickettsia parkeri is transmitted from the bite of an infected Gulf Coast tick (Amblyomma maculatum).

Symptoms usually appear within two weeks of the bite of an infected tick. R. parkeri disease is typically less severe than the other major disease of the SFR group with symptoms including fever, headache, muscle aches, and rash.  People diagnosed with this illness typically have an eschar (dark scab) at the tick bite location.

SFR can be diagnosed through laboratory tests of blood or skin.  If an eschar is present, it can be used to accurately diagnose R. parkeri disease. Antibodies to the infectious agent typically do not become detectable until seven to ten days after onset of illness, therefore testing for the agent’s DNA via PCR is the best diagnostic laboratory test in the early stages of illness.

Rickettsial infections can be treated with certain antibiotics in both children and adults.  Prompt treatment may decrease the chance of developing serious illness.

Tularemia cannot be spread from one person to another, but can be spread in a variety of other ways. The skin, eyes, mouth and throat of hunters may be exposed to the bacteria while skinning or dressing wild animals, especially rabbits or hares. Handling or eating uncooked meat from infected animals, handling pelts and paws of animals, drinking contaminated water, or getting bitten by certain arthropods may also transmit the bacterial disease. Another possible, but rare, route of exposure is by inhaling infected aerosols, such as dust from contaminated soil, hay or grain.

Symptoms typically appear 3 to 5 days after exposure to the bacteria, but can take anywhere between 1 to 14 days to develop. Tularemia causes different symptoms depending on where and how the bacteria has entered the body. Tularemia can cause swollen and painful lymph glands, inflamed eyes, sore throat, ulcers in the mouth or on the skin, and pneumonia-like illness. Early symptoms almost always include the abrupt onset of fever, chills, headache, muscle aches, joint pain, dry cough and progressive weakness. Pneumonia may be a complication of infection and requires prompt diagnosis and specific treatment to prevent death.

Tularemia can be difficult to diagnose. It is a rare disease, and the symptoms can be mistaken for other more common illnesses. For this reason, it is important to share with your health care provider any likely exposures, such as tick and deer fly bites, or contact with sick or dead animals. Laboratory tests of specimens taken from the affected part(s) of the body can help confirm the diagnosis.

Early treatment with an antibiotic is recommended.

It is currently believed that people acquire Heartland virus from the bite of an infected lone star tick.

People infected with Heartland virus may experience symptoms such as fever, fatigue, headache, nausea, joint aches, and diarrhea. Incubation time, or time from tick exposure to illness onset, is estimated to be about 14 days.

No commercially available testing currently exists for Heartland virus. However, patients with symptoms and exposure consistent with Heartland virus may be tested for evidence of viral antibodies at CDC arboviral diseases branch upon clinician request and consultation with the local/state health department.

Currently there are no vaccines or medications to treat or prevent illness from Heartland virus. Persons with Heartland virus often need to be hospitalized, but most can make a full recovery.

People acquire POW virus through the bite of an infected Blacklegged tick. The virus can be transmitted in as little as 15 minutes, much faster than most other tick-borne illnesses found in Virginia. Powassan virus is typically maintained in a cycle amongst ticks and small-to-medium-sized rodents that they feed on, such as woodchucks, squirrels, and white-footed mice to name a few. There are two separate types of POW virus in the U.S. (POW1 and POW2). POW1 virus is transmitted by the ticks that feed on woodchucks and squirrels. POW2 virus is transmitted by the black-legged tick, the same tick responsible for Lyme disease transmission in Virginia.

Most individuals do not experience symptoms. However, those that do may notice symptoms such as fever, headaches, vomiting, general weakness, confusion, loss of coordination, speech difficulties, or seizures appearing within 1 week to 1 month of suspected tick bite. About half of the survivors of POW experience permanent neurological symptoms.

Laboratory diagnosis generally involves testing of serum or Cerebrospinal fluid (CSF) to detect virus specific IgM and neutralizing antibodies. Initial serological testing will be performed using IgM capture ELISA, MIA (Microsphere-Based Immunoassay) and IgG ELISA. If the initial results are positive, further confirmatory testing is available at CDC through coordination with local/state health department.

Currently there are no vaccines or medications to treat or prevent POW virus infection. Persons with severe POW illnesses often need to be hospitalized, where they can receive respiratory support, intravenous fluids, and medications that decrease swelling in the brain. After illness, recovery may require long-term therapy to regain speech and/or movement of limbs.

It is currently hypothesized that people acquire Bourbon virus through the bite of an infected Lone Star tick.

Due to a limited number of identified cases, little is known about the typical presentation of Bourbon virus. People with confirmed cases of Bourbon virus have had fever, fatigue, headache, joint aches, nausea, vomiting, and rash. People have also reported leukopenia (low white blood cell count) and thrombocytopenia (low platelet count).

No commercially available testing currently exists for Bourbon virus. CDC has the capacity to test a specimen if a case of Bourbon virus is suspected by a clinician; this will be coordinated with the local/state health department.

Currently there are no vaccines or medications developed to treat or prevent illness with Bourbon virus. Persons with Bourbon virus often need to be hospitalized, but most can make a full recovery.