CDC — Tick-Borne Diseases — NIOSH Workplace Safety and Health Topic


Tick-borne pathogens can be passed to humans by the bite of infected ticks. Ticks can be infected with bacteria, viruses, or parasites. Some of the most common tick-borne diseases in the United States include: Lyme disease, babesiosis, ehrlichiosis, Rocky Mountain Spotted Fever, anaplasmosis, Southern Tick-Associated Rash Illness, Tick-Borne Relapsing Fever, and tularemia. Other tick-borne diseases in the United States include: Colorado tick fever, Powassan encephalitis, and Q fever. Lyme disease is the most commonly reported tick-borne disease in the United States. In 2010, more than 22,500 confirmed and 7,500 probable cases of Lyme disease were reported to the Centers for Disease Control and Prevention (CDC).

Outdoor workers are at risk of exposure to tick-borne diseases if they work at sites with ticks. Worksites with woods, bushes, high grass, or leaf litter are likely to have more ticks. Outdoor workers in most regions of the United States should be extra careful to protect themselves in the spring, summer, and fall when ticks are most active. Ticks may be active all year in some regions with warmer weather.

Protecting Yourself from Ticks and Mosquitoes: Cdc-pdf Print or order this free card for easy access to important safety information.

List of Tick Borne Diseases

Did you just find a tick on yourself or a loved one? TickCheck can test your tick and determine whether it carries the bacteria that transmit Lyme disease and other tick-borne infections.

Ticks can carry a wide range of diseases.

As one of the most dangerous disease vectors in North America, there are over a dozen tick-borne diseases of various severity which can be transmitted to both humans and animals through a tick bite. It can take weeks for human testing to detect these vectors.

At TickCheck, we can determine if your tick carries any of the disease-causing agents below. The most common tick-borne disease in the wild, and our most commonly requested test, is for Lyme disease. To order a tick test, visit the tick test order form.

Lyme disease (Borrelia burgdorferi)

Lyme disease, caused by the bacteria Borrelia burgdorferi, is the most common tick-borne disease in the northern hemisphere. Lyme disease is transferred by the bite of an infected tick, and is dangerous to both people and pets. Infection can cause severe long-term health issues including fever, fatigue, migraines, and skin rash. Left untreated, Lyme disease can spread to the joints, heart, and nervous system. With prompt diagnosis, Lyme disease can be successfully treated with several weeks of strong antibiotics.

anaplasmosis (Anaplasma phagocytophilum)

Anaplasmosis (formerly HGE Ehrlichia, or Human Granulocytic Ehrlichiosis) is a tick-borne disease caused by the bacterium Anaplasma phagocytophilum. Left untreated, anaplasmosis can result in bleeding or kidney failure. Anaplasma infections are also common in dogs. This disease has immediate symptoms similar to Lyme disease, and is thus difficult to diagnose and treat without lab analysis of the tick vector. Our lab uses PCR to determine the existence of the bacterium in a tick specimen.

babesiosis (Babesia microti)

Babesia is a tick-borne protozoan parasite that causes symptoms similar to malaria, and can pose severe health issues or even death in individuals with weak immune systems. Babesia can also cause problems in dogs. Babesia is curable in humans and animals with several modern antibiotic treatments. Our lab can determine if your tick specimen was infected with Babesia protozoa.

bartonellosis (Bartonella spp.)

Bartonella is a disease-causing bacterium transmittable to both humans and other mammals. Bartonella is the primary agent of Cat scratch disease (CSD), which has symptoms such as swollen lymph nodes, headaches, and abdominal pain.

ehrlichiosis (Ehrlichia chaffeensis)

HME Ehrlichia, or Human Monocytotropic Ehrlichiosis, is a tick-borne disease caused by the bacterium Ehrlichia chaffeensis. The bacterium infects the immune system, and can cause serious health issues including bleeding disorders. Other symptoms include fever, headache, and myalgia. When discovered, Ehrlichiosis is treatable with the antibiotic Doxycycline. Our lab can determine if your specimen is a carrier of Ehrlichia species, however our test is not specific to E. chaffeensis.

Rocky Mountain spotted fever (Rickettsia spp.)

Rocky Mountain Spotted Fever is the most lethal and most frequently reported rickettsial illness in the United States. Caused by the bacterium Rickettsia rickettsii and spread by Dog ticks and Lone Star ticks, the disease results in fever, abdominal pain, and a spotted rash on the skin. If not treated promptly, Rocky Mountain spotted fever can be fatal. However, prompt modern antibiotic therapy has dramatically reduced the number of deaths caused by the disease. Our lab can determine if your specimen is a carrier of Rickettsia species, but is not specific to Rickettsia rickettsii.

tularemia (Francisella tularensis)

Tularemia, also known as Pahvant Valley plague or Rabbit Fever, is a tick-borne disease caused by the bacterium Francisella tularensis. Used as a biological weapon in the past, Tularemia is extremely infectious and can result in fever, lethargy, anorexia, septicemia (blood infection), and even death. If diagnosed, Tularemia is treatable with powerful antibiotics like streptomycin or doxycycline.

B. miyamotoi (Borrelia miyamotoi)

Borrelia miyamotoi is a spiral-shaped bacterium that can transferred to humans through the deer tick. It is related to the bacterium that causes Lyme disease. Although infection can cause some similar symptoms including fever, headache, fatigue, and muscle aches, acute Lyme disease often presents with rash while infection with B. miyamotoi does not. Physicians have successfully treated patients infected with B. miyamotoi with a 2-week course of doxycycline.

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STARI (Borrelia lonestari)

Borrelia lonestari is suspected of causing STARI, however, further research is does not support this idea. Currently, no diagnostic test is available for STARI, and no official treatment protocol exists, though antibiotics are generally prescribed.

babesiosis (Babesia spp.)

Babesia is a tick-borne protozoan parasite that causes symptoms similar to malaria, and can pose severe health issues or even death in individuals with weak immune systems. Babesia can also cause problems in dogs. Babesia has become more common in recent years, and is found in ticks even more frequently then Lyme disease. Babesia is curable in humans and animals with several modern antibiotic treatments. Our lab can determine if your tick specimen was infected with Babesia protozoa.

cat-scratch fever (Bartonella henselae)

Cat-scratch disease (CSD) is a bacterial infection spread by cats. The disease spreads when an infected cat licks a person’s open wound, or bites or scratches a person hard enough to break the surface of the skin. About three to 14 days after the skin is broken, a mild infection can occur at the site of the scratch or bite. It is caused by CSD is caused by a bacterium called Bartonella henselae.

Rickettsia endosymbiont (Rickettsia endosymbiont)

Rickettsia endosymbiont is a bacteria found in ticks that aid in the survivial, acquisitio and transmission of pathogenic bacteria. R. endosymbiont has been found in western blacklegged ticks in California. It is hypothesized that R. endosymbiont speeds up the transmission process of other pathogens.

mycoplasmosis (Mycoplasma fermentas)

Mycoplasmosis can cause an array of different symptoms depending on the species that is transmitted. Mycoplasma sp. are the smallest bacteria and have no cell wall which allow them to invade human cells easily and disrupt the immune system. When transmitted by a tick, is commonly found as a co-infection of Lyme disease and Mycoplasma fermentans being the most common species. Symptoms can include fatigue, muscle and joint pain, abdominal bloating, bronchitis and diarrhea. Mycoplasmosis can be treated with a long course of antibiotics.

Deer tick virus (Powassan virus Lineage II)

Powassan virus also known as Deer Tick Virus is transmitted by an infected Blacklegged tick or Groundhog tick. Over the last decade cases have increased in the Northeast and Great Lakes region. Powassan is a potentially fatal disease that can cause fever, vomiting, dizziness, confusion, seizures, coma and encephalitis. Individuals with Powassan may suffer long-term neurological problems. There are no specific treatments for severe Powassan virus illness besides hospital care.

Lyme disease (Borrelia mayonii)

Borrelia mayonii was recently discovered in 2013 in the Wisconsin and is a spirochete bacterium which causes Lyme disease in the United States. It has currently only been found in upper Midwest States. Similar to B. burgdorferi it can cause rash, fever, headache, arthritis but also causes symptoms of nausea, vomiting, diffuse rashes and a higher concentration of bacteria in the blood. B. mayonii can be treated with several weeks of strong antibiotics.

ehrlichiosis (Ehrlichia ewingii)

Ehrlichiosis can be a serious infection if not treated in timely manner and is caused by the bacterium Ehrlichia ewingii. Ehrlichiosis can infect the immune system of humans and dogs and cause similar symptoms as E. chaffeensis; fever, headache, muscle pain, confusion and vomiting/diarrhea. Unlike E. chaffeensis, E. ewingii does not commonly have a rash and usually infects granulocytes. Ehrlichiosis is treatable with doxycycline.

Rocky Mountain spotted fever (Rickettsia amblyommii)

Rickettsia amblyommii is part of the spotted fever group of Rickettsia. It is an obligate intracellular bacteria that has been found to cause symptoms similar to Rocky Mountain spotted fever (RMSF). R. amblyomii is currently still being researched to fully understand it pathogenicity to humans.

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Dangerous Tick Bites: 3 Tick-Borne Illnesses You Should Know About

by Dr. Bill Rawls
Posted 8/10/18

Lyme disease may be the best known tick-borne illness, but it’s not the only one you should be concerned about. Ticks carry all sorts of infectious human diseases, including some that are potentially deadly.

Beyond Borrelia burgdorferi, the microbe associated with Lyme, the three other tick-borne bacteria you should have on your radar are ehrlichia (which causes Ehrlichiosis), anaplasma (responsible for anaplasmosis), and rickettsia (the cause of Rocky Mountain Spotted Fever). All three are gram-negative (double cell wall) bacteria, and they’re intracellular, meaning they live inside cells, though each prefers a different type of cell.

The good news is, these microbes are much less common than borrelia and top Lyme coinfections like mycoplasma and bartonella, and in fact, they’re rarely a Lyme coinfection (5% or less of ehrlichia and anaplasma cases occur with Lyme). The bad news: They have a higher potential for causing severe and life-threatening illness.

Here’s what you need to know about ehrlichia, anaplasma, and rickettsia, including signs of infection, diagnostic approaches, and the best treatments.

Symptoms of Ehrlichiosis, Anaplasmosis, or Rocky Mountain Spotted Fever

The signs of infection with either ehrlichia, anaplasma, or rickettsia are remarkably similar. With milder infections you may experience no symptoms at all, or it could manifest as mildly flu-like.

But it is possible for severe, acute illness to occur, especially in those infected with rickettsia. And certain people are at higher risk of severe infection and even death, including those over age 50; those who have HIV; and/or those with depressed immune function due to another factor such as taking corticosteroids or other immunosuppressive drugs, cancer and cancer therapy, or splenectomy. It also seems that men are more vulnerable, as the ratio of men to women with these illnesses is 2:1 (perhaps because men are more likely to frequent the outdoor areas where ticks thrive).

Hallmark symptoms of severe infection include high fever, chills, and muscle aches, and they generally start an average of 12 days (5 to 21 days) after a tick bite. History of tick bite is the number one tip-off to infection, but because tick bites are painless and people are often unaware of being bitten, that history is not always helpful.

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Here are the acute symptoms (associated with severe disease):

  • High fever and chills
  • Headache
  • Muscle aches (myalgia)
  • Arthralgia (joint pain)
  • Malaise
  • Confusion
  • Abdominal pain (can mimic appendicitis)
  • Nausea / vomiting / diarrhea
  • Cough (anaplasma)
  • Pharyngitis (sore throat)
  • Weight loss
  • Difficulty breathing
  • Pulmonary complications (lungs)
  • Bleeding disorders (disseminated intravascular coagulation)
  • Kidney failure
  • Seizures
  • Coma
  • Death

Conjunctivitis (eye infection) and rash are also highly common with both RMSF and ehrlichiosis. About 60% of children and 30% of adults see a rash associated with Ehrlichiosis, which appears as small, red, flat patches (macules), with small raised bumps (papules) in evenly distributed clusters. Rash mainly occurs with the Ehrlichia chaffeensis strain of ehrlichia; it’s less common with Ehrlichia ewingii and Ehrlichia muris-like strains.

It should be noted that a similar rash can occur in many other viral and bacterial diseases including measles, dengue fever, parvovirus B19, Epstein-Barr virus (mononucleosis), cytomegalovirus (CMV), borrelia (Lyme disease), and many others. It can also occur as a reaction to drugs or toxins. A sunburn-like rash (erythroderma) is also possible with E. chaffeensis, but less common.

The vast majority (90%) of people with Rocky Mountain Spotted Fever develop a rash that appears as pink, flat, non-itchy small “spots” (macules) that are densely packed and widely distributed on the wrists, forearms, ankles, and buttocks, and sometimes on the palms and soles of the feet. It generally appears two to five days after fever starts, but can occur later in the course of illness, even after treatment is started. In later stages with progressive disease, the spots progress to a red or purple color (petechiae).

Chronic infection with all three of these types of microbes is categorized by subclinical phases (no symptoms) that can last months or years, followed by episodes of primary symptoms. Ehrlichia and anaplasma are more likely to be associated with relapsing disease than rickettsia.

Get to Know Rickettsia + Rocky Mountain Spotted Fever

Rickettsia is one of the more virulent tick-borne microbes: On the virulence scale of 1-10, with 10 being most virulent, rickettsia is about a 7, putting it on par with pneumonia. If left untreated, rickettsia can cause potentially fatal illness. Even very healthy people can become severely ill. Those affected with severe disease can have long-term complications, especially if not treated early.

Rocky Mountain Spotted Fever tends to occur alone as an isolated infection; it’s not typically a Lyme coinfection. Symptoms are typically more severe than those caused by Ehrlichiosis and anaplasmosis, and more apt to occur in healthy individuals.

The R. rickettsii strain is transmitted by the American dog tick (Dermacentor variabilis), which is most commonly distributed in Midwestern states east of the Rockies; the Rocky Mountain wood tick (Dermacentor andersoni); and the brown dog tick (Rhipicephalus sanguineus) in Arizona. However, RMSF can occur in any state. The highest concentration of cases occurs in a band from North Carolina to Oklahoma. Different species and strains of rickettsia cause similar syndromes around the world.

Though it is widely distributed, infections are much less common than other tick-borne microbes. The primary difference between rickettsia and ehrlichia and anaplasma is the type of cell infected. Rickettsia has a preference for infecting cells that line blood vessels (called endothelial cells), making it much more virulent.

Infection of endothelial cells results in severe vasculitis (inflammation of blood vessels). Fluid leaks into tissues causing swelling and edema, and vessel damage constricts blood flow and causes blood clotting. Loss of circulation in extremities can result in damaged toes and fingers, sometimes causing partial paralysis and/or requiring amputation in extreme cases. Vasculitis in organs, including the brain, can result in serious and sometimes permanent complications.

Rocky Mountain Spotted Fever can also cause long-term problems in children, including cognitive delay, fine motor impairment, and persistent foot drop. Acute infections should be treated aggressively with antibiotic therapy.

Get to Know Ehrlichia + Ehrlichiosis

Though ehrlichia infections are considered to be a newly emerging microbial illness, the fact that it is so widely distributed across the globe (in both animals and humans) suggests that it has been around for a while. More likely, as with other stealth microbes, it is just being recognized as a significant cause of disease. In other words, people have been getting sick with ehrlichia for a long time, but it has been only in the past 30 years that ehrlichia has been recognized as the cause.

The primary cause of Ehrlichiosis (formerly called Human Monocytic Ehrlichiosis) in the United States is the E. chaffeensis strain. It lives inside cells of a host and infects white blood cells of the body, preferentially monocytes and macrophages. After infection, E. chaffeensis stimulates formation of cyst-like structures (vacuoles) called morulae, inside the white blood cell. Nestled inside the morulae, the microbe is protected and can multiply.

Ehrlichia organisms are spread throughout the body by way of infected white blood cells, via blood and lymph systems. The microbe is able to thrive inside macrophages that are fixed in bone marrow, spleen, lymph nodes, and hepatic sinusoids (a type of blood vessel). Inside these isolated niches, it is protected from the immune system. It is also found in meninges of the brain, other brain tissues, lungs, kidneys, intestinal tract, and heart.

There are seven species of ehrlichia worldwide known to infect humans (E. chaffeensis, E. canis, E. ewingii, E. ruminantium, E. mineirensis, E. muris, and a new muris-like species). Different species cause similar illnesses with similar symptoms. There are many strains (genotypes) of each species.

Two other species of ehrlichia, E. ewingii and E. muris, cause ehrlichiosis in the US, but are much less common than E. chaffeensis. Most cases of ehrlichiosis occur April through October.

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Two-thirds of infections are asymptomatic or associated only with mild flu-like symptoms that resolve spontaneously without any therapy. Severe and even life-threatening illness is more apt to occur in immunocompromised individuals, but can also occur in healthy people. In cases of severe ehrlichiosis, 48% are ill enough to require hospitalization, and 17% have life-threatening complications (mostly neurological). The fatality rate is 3%.

Ticks are the predominant vector for ehrlichia. It’s most commonly found in Mid-Atlantic and Southeast US, with the highest concentration in a band stretching from North Carolina to Oklahoma (South, South-Central, Southeast). This band mimics the distribution of the lone star tick (Amblyomma americanum), a primary carrier of ehrlichia. Ehrlichia is also transmitted by black-legged ticks (Ixodes scapularis) and western black-legged ticks (Ixodes pacificus), along with other tick species worldwide.

Besides ticks, other vectors are possible for ehrlichia, including fleas and other biting insects. Ehrlichia chaffeensis is commonly found in cats and dogs (60%). Interestingly, some owners are seropositive for the same strain of ehrlichia as their pet. Ehrlichia is also found in foxes and other wild mammal populations. Transmission by blood transfusion and organ donation has also been documented.

Get to Know Anaplasma + Anaplasmosis

Anaplasma is an obligate intracellular bacteria, meaning that it’s entirely reliant on intracellular resources to reproduce. It infects white blood cells and multiplies within morulae (those cyst-like structures). Anaplasma prefers neutrophils (also called granulocytes), but can also infect other kinds of white blood cells.

Anaplasma phagocytophilum causes anaplasmosis (formerly called Human Granulocytic Anaplasmosis). Anaplasmosis has very similar characteristics to ehrlichiosis, but tends to be less severe. Hospitalization with severe infection is much less likely, and neurological complications are much less common. Associated fatality is only 1%.

Anaplasma is transmitted by black-legged ticks (Ixodes scapularis) in the Northeast and Upper Midwest, and western black-legged ticks (Ixodes pacificus) in Northern California — most commonly by nymph and adult ticks. It has common overlap with typical ehrlichia areas, and is also spread by other species of ticks worldwide.

Person-to-person transmission is also possible through direct contact with blood, blood transfusions, respiratory secretions of someone acutely infected, and blood contact with infected animals (hunters cleaning carcasses). A few cases of mother-fetus transfer in the womb and one case of transfer via breast milk have also been documented.

Diagnosing RMSF, Ehrlichiosis + Anaplasmosis

Diagnosis is challenging, because these three diseases look alike on clinical presentation and also resemble other common infectious diseases, like the flu. Having a high level of suspicion is critical to initiate therapy early in the course of disease, especially with RMSF. Any person presenting with shaking chills, high fever, and low back pain should be considered for one of these diseases, especially in endemic areas (where infection is common), with or without a known tick bite.

The following methods can be used to detect these tick-borne diseases:

    General labs, key findings in severe infection

Treating Ehrlichiosis, Anaplasmosis, and RMSF

Having a high level of suspicion is important for early diagnosis. These are not illnesses to mess around with. They should be treated aggressively with conventional antibiotics. Diagnosis is based on clinical signs and symptoms and confirmed by labs after treatment is initiated. Labs are not helpful for the first two weeks when acute symptoms are most pronounced.

Serious complications are more apt to arise if infections are not recognized and antibiotic therapy is delayed. Herbal therapy should not be a primary therapy for these infections, but it can be used as supportive therapy. For instance, I’ve developed an herbal protocol that’s ideal for supporting antibiotic treatment and promoting immune system restoration.

Standard treatment for adults is 100 mg of doxycycline twice daily for 30 days or until three days after symptoms subside completely. Failure to respond to doxycycline (decreased fever) acutely is an indication that an acute tick-borne infection is not present; instead, it may be a virus or babesia infection. Resistance is high with any other antibiotics.

Alternative treatment plans may include:

  • For ehrlichiosis/anaplasmosis: 300 mg of Rifampin three times daily for 30 days or until three days after symptoms resolve
  • For RMSF: 12.5 mg/kg body weight of Chloramphenicol orally every six hours. It also can be administered intravenously. Use of this antibiotic is associated with a high potential for side effects.

Prophylactic treatment for an asymptomatic tick bite is not recommended by the Centers for Disease Control. It is considered ineffective and may simply delay onset of disease. This stance is controversial, especially because asymptomatic individuals can become chronic carriers and develop relapsing illness later if immune function falters. A more severe course may require acute treatment with IV antibiotics.

When chronic disease occurs with these bacteria, it’s in the form of relapse of acute symptoms after prolonged periods without symptoms. In this way, ehrlichia, anaplasma, and rickettsia are much less like other stealth microbes. Relapses should be treated with antibiotic therapy, like primary disease.

While ehrlichia, anaplasma, and rickettsia are less common tick-borne infections, they can be serious and even life-threatening. Whether you remember an insect bite or not, if you suspect infection due to symptoms and time spent in a high-tick area, consult your doctor as soon as possible. Early diagnosis is vital to restoring your health.

Dr. Rawls is a physician who overcame Lyme disease through natural herbal therapy. You can learn more about Lyme disease in Dr. Rawls’ new best selling book, Unlocking Lyme.
You can also learn about Dr. Rawls’ personal journey in overcoming Lyme disease and fibromyalgia in his popular blog post, My Chronic Lyme Journey.

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