Confession: I never check myself for ticks after I go on a hike, even though I know I should. I’m usually thumbing through all the pictures I took to find the ideal Instagram shot instead of combing over my body for blood-sucking creatures. But even if you’re one of those responsible people who is diligent about checking for ticks after you’ve been outdoors, you may be most familiar with Lyme disease, an illness you can get if a deer tick (commonly know as a blacklegged tick) bites you.
It totally makes sense if you immediately think of Lyme disease while you’re doing a tick check or even remotely thinking about ticks. The Centers for Disease Control and Prevention (CDC) estimates that there are around 300,000 diagnosed cases of Lyme disease each year in the United States, making Lyme is the most commonly diagnosed tick-borne illness in this country. So, having Lyme on your radar certainly isn’t a bad thing. And some ticks (like deer ticks) can carry multiple illnesses. Even if you’re only checking for ticks with Lyme in mind, you could be cutting down on your risk of being bitten by those that carry other illnesses.
The more you know about tick-borne illnesses and where they’re most common, the more you can help your doctor parse through any symptoms you have if necessary. Here are a few non-Lyme tick-borne illnesses you should keep on your radar.
If you live in the Northeast or upper Midwest (including places like New England, New York, or Wisconsin) let’s chat a bit about babesiosis. Like Lyme, this illness is transmitted by deer ticks in warm months, according to the CDC. But while Lyme disease is caused by bacteria called Borrelia burgdorferi, babesiosis is caused by the Babesia parasite, which attacks red blood cells, according to the CDC.
Many people who have babesiosis never actually show any symptoms, the CDC says, in which case this is basically a harmless infection that typically doesn’t require any treatment. But some people begin to show flu-like symptoms like a loss of appetite, fever, fatigue, body aches, headache, and nausea anywhere from a week to a few months after being infected, the CDC says. It’s also worth mentioning that because the Babesia parasite destroys red blood cells, you might get something called hemolytic anemia, which is a disorder where red blood cells are destroyed faster than your body can make them, the Mayo Clinic says. This can lead to additional symptoms like shortness of breath, cold hands and feet, and weakness. And, if you’re immunocompromised for any reason, babesiosis can be severe and even life-threatening, the CDC says.
If you’re dealing with these types of symptoms, see your doctor. “These tick-borne diseases are really hard to diagnose in general, because so many things cause fatigue and [similar] symptoms,” Seemay Chou, Ph.D., assistant professor in the Department of Biochemistry & Biophysics at the University of California, San Francisco, tells SELF. “It’s really hard for a doctor to just think, ‘This is Lyme’ or ‘This is babesiosis,’” says Chou, whose research examines the relationship between ticks and the various pathogens they carry.
To help figure out what’s going on, your doctor might perform blood tests to identify the Babesia parasite, the CDC says. If you do have babesiosis, your doctor may prescribe anti-parasite medications, according to the CDC.
2. Rocky Mountain spotted fever
Rocky Mountain spotted fever (RMSF) occurs throughout the United States, but over 60 percent of all reported cases happen in Tennessee, North Carolina, Oklahoma, Arkansas, and Missouri, according to the CDC. Cases are also rising in Arizona. Wherever you are, RMSF is most commonly transmitted in the summer months (granted, these ticks are equal-opportunists that can bite people in other warm seasons, or even in the winter in warmer parts of the country), the CDC says.
The type of tick most likely to carry this disease depends on your area; for instance, if you’re in the Eastern United States, it’s most likely to be the American dog tick, the CDC says. If you’re in a state that houses the Rocky Mountains, it probably won’t surprise you to hear that the Rocky Mountain wood tick would usually be the one to give you this illness.
Signs of RMSF can set in within a day of getting bitten. Naturally, fever is a big one, along with things like headache, nausea and vomiting, stomach pain, muscle pain, and a fading appetite, the CDC says. These symptoms are pretty nebulous and can be a fit for so many conditions, but there is one hallmark RMSF sign to keep in mind: Two to four days after your body temperature starts climbing, you can develop a distinct rash that looks like red splotches or pinpoints, the CDC says. (However, around 10 percent of people with RMSF don’t develop such a rash.) If you notice this rash—or think you have other symptoms that could point to RMSF—see a doctor as soon as possible. This illness can become serious or even life-threatening as soon as five days post-infection, the CDC says. At that point, you’re at risk for complications like coma, brain swelling, comas, and significant trouble breathing.
That’s obviously scary to read, but doctors can treat RMSF with antibiotics, the CDC says. Getting those drugs ASAP is of the essence.
3. Borrelia miyamotoi disease
If you happen to be an outdoors aficionado living or vacationing in the upper Midwest, the Northeast, or any mid-Atlantic states, you might want to be on the lookout for symptoms of Borrelia miyamotoi disease, the CDC says. July and August are prime months for Borrelia miyamotoi disease infection. Experts view it “kind of like a cousin to Lyme disease” since that infamous deer tick can cause both of these conditions, Shannon Delaney, M.D., assistant professor of psychiatry at Columbia University Irving Medical Center and director of Child and Adolescent Evaluation at the Lyme & Tick-Borne Disease Research Center, tells SELF.
Unlike Lyme disease and some of the other tick-borne illnesses on this list, Borrelia miyamotoi disease symptoms don’t commonly feature a rash, according to the CDC. More typical signs of Borrelia miyamotoi disease are fever, chills, intense headache, muscle and joint aches, and fatigue, which can all set in within days to weeks after infection. The lack of a rash might sound like a good thing. At least that’s one less symptom to worry about, right? But actually, something as unusual as a rash is often what helps people realize they need to see a doctor, Dr. Delaney says. Otherwise, they might just think these symptoms are due to something like the cold or flu.
“When they don’t have the rash … they don’t think they have a tick-borne illness, and they don’t get tested,” Dr. Delaney says. Going in to see a doctor for testing is the only way you’ll get proper treatment for something like Borrelia miyamotoi disease.
In order to diagnose you with Borrelia miyamotoi disease, a doctor can evaluate your symptoms and run lab tests, like looking for specific antibodies in your system, the CDC says. While there isn’t a definitive treatment regimen for this condition, the antibiotic doxycycline has been shown to help patients who have it, the CDC says.
4. Powassan virus
Powassan virus is typically found in the Northeast and Great Lakes region of the United States, but there have been cases in other parts of the country as well, according to the CDC. Infection with this virus most commonly happens from late spring into mid-fall, the CDC says. (So, there’s a very inconvenient overlap there with when you may be most likely to be outside enjoying nature.)
We’ll give you a guess as to one type of tick that spreads Powassan virus. If your answer is…drum roll…the deer tick, congratulations: You’re starting to realize just how many illnesses those creepy little dudes can carry. In addition to the deer tick, the squirrel and groundhog ticks can also spread this illness, the CDC says.
One thing that makes Powassan virus so concerning is how quickly infection can occur, Chou says. While it can take hours for a tick to infect someone with various other illnesses, Powassan virus infection can happen in as little as 15 minutes, Chou says.
A lot of people with Powassan virus won’t actually have any symptoms, the CDC says, in which case no treatment is necessary. But some people with Powassan virus can start to experience symptoms like fever, weakness, headache, and vomiting a week to a month after infection, the CDC says.
Unlike some other types of tick-borne illnesses, Powassan virus can progress into a dangerous condition that infects a person’s brain or the membranes surrounding their brain and spinal cord, the CDC says. Symptoms that the illness has gotten to this point can include seizures, confusion, and trouble speaking and moving normally. In rarer cases, this can lead to death, and when people survive, they may deal with long-term health effects like memory issues, the CDC explains.
If a doctor suspects you have Powassan virus, they might do lab testing on your blood or spinal fluid, the CDC says. The thing is that there isn’t a specific medication or course of treatment for Powassan virus, as the CDC explains. If someone has a milder case, doctors typically try to treat the symptoms until the virus passes. People with more severe versions of the illness are usually hospitalized so doctors can address complications like brain swelling.
5. Colorado tick fever
Colorado tick fever is transmitted by the Rocky Mountain wood tick (yup, it’s confusing). It most often occurs in the western United States and western Canada, specifically in areas that are 4,000 to 10,000 feet above sea level, according to the CDC. Spring and summer are the most common times for infection, the CDC says. (Weirdly enough, this virus can also be transmitted via blood infusion or bone marrow transplant, although that’s really rare.)
Like many other tick-borne illnesses, the symptoms include—say it with us now—fatigue, nausea, chills, headache, and fever, the CDC says. But about that last one: One of the more unique features of Colorado tick fever is something called “biphasic” fever, which affects about half of people with this condition, according to the CDC. This means you can have a fever that goes away after a few days only to return several days later for a shorter period of time. Basically, you think you’re getting better, but it’s really just your body playing a cruel trick on you. Rarely, Colorado tick fever can cause more severe symptoms by impacting the central nervous system, the CDC explains. In that case, someone might experience symptoms like a stiff neck and confusion. Even then, it’s exceedingly rare for Colorado tick fever to become deadly.
A doctor can run lab tests to detect Colorado tick fever, like by examining your blood for material from the virus, the CDC says. There’s no treatment regimen for regular cases of the illness, according to the CDC, but if you have a severe case, it could require hospitalization and treatment with IV fluids and meds to reduce your symptoms.
This potentially serious illness, which has been reported in every state except Hawaii, happens due to Francisella tularensis bacteria, according to the CDC. You can actually pick up this bacteria in a ton of ways. Since it’s on this list, ticks are clearly one of them—the dog tick, the wood tick, and the lone star tick can all transmit this illness, according to the CDC. But you can also get it through contact with various animals ranging from wild rabbits to domestic cats, according to the CDC. Beyond that, tularemia infection can happen from breathing in matter such as dust that contains Francisella tularensis bacteria, like while gardening.
Because tularemia can be transmitted in so many different ways, it can manifest in a bunch of different ways, too. With that said, if you do have this illness, you might experience symptoms like fever, chills, headache, fatigue, coughing, sore throat, vomiting, diarrhea, and abdominal pain, the CDC says. In the most common form of this illness, which is called ulceroglandular tularemia, you might also develop skin ulcers at the part of your body where you got infected, the CDC says, along with swollen lymph glands in areas like your armpits or groin.
The CDC says that tularemia can be diagnosed through lab tests to ID the bacteria, and antibiotics, including doxycycline, can be an effective treatment.
7 and 8. Anaplasmosis and ehrlichiosis
Even though anaplasmosis and ehrlichiosis are transmitted by different ticks (and exist in different regions), they are often mentioned together because they’re wildly similar in a lot of ways, according to the CDC.
Anaplasmosis is transmitted by the deer tick and is most prevalent in the Northeast and the upper Midwest. Cases of anaplasmosis have also cropped up in other parts of the country, including along the West Coast, where it is transmitted by the western blacklegged tick, the CDC says. On the other hand, ehrlichiosis is transmitted by the lone star tick and the deer tick, and is usually found in Southeastern and South-central parts of the country, the CDC reports. As with a lot of the other conditions on this list, these infections are most likely to occur in the spring and summer months, both with peaks in June and July.
For both anaplasmosis and ehrlichiosis, symptoms typically start within two weeks after the bite. Both can cause the same signs of infection that, after reading this list, probably scream “tick bite” to you, like fever, chills, headache, muscle aches, nausea, vomiting, diarrhea, and loss of appetite. One major difference is that getting a rash isn’t super common with anaplasmosis, but one out of three people do see a rash develop if they have ehrlichiosis, the CDC says. (This typically looks splotchy and red or like tiny pinpricks.)
Blood testing can help diagnose both anaplasmosis and ehrlichiosis, and both can also be treated with antibiotics. However, getting treatment ASAP if you experience symptoms is incredibly important. Both of these conditions can cause serious complications like respiratory failure, bleeding problems, and even death in rare cases, according to the CDC.
Here’s how to keep ticks away from you.
Perhaps like you on that ex’s Instagram page, ticks are total lurkers. “One thing people don’t realize is that ticks don’t fly,” Chou says. Instead, they’re sort of waiting for an opportunity to hitch a ride on you (or some other animal).
To protect yourself against this, the CDC recommends being aware of which areas are most likely to hide ticks, like grassy, wooded spots. If generally avoiding those areas isn’t an option—we see you, avid hikers, campers, and gardeners—at least dress for the occasion, like by wearing pants you can tuck into socks so your legs and ankles aren’t exposed, and try to stay on trails rather than fully bushwacking your way through the wilderness.
When exploring the great outdoors, the CDC suggests wearing a repellant that contains ingredients like DEET, picaridin, IR3535, oil of lemon eucalyptus, para-menthane-diol (PMD), or 2-undecanone. These are all ingredients “registered” by the Environmental Protection Agency (EPA), meaning there is data to show they’re safe and effective. Also, consider treating things like your clothes, shoes, and camping gear with products that contain 0.5 percent of the insecticide permethrin, which stays effective for several washes, the CDC says (or buy gear pre-treated with this chemical). Then, after you get home from an outdoorsy trip, wash your clothes in hot water and run them through the dryer to kill any lingering ticks, the CDC says.
Even if you can firmly say you’re never going to go on a hike in your life, depending on where you live you could still pick up ticks in areas like parks or even backyards, Dr. Delaney says. If you have any pets that hang out outdoors, like dogs, they can also transmit ticks to you.
All of this means that whether you were on an epic backpacking trip or just running around with your dog at your local park, you should be aware of any ticks that tend to live in your area. Then, when you get home, do a tick check (and check your pet if necessary, too): Look over your whole body, including easy-to-miss spots like your elbows, ears, along your hairline, the backs of your knees, and even inside your bellybutton, the CDC says. You can do this while showering, which the CDC recommends doing within two hours of going inside. (As a bonus, a hot shower can be very effective at removing unattached ticks.)
And if you realize that, aw hell, a tick did wind up biting you? Don’t panic. We have a full guide for exactly how to handle a tick bite right here.