Heartland Virus Symptoms: What We Know About This Rare Tick-Borne Infection
Symptoms resemble Lyme disease
Illness begins weeks after a bite
No test, treatment, or vaccine
Severe cases can require hospitalization
Heartland virus symptoms often resemble other tick-borne illnesses, making diagnosis difficult and delaying appropriate care.
Patients typically experience fever, headache, fatigue, and muscle or joint aches—symptoms that overlap with Lyme disease and ehrlichiosis.
Additional symptoms may include:
- Loss of appetite
- Diarrhea
- Generalized weakness
Illness usually develops about two weeks after a tick bite.
No Test, No Treatment, No Vaccine
Heartland virus presents a significant clinical challenge:
- No widely available diagnostic test
- No approved antiviral treatment
- No vaccine for prevention
Care is primarily supportive.
This makes early recognition and differentiation from treatable tick-borne diseases especially important.
Where and When Cases Occur
Since its identification in 2012, more than 35 cases have been reported in the Midwest and southern United States.
A review by Brault and colleagues found:
- Most cases occurred between April and September
- Peak symptom onset occurred in June
- Median patient age was 66 years
“All ten patients presented or had a history of acute onset of fever,” the authors report.
Rash is uncommon, though some patients noted a localized rash at the tick bite site.
Severe Illness and Hospitalization
Heartland virus infection can lead to serious complications.
Among 10 reported cases:
- 8 required hospitalization
- 7 recovered
- 3 died
Several patients developed confusion or altered mental status.
Severe disease appears more likely in older adults or those with underlying health conditions.
Laboratory Findings and Diagnostic Clues
Patients with Heartland virus often present with:
- Thrombocytopenia (low platelets)
- Leukopenia (low white blood cells)
These findings overlap with ehrlichiosis, a bacterial tick-borne illness.
However, ehrlichiosis typically improves with antibiotics—Heartland virus does not.
This lack of response to antimicrobial therapy may help differentiate the conditions.
Why This Matters Clinically
Heartland virus remains poorly understood.
As the authors conclude, “the full extent of the human disease risk… is not currently established.”
This uncertainty makes awareness critical—especially in patients who do not respond to standard treatment for tick-borne infections.
For broader context, see tick-borne coinfections.
Clinical Takeaway
Heartland virus symptoms overlap with other tick-borne diseases but lack effective treatment options.
Failure to respond to antibiotics, combined with characteristic lab findings, may help raise suspicion.
Recognition is essential, particularly in high-risk regions and vulnerable patients.
Related Reading
References
- Pastula DM et al. MMWR, 2014.
- CDC Heartland virus statistics
- Brault AC et al. 2018
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
According to Dr. Daniel Cameron, MD, MPH, a nationally recognized expert on ticks, there are many tick-borne infections that pose a threat to humans and dogs. Below are some of the well known and recently surfaced tick-borne illnesses.
According to Dr. Daniel Cameron, MD, MPH, a nationally recognized expert on ticks, there are many tick-borne infections that pose a threat to humans and dogs. Below are some of the well known and recently surfaced tick-borne illnesses.
I had a severe case of Heartland tick Virus July 2017. I had horrible tremors, hemorrragic diarrhea, headache high fever, the worse nausea of my life. I had hallucinations and confusion from the Ativan they gave to try and decrease the nausea. Lab work horrible , very low platelets, wbc, and renal failure. Have bouts of exhaustion, and my memory has never been the same. In all the literature search I find nothing about long term effects. I have not regained my previous energy, a lot of days feel ill and my brain does not work as well.
I have also not read about long term effects. I typically look for treatable tick-borne infections if I have evidence of a tick-borne infection e.g. Poowassan virus.
My husband had a severe case of heartland virus last July and also developed HLH. His short term memory is non existent and he also says “my brain doesn’t work right” He has seen his regular doctor (after discharge from hospital) who referred us to neurologist when we mentioned the cognitive decline, but the neurologist ignored his complaints. We are at a loss on where to turn for help…it’s been almost a year now and he is not able to return to work do to the cognitive impacts from this virus. Have you had any luck with a physician that’s is knowledgeable on this virus?
I would advise my patients to revisit Lyme disease. A positive Heartland virus suggests a tick borne infection. The tests for these tick borne infections may not be positive. I would have had to consider antibody treatment even if the tests are negative.
According to Dr. Daniel Cameron, MD, MPH, a nationally recognized expert on ticks, there are many tick-borne infections that pose a threat to humans and dogs. Below are some of the well known and recently surfaced tick-borne illnesses.
According to Dr. Daniel Cameron, MD, MPH, a nationally recognized expert on ticks, there are many tick-borne infections that pose a threat to humans and dogs. Below are some of the well known and recently surfaced tick-borne illnesses
As of 12/7/22, the CDC lists the following disease at https://www.cdc.gov/ticks/diseases/index.html
Anaplasmosis Babesiosis Borrelia mayonii Borrelia miyamotoi Bourbon virus Colorado tick fever Ehrlichiosis Heartland virus Lyme disease Powassan disease Rocky Mountain spotted fever (RMSF) STARI (Southern tick-associated rash illness) Tick-borne relapsing fever (TBRF) Tularemia 364D rickettsiosis (Rickettsia phillipi, proposed)
According to Dr. Daniel Cameron, MD, MPH, a nationally recognized expert on ticks, there are many tick-borne infections that pose a threat to humans and dogs. Below are some of the well known and recently surfaced tick-borne illnesses.