Heartland Virus Symptoms: Fever, Fatigue, and Severe Illness
Symptoms may resemble other tick-borne illnesses
Severe illness can require hospitalization
Diagnosis and treatment remain challenging
Heartland virus symptoms can resemble several other tick-borne illnesses, making diagnosis difficult. Patients may develop fever, headaches, muscle aches, fatigue, diarrhea, and abnormal laboratory findings including low platelet and white blood cell counts.
So, what do we actually know about this potentially deadly virus? Symptoms are similar to those seen with other tick-borne illnesses. Patients may experience fever, headaches, joint and muscle aches, fatigue, loss of appetite, and diarrhea.
Individuals with the virus have reported becoming ill about two weeks after being bitten by a tick.
What do published Heartland virus cases show?
Since 2012, more than 35 cases have been reported in the Midwest and southern United States. Ten patient cases have been described in the literature. According to a recent review article by Brault and colleagues from the CDC, illness onset occurred primarily between April and September with the majority of symptoms developing in June. The median age of patients was 66 years.
“All ten patients presented or had a history of acute onset of fever,” writes Brault. “Rash is typically not reported, though some case-patients reported a local rash that was often associated with their original tick bite.”
Several patients reported a confused mental state. Out of the 10 cases, 8 people required hospitalization. Seven individuals recovered and 3 died.
“Two of the three fatal cases had multiple underlying medical comorbidities,” Brault explains, “while the third was noted to have a history of intracerebral hemorrhage, melanoma, and hypertension.”
How is Heartland virus diagnosed?
Diagnosis remains challenging because testing is not widely available and many symptoms overlap with other tick-borne infections. Laboratory abnormalities including thrombocytopenia and leukopenia may raise suspicion.
Both thrombocytopenia and leukopenia are also seen with illnesses such as ehrlichiosis and other tick-borne coinfections, making diagnosis more complicated.
Can Heartland virus be confused with ehrlichiosis?
All individuals with acute Heartland virus disease had thrombocytopenia at presentation and 9 also had leukopenia. These laboratory abnormalities are commonly seen with ehrlichiosis as well.
However, unlike ehrlichiosis, which can often improve with antibiotic therapy, Heartland virus does not appear to respond to antimicrobials. A poor response to antibiotics may help clinicians consider alternative diagnoses.
Is there treatment for Heartland virus?
There is currently no approved antiviral treatment or vaccine for Heartland virus disease. Management remains supportive and may require hospitalization for severe illness.
Because symptoms overlap with bacterial tick-borne infections, clinicians may initially evaluate patients for other vector-borne illnesses.
Can Heartland virus be fatal?
Severe illness has been reported. In the review of ten published cases, eight patients required hospitalization and three died. Researchers caution that the full disease burden remains uncertain because infections may be underrecognized.
It has been more than a decade since Heartland virus disease was first identified and many unanswered questions remain. As the authors conclude, “the full extent of the human disease risk that [Heartland virus] presents is not currently established.”
Frequently Asked Questions
What are the most common Heartland virus symptoms?
Fever, fatigue, muscle aches, headaches, diarrhea, and abnormal blood counts are commonly reported.
How soon do symptoms begin after a tick bite?
Reported cases suggest symptoms may develop approximately two weeks after exposure.
Can antibiotics treat Heartland virus?
No. Antibiotics do not appear effective because Heartland virus is caused by a virus rather than bacteria.
How common is Heartland virus disease?
Reported cases remain uncommon, but researchers believe infections may be underrecognized.
Can Heartland virus cause death?
Fatal cases have been reported, particularly among individuals with severe disease or underlying health conditions.
Clinical Takeaway
Heartland virus symptoms overlap considerably with other tick-borne illnesses, which can delay diagnosis and treatment decisions. Low blood counts, fever, fatigue, and severe illness requiring hospitalization have all been reported.
Clinicians should consider Heartland virus in patients with compatible symptoms, tick exposure, and laboratory abnormalities that do not fit more common tick-borne diseases.
Related Articles
Related articles:
Lyme disease misdiagnosis
Testing limitations in tick-borne disease
Neurologic Lyme disease
Delayed Lyme disease diagnosis
Lyme disease symptoms guide
References
- Pastula DM, Turabelidze G, Yates KF, et al. Heartland Virus Disease — United States, 2012–2013. MMWR Morb Mortal Wkly Rep. 2014;63(12):270-271.
- CDC. Heartland Virus: Statistics & Maps. Accessed May 30, 2026.
- Brault AC, Savage HM, Duggal NK, Eisen RJ, Staples JE. Heartland Virus Epidemiology, Vector Association, and Disease Potential. Viruses. 2018;10(9):498.
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.