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Heartland Virus Symptoms: What We Know About This Tick-Borne Disease
Heartland virus symptoms can resemble several bacterial tick-borne diseases.
Diagnosis is challenging because early illness often mimics ehrlichiosis.
There is currently no approved vaccine or specific antiviral treatment.
Heartland virus symptoms commonly include fever, fatigue, headache, muscle aches, diarrhea, and loss of appetite. Because these findings overlap with several tick-borne diseases, diagnosis can be challenging.
Heartland virus disease was first identified after two Missouri farmers became ill in 2009 with fever, leukopenia, and thrombocytopenia. The virus has since been linked primarily to the lone star tick, Amblyomma americanum, and has been reported in the Midwest, South, and parts of the eastern United States.
Individuals with the virus have reported becoming ill within a few days to approximately two weeks after being bitten by a tick. Because the early symptoms overlap with ehrlichiosis, anaplasmosis, and other tick-borne diseases, diagnosis can be difficult.
There is no commercially available routine test for Heartland virus. Testing is generally coordinated through state health departments and the CDC. There is no approved vaccine to prevent the disease and no specific antiviral treatment for Heartland virus infection.
How many Heartland virus cases have been reported?
More than 60 laboratory-confirmed human cases have been reported, although experts believe the true number is likely higher because testing is limited and the illness may be underrecognized.
A 2024 review described Heartland virus as an underreported emerging infection. The authors noted that the expanding range of the lone star tick, limited surveillance, and the absence of widely available testing may contribute to underrecognition of the disease.
According to a review article by Brault and colleagues, from the CDC, illness onset in published cases occurred primarily between April and September, with the majority of symptoms developing in June. The median age of patients was 66 years.
What are the symptoms of Heartland virus?
“All ten patients presented or had a history of acute onset of fever,” wrote Brault and colleagues. “Rash is typically not reported, though some case-patients reported a local rash that was often associated with their original tick bite.”
Reported Heartland virus symptoms may include:
- Fever
- Fatigue
- Headache
- Muscle aches
- Joint pain
- Loss of appetite
- Nausea
- Diarrhea
- Weight loss
- Confusion or altered mental status in some severe cases
Several patients have reported a confused mental state. Out of the 10 earlier published 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.”
[bctt tweet=”Heartland virus symptoms can resemble ehrlichiosis, but antibiotics do not treat the virus itself.” username=”DrDanielCameron”]
Why Heartland virus can be difficult to diagnose
Heartland virus disease can resemble ehrlichiosis because both illnesses may present with fever, low white blood cell counts, low platelet counts, and elevated liver enzymes. Ehrlichiosis, however, can often be treated successfully with doxycycline, while Heartland virus does not respond to antibiotics.
All individuals with acute Heartland virus disease in early reports had thrombocytopenia at presentation, and 9 also had leukopenia. These clinical signs are also seen with ehrlichiosis. Therefore, a lack of response to antimicrobial therapy may raise suspicion for a viral cause, including Heartland virus, when the clinical picture and exposure history fit.
Because no commercial laboratory routinely offers Heartland virus testing, diagnosis generally requires coordination with state public health laboratories or the CDC.
Health-care providers should consider Heartland virus testing in patients who develop fever, leukopenia, and thrombocytopenia without a more likely explanation, particularly if testing for Ehrlichia and Anaplasma is negative or the patient does not improve with doxycycline therapy.
Is there a treatment for Heartland virus?
There are no approved antiviral medications to treat Heartland virus disease. Treatment is supportive and may include rest, fluids, fever control, pain relief, and monitoring. Patients with severe illness may require hospitalization for intravenous fluids, blood pressure support, respiratory support, or other intensive care measures.
Because early Heartland virus symptoms can resemble treatable tick-borne infections, clinicians may initially prescribe doxycycline while evaluating for ehrlichiosis, anaplasmosis, Rocky Mountain spotted fever, and other infections. However, antibiotics are not active against Heartland virus because it is caused by a virus rather than bacteria.
What is new in Heartland virus research?
Recent research suggests that Heartland virus may be more geographically established than early case counts suggested. Surveillance studies have detected Heartland virus in lone star ticks in multiple states, and a 2025 Georgia study found persistent Heartland virus-positive tick populations across multiple years.
The 2025 Georgia surveillance study screened more than 21,000 field-collected ticks from 2021 to 2023 and identified Heartland virus-positive pools of Amblyomma americanum. The authors found that Georgia Heartland virus sequences were highly related across time and distance, suggesting focal persistence and local transmission ecology.
Researchers continue to study Heartland virus pathogenesis, transmission, diagnostics, and prevention. However, at this time, there is still no approved vaccine and no approved antiviral therapy for human Heartland virus disease.
How can Heartland virus be prevented?
Prevention depends on reducing tick exposure. The CDC recommends using EPA-registered insect repellents, wearing long sleeves and long pants when outdoors, avoiding brushy or wooded areas when possible, and performing tick checks after spending time outside.
EPA-registered repellents may include products containing DEET, picaridin, IR3535, oil of lemon eucalyptus, para-menthane-diol, or 2-undecanone. Clothing and gear can also be treated with permethrin according to product instructions.
Because Heartland virus is linked primarily to the lone star tick, prevention is especially important in areas where Amblyomma americanum is common. Prompt tick removal and awareness of symptoms after a tick bite are important parts of reducing risk from tick-borne diseases.
Frequently Asked Questions
What are the symptoms of Heartland virus?
Heartland virus symptoms may include fever, fatigue, headache, muscle aches, joint pain, loss of appetite, nausea, diarrhea, and weight loss. Some patients may develop confusion or more severe illness requiring hospitalization.
How soon do Heartland virus symptoms appear after a tick bite?
Symptoms may begin within a few days to approximately two weeks after a tick bite. Many reported patients recalled tick exposure in the two weeks before becoming ill.
Can Heartland virus be diagnosed with a blood test?
There is no widely available commercial blood test for Heartland virus. Testing is generally coordinated through public health laboratories or the CDC when Heartland virus is suspected.
Is Heartland virus deadly?
Heartland virus can be serious and has been fatal in some reported cases, particularly among older patients or individuals with underlying medical conditions. Most reported hospitalized patients have recovered, but severe illness can involve multiorgan failure.
Is there a treatment for Heartland virus?
There is no approved antiviral treatment for Heartland virus disease. Care is supportive and may include fluids, fever control, monitoring, and hospitalization for severe illness.
Is there a Heartland virus vaccine?
There is currently no approved vaccine to prevent Heartland virus disease. Prevention depends on avoiding tick bites and reducing exposure to lone star ticks.
Clinical Takeaway
Heartland virus disease remains uncommon but clinically important because it can resemble other tick-borne infections, especially ehrlichiosis. Fever, fatigue, gastrointestinal symptoms, low white blood cell counts, and low platelet counts after a tick bite should prompt consideration of several tick-borne diseases.
Because there is no approved antiviral treatment or vaccine for Heartland virus, clinicians must rely on exposure history, laboratory findings, public health testing, and supportive care. A lack of response to doxycycline may be one clue that the illness is not caused by a treatable bacterial tick-borne infection.
Heartland virus should remain on the differential diagnosis when a patient develops fever, leukopenia, and thrombocytopenia after tick exposure and does not improve as expected with standard antimicrobial therapy.
Related Articles
These related articles discuss other tick-borne infections, diagnostic challenges, and clinical presentations that can overlap with Heartland virus disease.
Ehrlichiosis and Lyme disease
Anaplasmosis symptoms and diagnosis
Tick-borne diseases
Can one tick bite cause multiple diseases?
Tick bite prevention
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.
- Centers for Disease Control and Prevention. Heartland Virus: Statistics and Maps. CDC.
- Brault AC, Savage HM, Duggal NK, Eisen RJ, Staples JE. Heartland Virus Epidemiology, Vector Association, and Disease Potential. Viruses. 2018;10(9):498.
- Dembek ZF, Mothershead JL, Cirimotich CM, Wu A. Heartland Virus Disease—An Underreported Emerging Infection. Microorganisms. 2024;12(2):286.
- Feng K, Ushie BB, Zhang H, et al. Pathogenesis and virulence of Heartland virus. Virulence. 2024;15(1):2348252.
- Bellman S, Shariatzadeh N, Ferrell T, et al. Focal persistence and phylodynamics of Heartland virus in Georgia. Virus Evol. 2025;11(1):veaf064.
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
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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.