Is Lyme Disease Spreading to Tennessee and the Southeast?

Lyme disease cases may be increasing in Tennessee and the Southeast
Researchers have identified infected blacklegged ticks in parts of Tennessee
Expanding tick populations may complicate diagnosis in emerging regions

Many people ask whether Lyme disease exists in Tennessee or whether ticks in Tennessee carry Lyme disease. While Tennessee has historically reported fewer cases than Northeastern states, studies suggest infected ticks and locally acquired infections are increasingly being recognized.

In 2015, Lantos and colleagues described cases of Lyme disease occurring in Tennessee. Their study, Geographic Expansion of Lyme Disease in the Southeastern United States, 2000–2014, reported that human Lyme disease cases had expanded southward along the eastern foothills of the Appalachian Mountains and into nearby regions.

Investigators also identified infected blacklegged ticks approximately 100 kilometers away in the Tennessee Valley, raising concern that Lyme disease risk may be shifting geographically.

Travel patterns, environmental change, wildlife migration, and changing tick habitats may all contribute to expansion patterns. These trends can complicate diagnosis in areas traditionally considered lower risk.

Do ticks in Tennessee carry Lyme disease?

Two years later, investigators took a closer look at blacklegged ticks infected with Borrelia burgdorferi in the Tennessee Valley. Hickling and colleagues from the University of Tennessee Institute of Agriculture surveyed forests during peak deer tick activity between October and January.

An image from the study illustrates surveillance efforts examining infected blacklegged ticks within the Tennessee Valley region rather than implying uniform risk across the entire state.

The investigators collected 479 deer ticks from the upper Tennessee Valley and identified Ixodes scapularis ticks in all 26 counties surveyed. Of these ticks, 46 (9.6%) were infected with Borrelia species.

The infected ticks were identified in Anderson, Claiborne, Hamilton, and Union counties. Two Union County sites demonstrated infection prevalences of 44% and 78%, suggesting localized hot spots may exist.

Is Lyme disease common in Tennessee?

Lyme disease remains less common in Tennessee than in highly endemic Northeastern states. However, emerging evidence suggests that clinicians and patients should avoid assuming Lyme disease cannot occur locally.

Delayed recognition remains an important concern because symptoms may overlap with other illnesses and early cases may be missed. Understanding common presentations using the Lyme disease symptoms guide may improve recognition.

Patients with persistent neurologic complaints or prolonged symptoms may also face challenges related to delayed Lyme disease diagnosis, particularly in regions where Lyme disease is considered uncommon.

Why are investigators concerned about spread in the Southeast?

The authors suggested that “immigrant ticks from the North” may contribute to changing patterns within the Tennessee Valley.

They speculated that infected I. scapularis populations emerging in southwestern Virginia and neighboring regions may increase human exposure risk if host-seeking behavior changes.

Health officials and clinicians continue to emphasize vigilance as geographic patterns evolve.

Frequently Asked Questions

Is Lyme disease common in Tennessee?

Lyme disease remains less common in Tennessee than in Northeastern states, but evidence suggests infected ticks and human cases are increasingly recognized.

Do ticks in Tennessee carry Lyme disease?

Studies have identified blacklegged ticks carrying Borrelia burgdorferi in several Tennessee counties, particularly within the Tennessee Valley region.

Can you get Lyme disease in Tennessee?

Yes. Researchers have documented locally acquired cases and infected tick populations in parts of Tennessee.

Are Lyme disease cases expanding into the Southeast?

Multiple studies suggest Lyme disease risk may be expanding geographically into parts of the Southeast, although distribution remains uneven.

Why is Lyme disease harder to diagnose in emerging regions?

Clinicians may not immediately suspect Lyme disease in lower-incidence states, increasing the risk of delayed recognition and diagnosis.

Clinical Takeaway

Tennessee remains a lower-incidence state compared with the Northeast, but emerging surveillance data suggest clinicians should remain alert to changing geographic patterns.

Assuming Lyme disease cannot occur in Tennessee may increase the risk of delayed diagnosis as infected tick populations expand.

Related Articles

These related articles explore Lyme disease expansion, surveillance challenges, and diagnosis in emerging regions.

Hundreds of Lyme disease patients in Tennessee
CDC advises doctors to consider Lyme disease in emerging states
Lyme disease misdiagnosis
Lyme coinfections
Prevention of Lyme disease

References

1. Rosen ME, Hamer SA, Gerhardt RR, Jones CJ, Muller LI, Scott MC, et al. Borrelia burgdorferi not detected in widespread Ixodes scapularis collected from white-tailed deer in Tennessee. J Med Entomol. 2012;49:1473–1480.
2. Lantos PM, Nigrovic LE, Auwaerter PG, et al. Geographic expansion of Lyme disease in the southeastern United States, 2000–2014. Open Forum Infect Dis. 2015;2(4):ofv143.
3. Hickling GJ, Kelly JR, Auckland LD, Hamer SA. Increasing prevalence of Borrelia burgdorferi sensu stricto-infected blacklegged ticks in Tennessee Valley, Tennessee, USA. Emerg Infect Dis. 2018;24(9).

---

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