Is There Lyme Disease in Texas? What the Research Shows

Can Lyme disease occur in Texas?
Blacklegged ticks have been identified in multiple Texas counties.
Research suggests Lyme disease is uncommon but should not be overlooked.

Can you get Lyme disease in Texas?

Yes. Lyme disease occurs in Texas, although it is much less common than in the Northeastern United States. Blacklegged ticks (Ixodes scapularis) have been identified in multiple Texas counties and are the principal vector of Lyme disease in the eastern United States. While the overall risk of Lyme disease is lower in Texas than in highly endemic regions, the diagnosis should not be dismissed solely because a patient lives in—or was bitten by a tick in—Texas.

Patients who develop an expanding rash, fever, facial weakness, arthritis, or neurologic symptoms following a tick bite deserve an individualized evaluation. Early diagnosis can be challenging because Lyme disease testing has important limitations, particularly during the first few weeks of illness.

More recent research has reinforced these diagnostic challenges. In a survey of patients with chronic Lyme disease symptoms in Texas, Maxwell and colleagues found that individuals with clinically diagnosed Lyme disease reported symptom severity and quality-of-life impairment comparable to those with serologically confirmed disease. The authors concluded that clinicians in non-endemic regions should consider Lyme disease when patients have compatible multisystem symptoms and other causes have been excluded. [1]

This expansion into new geographic areas includes regions in the South that were once thought to be largely free of ticks carrying Borrelia burgdorferi, the bacterium that causes Lyme disease. Investigators have identified blacklegged ticks (Ixodes scapularis) in numerous Texas counties, demonstrating that established populations of the principal Lyme disease vector occur in parts of the state. While the western blacklegged tick (Ixodes pacificus) occurs farther west, it is I. scapularis that is relevant to Lyme disease transmission in Texas. Recognizing the symptoms of Lyme disease remains important when evaluating patients after a tick bite.

According to Rebecca Eisen, lead author of a study published in the Journal of Medical Entomology, investigators documented I. scapularis ticks in 71 (28%) of Texas’ 254 counties. Of these, 26 counties (10.2%) had established populations, defined as six or more ticks or more than one life stage collected during a single year. An additional 45 counties reported I. scapularis without sufficient evidence to classify the populations as established. [2]

Blacklegged ticks may be more widespread than surveillance suggests

Eisen cautioned that the true distribution of blacklegged ticks may be broader than currently documented because surveillance depends on available resources and collection efforts.

“Lack of tick records from a county does not imply that ticks are absent from that county, only that records of ticks having been collected in the county are lacking,” Eisen explained.

She further noted that “the lack of routine systematic surveillance across the continental United States of ticks of public health importance hampers our ability to define their current geographic distributions and to monitor changes in their ranges and densities over time.” [2]

In other words, the absence of surveillance data should not be interpreted as proof that blacklegged ticks—or the potential for Lyme disease—are absent from a county.

White-tailed deer studies support exposure to Borrelia burgdorferi

Additional evidence comes from investigators led by Adetunji at the College of Veterinary Medicine & Biomedical Sciences at Texas A&M University. The researchers examined antibodies to Borrelia burgdorferi in 1,493 white-tailed deer collected during Texas hunting seasons between 2001 and 2015. [3]

The findings were consistent with earlier reports documenting B. burgdorferi in humans and blacklegged ticks removed from animals in Texas during the 1980s and 1990s.

Adetunji also identified six additional publications between 2012 and 2016 describing the emergence of Lyme disease in the Texas-Mexico transboundary region, supporting continued surveillance. [3]

Using ELISA testing, investigators found that 4.7% of deer samples were reactive to Borrelia burgdorferi. Positive animals originated primarily from the Edwards Plateau and South Texas Plains ecoregions. The investigators also observed that positive deer samples corresponded with years in which Texas reported its highest numbers of Lyme disease cases to the CDC. [3]

Although white-tailed deer do not serve as the primary reservoir for Borrelia burgdorferi, they are important hosts for adult blacklegged ticks. Monitoring deer populations can therefore help researchers understand where Lyme disease vectors are becoming established.

Why were fewer deer positive on Western blot?

Only 0.5% of the deer samples were positive by a standardized IgG Western immunoblot assay. [4] Although this result was substantially lower than the ELISA findings, it should be interpreted cautiously.

In human Lyme disease, the IgG Western blot has recognized limitations and may fail to identify some patients with clinically diagnosed Lyme disease, particularly early in the illness or when immune responses vary. Several studies from endemic regions have documented these limitations. [5] Therefore, the lower percentage of positive Western blot results in deer should not be interpreted as evidence that Lyme disease is absent from Texas.

Adetunji and colleagues also emphasized another important limitation. There are no standardized Western blot criteria for white-tailed deer.

“There is a lack of standardized tests for WTD [white-tailed deer] and any information on their reactivity to specific Borrelia burgdorferi antigens,” the investigators explained. [3]

Because of these limitations, antibody results in deer cannot be interpreted the same way they are in humans.

How common is Lyme disease in Texas?

Lyme disease is considerably less common in Texas than in highly endemic states in the Northeast and Upper Midwest. Nevertheless, established populations of blacklegged ticks have been identified in multiple Texas counties, making Lyme disease an important consideration when patients present with compatible symptoms after a tick bite.

Geography alone should not determine the diagnosis. Physicians should consider a patient’s travel history, tick exposure, physical findings, and overall clinical presentation. An expanding erythema migrans rash, facial nerve palsy, arthritis, meningitis, or other neurologic symptoms may warrant evaluation for Lyme disease even in patients who live in Texas.

The Texas patient survey by Maxwell and colleagues illustrates this challenge. Individuals with clinically diagnosed Lyme disease reported symptom severity and quality-of-life impairment comparable to those meeting serologic criteria, supporting the importance of clinical judgment when evaluating patients with compatible multisystem illness in low-incidence regions. [1]

Likewise, a recent case report described a patient who presented in Texas with Lyme neuroborreliosis (Bannwarth syndrome) after travel to Pennsylvania. The case highlights that patients evaluated in Texas may acquire Lyme disease elsewhere, emphasizing the importance of obtaining a careful travel history rather than relying on geography alone. [6]

Likewise, a negative laboratory test early in the illness does not completely exclude Lyme disease because antibody tests may be negative during the first few weeks of infection. Understanding the limitations of Lyme disease testing can help prevent delayed diagnosis.

STARI can resemble early Lyme disease

Another important tick-borne illness in the South is Southern Tick-Associated Rash Illness (STARI). Unlike Lyme disease, STARI is associated with the Lone Star tick (Amblyomma americanum), one of the most common human-biting ticks in Texas.

STARI frequently produces an expanding rash that closely resembles the erythema migrans rash of Lyme disease, making the two conditions difficult to distinguish based on appearance alone.

The syndrome, sometimes referred to as Masters disease, was first described by Dr. Edwin Masters of Missouri. [7] Because no validated laboratory test currently exists for STARI, diagnosis depends on the patient’s history, tick exposure, rash, and geographic location.

Whether all cases currently diagnosed as STARI represent a distinct illness—or whether some may instead represent unrecognized Lyme disease—remains an area of ongoing research and debate. Because no validated laboratory test exists for STARI and early Lyme disease can also be seronegative, distinguishing between the two conditions may be difficult in some patients. Clinicians should therefore consider the entire clinical picture—including the patient’s symptoms, tick exposure, travel history, and follow-up course—rather than relying on geography alone.

Patients often confuse Lone Star ticks with blacklegged ticks. While Lone Star ticks can transmit several tick-borne illnesses and are associated with STARI, they are not considered established vectors of Lyme disease. Recognizing the difference between these tick species can help guide diagnosis and management following a tick bite.

Why this research matters

The Texas studies reinforce an important public health message: Lyme disease should not be considered exclusively a Northeastern illness. Established populations of blacklegged ticks have been documented in multiple Texas counties, and surveillance studies continue to improve our understanding of their geographic distribution.

Although this article focuses on Texas, similar diagnostic challenges may also arise in neighboring low-incidence states where blacklegged ticks are present and travel-associated Lyme disease occurs.

Newer clinical studies also demonstrate that physicians in Texas continue to encounter patients with Lyme disease, whether acquired locally or during travel to endemic regions. These reports emphasize careful clinical assessment, thoughtful interpretation of laboratory testing, and a detailed travel history when evaluating patients with compatible symptoms. [1,6]

For patients and clinicians, these findings reinforce that Lyme disease should remain part of the differential diagnosis after an appropriate tick exposure or compatible travel history.

As Eisen noted, people should recognize that ticks may be present in areas where they have not previously been reported. Continued surveillance, prompt tick removal, and early recognition of Lyme disease symptoms remain important strategies for reducing the impact of tick-borne diseases. [8]

Frequently Asked Questions

Is there Lyme disease in Texas?

Yes. Lyme disease occurs in Texas, although it is much less common than in the Northeastern United States. Blacklegged ticks have been identified in multiple Texas counties, and physicians should consider Lyme disease when patients have compatible symptoms and tick exposure.

Do Texas ticks carry Lyme disease?

Some do. Blacklegged ticks (Ixodes scapularis) are the principal vector of Lyme disease in the eastern United States and have established populations in parts of Texas. However, many ticks found in Texas—including Lone Star ticks—are associated with other tick-borne illnesses rather than Lyme disease.

Are there deer ticks in Texas?

Yes. Blacklegged ticks, commonly called deer ticks, have been documented in numerous Texas counties, with established populations identified in several areas of the state.

Is Lyme disease common in Texas?

No. Lyme disease is considerably less common in Texas than in the Northeast or Upper Midwest. However, because blacklegged ticks occur in Texas, Lyme disease should remain part of the differential diagnosis when patients have compatible symptoms.

Which tick causes Lyme disease in Texas?

Blacklegged ticks (Ixodes scapularis) are the principal vector of Lyme disease in Texas. Lone Star ticks are associated with other tick-borne illnesses, including STARI, but are not considered established vectors of Lyme disease.

Can a Lone Star tick give you Lyme disease?

Current evidence indicates that Lone Star ticks are not established vectors of Lyme disease. However, they can transmit other infections and are associated with Southern Tick-Associated Rash Illness (STARI), which may resemble early Lyme disease.

Clinical Takeaway

Lyme disease is considerably less common in Texas than in the Northeastern United States, but it is not absent. Surveillance studies have documented established populations of blacklegged ticks in multiple Texas counties, while deer serosurveys provide additional evidence that Borrelia burgdorferi circulates in some Texas ecosystems.

More recent clinical studies reinforce that Lyme disease remains an important diagnostic consideration in Texas. A patient survey found that individuals with clinically diagnosed Lyme disease experienced symptom severity and quality-of-life impairment comparable to those with serologically confirmed disease, highlighting the importance of clinical judgment in low-incidence regions. [1]

Similarly, a recent case report described Lyme neuroborreliosis presenting in Texas after travel to Pennsylvania, emphasizing that clinicians should obtain a careful travel history and avoid excluding Lyme disease simply because a patient is evaluated in a non-endemic state. [6]

Patients should also recognize that not every tick-borne rash in Texas represents Lyme disease. Southern Tick-Associated Rash Illness (STARI), transmitted by the Lone Star tick, can closely resemble early Lyme disease. Whether all cases currently diagnosed as STARI represent a distinct illness—or whether some may instead represent unrecognized Lyme disease—remains an area of ongoing research and debate.

Current evidence shows that blacklegged ticks are established in parts of Texas. Although Lyme disease remains uncommon, it should remain in the differential diagnosis when patients present with compatible symptoms following a tick bite or after travel to an endemic region.

Related Articles

Lyme Disease Symptoms Guide
Why Lyme Disease Tests Can Be Negative
Tick Bite but No Symptoms: What Should You Do?
STARI vs. Lyme Disease: How Are They Different?
Lyme Disease Rash: Recognizing Erythema Migrans

References

1. Maxwell SP. The Elusive Understanding of Lyme Disease in Non-Endemic Geographic Areas: An Exploratory Survey of Patients With Chronic Symptoms in Texas. J Patient Exp. 2020;7(6):1621-1626.
2. Eisen RJ, Eisen L, Beard CB. County-Scale Distribution of Ixodes scapularis and Ixodes pacificus (Acari: Ixodidae) in the Continental United States. J Med Entomol. 2016;53(2):349-386.
3. Adetunji SA, Krecek RC, Castellanos G, et al. Seroprevalence of Borrelia burgdorferi Antibodies in White-Tailed Deer From Texas. Int J Parasitol Parasites Wildl. 2016;5(2):168-174.
4. Feder HM Jr, Gerber MA, Luger SW, Ryan RW. Persistence of Serum Antibodies to Borrelia burgdorferi in Patients Treated for Lyme Disease. Clin Infect Dis. 1992;15(5):788-793.
5. Fallon BA, Keilp JG, Corbera KM, et al. A Randomized, Placebo-Controlled Trial of Repeated IV Antibiotic Therapy for Lyme Encephalopathy. Neurology. 2008;70(13):992-1003.
6. Bhattarai A, Kaur M, Valaparla V, Li X. A Rare Case of Lyme Neuroborreliosis Presenting as Bannwarth Syndrome in Texas. Cureus. 2026;18(5):e109422.
7. Masters EJ, Grigery CN, Masters RW. STARI, or Masters Disease: Lone Star Tick-Vectored Lyme-Like Illness. Infect Dis Clin North Am. 2008;22(2):361-376.
8. Rapaport L. Ticks Carry Lyme Disease in Almost Half of U.S. Counties. Scientific American. January 19, 2016.

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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