Tick-borne illnesses are increasing in the United States: emphasis on the word ILLNESSES! Ticks can carry a bunch of nasty infections. Lyme disease, while potentially serious, is not the only problem. Also known as borreliosis, Lyme disease is an infection caused by Borrelia burgdorferi bacteria. It has been spreading from New England to mid-Atlantic states, the upper Midwest and as far west as California, Oregon and Washington. But there are over a dozen tick-borne illnesses including RMSF (Rocky Mountain Spotted Fever), Anaplasmosis, Babesiosis, Ehrlichiosis, Powassan (POW), STARI (southern tick-associated rash illness) and let’s not forget alpha-gal syndrome (aka AGS or tick-induced mammalian meat allergy). This red-meat allergy is growing fast because the lone star tick is now widespread.
Tick-Borne Illnesses Are Spreading and CDC is Gradually Catching Up:
On September 14, 2014 we wrote that:
“Lyme disease is far more common than most public health officials realized. Until this week, the CDC estimated that between 20,000 and 30,000 Americans were infected with the bacteria that causes Lyme disease each year. Now, the CDC has drastically revised its estimate.
“Acknowledging that many doctors underreport cases of Lyme, the agency now calculates that approximately 300,000 Americans are diagnosed with the disease annually.”
CDC ‘s Lyme Disease Surveillance and Data (March 13, 2025) reviews historic surveillance systems:
“Recent estimates using other methods suggest that approximately 476,000 people may be diagnosed and treated for Lyme disease each year in the United States.”
We’ve gone from 20,000 cases to 300,000 cases to nearly half a million cases annually.
CDC’s Estimated Alpha-Gal Syndrome Cases:
Just as in the case of Lyme disease, the CDC has been increasing its estimates of alpha-gal syndrome (AGS) rather dramatically in recent years:
“More than 110,000 suspected cases of AGS were identified between 2010 and 2022. However, cases of AGS are not nationally notifiable to CDC. The actual number of AGS cases in the United States is not known, but as many as 450,000 people may be affected.”
More about AGS shortly. The bottom line is that there is no bottom line. The CDC has no actual data on how many people catch Lyme or alpha-gal syndrome/meat allergy annually. What we do know is that many species of ticks have been extending their range into new territory. These recent arrivals carry disease-causing pathogens with them. However, when they are new, clinicians may not recognize the resulting illnesses at first.
In a moment we will describe why one tick bite could make you quite ill, but first, let’s prevent tick bites in the first place!
Avoiding Tick-Borne Illnesses by Being Prepared:
Your first step is wearing protective gear. We especially like permethrin-coated gaiters that cover our shoes and pants legs. This is the one we wear:
Careful tick checks upon coming inside are also essential.
If you find a tick that has become attached, what do you do to remove it? We recently received this comment from a reader of this column:
“Last summer I learned that antiseptic mouth rinse kills ticks immediately. When I found a tick, I used to remove it and put it into rubbing alcohol where it died after a minute or so.
“Once I had no alcohol, but my mouthwash was handy. I wet some toilet paper with it, laid it on the tick for a few seconds and shazam! The tick released its nasty grip. I wiped it away with the paper.
“Check it out. Be sure the active ingredients match those of Listerine blue or yellow. If you put a live tick into this solution, it dies in a couple of seconds.”
This might work exactly as our reader suggests; we haven’t tested it. But we don’t recommend this procedure. Another reader explains why:
“As a long-time patient advocate in Tick-Borne Diseases, I must correct an idea that may be ill advised. Yes, you can put the tick in something to kill it. If you do that, though, you will not be able to get it tested.
“More people these days should send the tick off to be tested when possible. To test the tick, the lab might want a live specimen. You can look up a tick-testing lab online and learn its requirements. Testing can help the doctor decide how best to treat the bite.
“The common recommendation for giving a one-time super dose of doxycycline or other antibiotic is NOT sufficient. Refer to the International Lyme and Associated Diseases (ILADS) for a discussion of this topic. I think it is unethical that doctors are being told a one-time dose will keep tick-borne disease(s) from taking hold in your body. There are many, including anaplasmosis, babesiosis, ehrlichiosis, Rocky Mountain Spotted Fever and STARI along with Lyme.
“One of the most difficult infections to eradicate may be carried by black legged ticks: Bartonella. Scientists are still discussing whether or not this infection is carried by ticks; we know it is carried by fleas. Nevertheless, with suspicion that it is carried by ticks, it should perhaps be mentioned as a possibility. We do know that it is turning up very frequently in the tests that are ordered to screen for tick-borne illnesses.
“Thank you for educating people on how NOT to remove a tick. Don’t try to burn, poison or agitate it, because it will regurgitate into your body when disturbed. That’s why pulling them out correctly is VERY important.”
Thank you for this useful information. Ticks are best removed with tweezers or a special inexpensive tool that can easily be purchased online. They should be pulled straight out without twisting. Everyone should have such a device just in case a tick gets by initial inspection.
An emergency physician offered these recommendations for tick removal devices:
The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you).
One Bite Can Transmit Multiple Tick-Borne Illnesses:
Lyme disease has spread widely from Old Lyme, Connecticut, where scientists isolated and identified it. However, Lyme disease is not the only disease that deer ticks (Ixodes scapularis) transmit. Researchers reported in 2022 that there was an increase in anaplasmosis and babesiosis in upstate New York. Tick-borne pathogens cause both diseases. Deer tick virus, also known as Powassan virus, is on the rise.
A study of ticks on Long Island found that they can carry multiple disease-causing pathogens (mBio, Sept/Oct, 2019). A single tick can transmit more than one disease with its bite. Doctors may find diagnosis more difficult as a result.
More than half of the deer ticks examined carried the Borrelia burgdorferi bacteria that causes Lyme disease. Many of them also carried other species of Borrelia as well as Anaplasma bacteria and Powassan virus. All of these pathogens can cause tick-borne illnesses.
Reader Reinforces Risk of One Bite, Many Dangers:
Dolores points out that there are co-infections linked to tick bites:
“There are many pathogens within ticks that include bacteria, viruses and parasites. Toxoplasma gondii is now proven to be within ticks along with Ehrlichia, Anaplasma, tick-borne typhus fever, Rocky Mountain Spotted Fever, Babesia, Franciscella Tularensis or Tularemia. In Sweden Franciscella holartica prevails. Borrelia miyamotoi and Borrelia hermsii show up in folks with Lyme as well. Powassan virus, Heartland virus, Bourbon and others are present and transmitted.
“Doxycycline will work on a few but not all of these pathogens and azithromycin can work on a few but not all. Once Lyme has taken hold, the immune system becomes compromised due to the effectiveness of Borrelia subverting both the complement system and other components of the immune system. Antigenic shifting of the outer surface proteins of Borrelia cripple our immune system. Common Variable Immune Deficiency is then diagnosed. We desperately need more research into how to cure these pathogens and less funding of a vaccine that will not work unless it prevents the tick from regurgitating pathogens as it sucks our blood.”
Lone Star Ticks Also Carry Disease, Though Not Lyme:
Lone star ticks (Amblyomma americanum) in this study (mBio, Sept/Oct, 2019) carried two species of Erlichia. These bacteria can cause severe disease. People bitten by a lone star tick may also develop Southern Tick-Associated Rash Illness (STARI). This may mimic Lyme disease when it presents with fever and a bulls-eye rash. However, scientists have not identified the pathogen that causes STARI. Initially, the lone star ticks that carry the disease lived mostly in southern states. Now, however, lone star ticks have spread far beyond their original southeastern territory.
Lone star ticks also seem to be the primary culprits transmitting Heartland virus. This disease was first identified at the Heartland Clinic in northwestern Missouri in 2009 (Missouri Medicine, Jul-Aug. 2016). Symptoms include fever, fatigue, muscle pains, diarrhea, headache, nausea and low white blood counts. Because this infection is caused by a virus, there are no effective treatments. Avoiding tick bites is the best approach.
Alpha Gal from Lone Star Ticks:
The meat-allergy syndrome, alpha gal, can also be triggered by the bite of Amblyomma americanum. We discussed the difficulty of diagnosing Lyme disease and alpha-gal allergy in Show 1003: From Lyme to Alpha-Gal: The Latest on Tick-Borne Diseases. You might also wish to listen to our interview with Dr. Scott Commins. It is Show 1167: Will a Tick Bite Make You Allergic to Meat? Our most recent interview with Dr. Commins and his colleague, gastroenterologist Sarah McGill, is Show 1344: Managing Meat Allergy and Other Tick-Borne Diseases. Both doctors are superb communicators, and you will learn a lot if you listen.
The CDC has also been learning about this condition. One thing it has learned is that two out of five healthcare providers surveyed were unfamiliar with alpha gal syndrome (MMWR, July 28, 2023). Sadly, this substantiates the reports we have heard from many visitors that providers may not be knowledgeable or helpful.
That is changing as alpha gal syndrome becomes more common. And it is becoming more common. The CDC has documented 110,229 suspected cases from 2010 to 2022. Its experts estimate, however, that is an underestimate. As many as 450,000 people may be affected (MMWR, July 28, 2023). That means nearly half a million people could be in serious danger if they consume meat or animal products, including something like gelatin.
Lone Star Ticks Are Not Alone:
When people started experiencing strange allergic reactions after eating meat, many physicians were stumped. Alpha-gal syndrome was discovered in 2009, but it took years for many health care providers to realize that their patients were suffering because of a lone star tick bite. The syndrome can involve delayed digestive tract symptoms, hives, difficulty breathing or swelling of the lips, throat and tongue. It has been far more common in the South and Southeast where lone star ticks are especially widespread. As a result, diagnosis is much more prompt in those areas now than it was previously.
Now, however, scientists have found that the lone star tick is not the only culprit. Two separate reports in the journal Emerging Infectious Diseases document alpha-gal syndrome outside the range of the lone star tick. Patients in Maine had been bitten by black-legged ticks, also known as deer ticks (Emerging Infectious Diseases, April, 2025). A wildlife biologist in Washington state developed anaphylaxis after a bite from a Western black-legged tick (Emerging Infectious Diseases, April, 2025). With very elevated alpha-gal IgE levels, she needed to avoid mammalian meat, including milk and gelatin. People everywhere now have even more reason to avoid tick bites this summer.
The Impact of Alpha-Gal:
Q. A friend had a severe anaphylactic reaction hours after eating a hamburger and barely made it to a local ER. They diagnosed him with alpha-gal, which is how I heard about it.
A couple of years ago, I began to have severe stomach cramps and diarrhea after a tick bite. When my family doctor tested me for tick-related reactions, we learned my alpha-gal antibodies were very high.
I stopped eating meat and dairy products. To avoid gelatin, I even opened capsules and put the contents in applesauce to take them. After 18 months, my antibody levels had dropped a lot, so I am starting to eat meat again.With so many deer around, I am sure many other people will also have to deal with this bizarre condition.
A. Lone star ticks (Amblyomma americanum) trigger alpha-gal allergy, but the reaction is to food rather than to the bite itself. As you discovered, the reaction to consuming mammalian meat can range from diarrhea and stomach cramps to wheezing and anaphylaxis. People who experience a life-threatening allergic reaction as your friend did need to keep injectable epinephrine like Auvi-Q or EpiPen on hand. The primary means of controlling alpha-gal reactions is to avoid consuming meat and, for some people, dairy.
Babesiosis Is Included in Tick-Borne Illnesses:
Now the CDC is concerned about another tick-borne illness (MMWR, March 17, 2023). Babesiosis is the result of infection from a microscopic parasite called Babesia microti. The first case was identified in 1969 on Nantucket Island. Since then, it has been spreading throughout the northeast wherever deer ticks are found. The parasites hang out in red blood cells.
The illness can range from mild to severe. Symptoms include fever, headache, muscle aches and joint pain. Left untreated it can lead to kidney failure, blood disorders and severe breathing problems. Doctors treat this infection with a combination of azithromycin and atovaquone.
Babesiosis is showing up in New York, New Jersey, and Minnesota, suggesting that the parasites are migrating along with the ticks that harbor them. It is only a matter of time for this disease to become widespread.
Asian Long-Horned Ticks Bite Humans, Too:
Entomologists have also noted the spread of the Asian long-horned tick (Haemaphysalis longicornis) in Connecticut. This tick is a relatively recent arrival first noted in the US in 2017. At this time, however, people have reported them from multiple states, including Arkansas, Connecticut, Delaware, Georgia, Kentucky, Maryland, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, and West Virginia. Contrary to initial reports, this tick does not seem averse to biting humans, and it may be able to spread Rocky Mountain spotted fever.
Rocky Mountain Spotted Fever:
The Long Island scientists cited above found that dog ticks carried Rickettsia that can cause Rocky Mountain Spotted Fever. Although the first clinicians to identify Rocky Mountain Spotted Fever were indeed in the Rocky Mountains, these tick-borne illnesses are now more common in the southeastern US.
The Problem with Tick-Borne Illnesses:
When more than one pathogen is present, doctors may have more trouble diagnosing and treating the resulting diseases. When health care providers use prompt, appropriate treatments, patients recover well from nearly all of these infections. However, Rocky Mountain Spotted Fever can be lethal if untreated.
Babesiosis, too, can kill those with compromised immunity. Powassan virus can cause severe disease with neurological complications. In addition, if Lyme disease is not treated early, infected patients may develop joint pain, headaches, facial palsy, heart rhythm problems, nerve pain and other complications.
Final Words About Preventing Tick Bites:
Mild winters mean more ticks. Prevention is always the best strategy. Using repellent on shoes, socks and pants can discourage ticks. Tucking pants into socks and wearing gaiters coated with permethrin can also help. People should also conduct conscientious tick checks whenever they come inside. Finding and removing a tick early can often forestall infection.
Do you live where ticks are abundant? Do you know family or friends who live in such an area? If so, please share this article with people who may be vulnerable to tick-borne illnesses. We happen to think that our radio show/podcast is also very helpful about avoiding tick-borne diseases. Here is a link you could also share: It describes some approaches to help people overcome these infections:
Show 1380: Avoiding Lyme and Other Tick-Borne Diseases
Half a million people may suffer symptoms of Lyme disease this year. Learn about avoiding Lyme and other tick-borne diseases.
Citations
- Sanchez-Vicente S et al, "Polymicrobial nature of tick-borne diseases." mBio, Sept/Oct, 2019. DOI: 10.1128/mBio.02055-19
- Esguerra EM, "Heartland virus: A new virus discovered in Missouri." Missouri Medicine, Jul-Aug. 2016.
- Carpenter A et al, "Health Care Provider Knowledge Regarding Alpha-gal Syndrome — United States, March–May 2022." MMWR, July 28, 2023.
- Thompson JM et al, "Geographic Distribution of Suspected Alpha-gal syndrome cases — United States, January 2017–December 2022." MMWR, July 28, 2023.
- Saunders EF et al, "Alpha-gal Syndrome after Ixodes scapularis tick bite and statewide surveillance, Maine, USA, 2014–2023." Emerging Infectious Diseases, April, 2025. DOI: 10.3201/eid3104.241265
- Butler WK et al, "Onset of alpha-gal syndrome after tick bite, Washington, USA." Emerging Infectious Diseases, April, 2025. DOI: 10.3201/eid3104.240577
- Swanson M et al, "Trends in reported babesiosis cases — United States, 2011–2019." MMWR, March 17, 2023. DOI: 10.15585/mmwr.mm7211a1
