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Tick-borne diseases are common throughout the United States, and most cases are treated effectively. A rarely diagnosed tick-borne infection, the Bourbon virus, transmitted by the common lone star tick, could soon begin to complicate diagnoses if it becomes more prevalent this summer and in coming years.
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So says a team of researchers led by Stony Brook Medicine. They confirmed the first Bourbon virus case in New York state, on Long Island, in a paper published in the American Journal of Tropical Medicine and Hygiene.
A rare virus with familiar symptoms
The Bourbon virus was discovered in 2014 and named for Bourbon County, Kansas, where it was first identified. There are no vaccines to prevent or medicines to treat the illness, which remains rare but occurs mostly in regions of the central United States. Symptoms include fever, fatigue, rash, headache, body aches and nausea.
The lone star tick acts as a vector for several bacterial and viral illnesses, including ehrlichiosis, tularemia and alpha-gal syndrome, the condition that causes the immune system to produce allergic antibodies that lead to a meat allergy. When someone presents with symptoms common to these conditions and has been bitten by a lone star tick, a diagnosis can result. But if someone has a rare infection via the lone star tick, such as the Bourbon virus, diagnosis and treatment are more difficult because there is currently no commercial test to confirm the viral infection.
"There are a lot of lone star ticks in New York and in the Northeast. We have dense populations, and when someone is infected with Bourbon virus, symptoms are similar to other tick-borne infections," says Luis Marcos, lead author and a professor in the Departments of Medicine and Microbiology and Immunology at the Renaissance School of Medicine (RSOM) at Stony Brook University, and director of the Tick-Borne Disease Clinic. "For these reasons, the Bourbon virus is likely more prevalent than we think in our region, and other cases are likely not being diagnosed."
The Bourbon virus remains a rare infection, and because of this, many clinicians may be unfamiliar with it, increasing the possibility of misdiagnosis. Because there is no commercial test for the virus, samples in New York are sent to the NYS Department of Health for analysis.
Evidence from Long Island patients
Marcos and colleagues identified the first tick-borne Bourbon virus case in April 2026. The finding was based on a published study of 107 individuals presenting with fever and other tick-borne illness symptoms between 2019 and 2024. Blood samples were collected from patients and sent to the NYS Department of Health.
Two cases had neutralizing antibodies for the Bourbon virus. One of these patients had a fourfold rise in antibody titers to the Bourbon virus, which, according to the researchers, indicates an acute or recent infection with the virus.
"This one case certainly was the Bourbon virus, and over a one-month period antibody titers increased eightfold. The patient showed some very severe symptoms and was hospitalized," Marcos summarizes.
He added that early symptoms can be very similar to Lyme disease, and this patient was initially diagnosed with Lyme disease and received standard doxycycline treatment but showed no improvement in symptoms, which included fatigue and severe headaches.
Surveillance gaps and clinical stakes
A 2014 Bourbon virus case in Kansas, caused by a tick bite, resulted in a patient's death. In 2026, it caused another fatal case.
Marcos and co-authors stress that, for clinicians, the results from their study "highlight the need for expanded viral surveillance, clinical testing and assay development to improve clinical decision-making and inform tick-borne disease epidemiology and vector management."
He added, "Without identifying the cause of an infection, the chances of developing accurate diagnostic tests or effective treatments are minimal. That is why it is so important to first understand the true impact of the virus in high-risk areas."
More information: Victoria A. Bateman et al, Evidence of Heartland and Bourbon Viruses Transmitted by Ticks in Suffolk County, New York, The American Journal of Tropical Medicine and Hygiene (2026). DOI: 10.4269/ajtmh.26-0012
Provided by Stony Brook University
This story was originally published on Medical Xpress.
