Ehrlichiosis

The gradient on the map below refers to average ehrlichiosis incidence rates for each county in Tennesee from 2013-2023, which was calculated using county population data from the 2020 U.S. Census.

Davidson and Williamson counties accounted for 27% of all ehrlichiosis cases reported in the state in 2023.

In Tennessee, illness onset for cases of ehrlichiosis is mainly reported in the warmer months of the year. The number of reported ehrlichiosis cases is lowest in the late autumn through winter (November-February), slightly increases in the early spring (March-April), peaks in the late spring to mid summer (May-July), and then gradually declines late summer through early autumn (August-October).

Signs and symptoms of ehrlichiosis typically begin 5-14 days after being bitten by an infected lone star tick. Therefore, late spring through early summer (April-June) is the time of year when Tennesseans are most at risk for contracting ehrlichiosis.

Anyone who spends time outdoors in Tennessee is at risk of contracting ehrlichiosis, because the lone star ticks that spread this disease are most often found in wooded, brushy areas. People holding outdoors-based occupations, such as farmers and landscapers, may be at increased risk of getting bitten by an infected tick, as are people who regularly hike, camp, hunt, or garden in or around wooded areas.

Lone star ticks may also dwell in the property surrounding Tennessee homes, especially if your yard is either next to a brushy area or has tall grass and/or leaf litter. Even outside of our state's forests, it is important to take the necessary steps to prevent tick bites in any environment habitable by these ticks.

Individuals of any reported gender, sex, and age group in Tennessee can get sick with ehrlichiosis. However, most cases of ehrlichiosis are reported in older residents over 50. Additionally, within almost every age group, ehrlichiosis was reported more in males than females.

The number of ehrlichiosis cases reported in 2023 increased 22% from the previous year. Although 2020 saw a significant decrease in case counts, likely due to less human-tick exposure during the start of the COVID-19 pandemic, reports of ehrlichiosis in Tennessee have generally been rising since 2015.

Unlike other reportable tick-borne diseases in the state, ehrlichiosis results in hospitalization for 35-65% of Tennesseeans who become infected. In 2023, approximately 56% of all probable and confirmed ehrlichiosis cases were hospitalized for their illness.

Signs and symptoms of ehrlichiosis typically develop within 1-2 weeks after being bitten by an infected tick. Early signs and symptoms (days 1-5) are usually mild or moderate, and they may include:

• Fever and/or chills
• Severe headache
• Muscle aches
• Nausea, vomiting, diarrhea, or loss of appetite
• Confusion
• Rash that looks like red splotches or pinpoint dots (more common in children than adults)

If antibiotic treatment is delayed, ehrlichiosis can sometimes cause severe illness. Early treatment can reduce your risk of developing severe illness. Late stage signs and symptoms can include:

• Damage to the brain or nervous system (e.g. inflammation of the brain and surrounding tissue)
• Respiratory failure
• Uncontrolled bleeding
• Organ failure
• Death

For more information, see the CDC's Ehrlichiosis Signs and Symptoms web page.

Ehrlichiosis is diagnosed by a healthcare provider, who can order blood tests to look for evidence of Ehrlichia chaffeensis or Ehrlichia ewingii infection. It may take several weeks for test results to return. If your provider is concerned, they may prescribe you with antibiotics while you wait for the results.

For more information, see the CDC's Ehrlichiosis Diagnosis and Testing web page.