A rare Bourbon virus case has been confirmed on Long Island, New York, for the first time, raising concerns because the symptoms overlap with Lyme disease. Bourbon virus infections tend to be more fatal and are carried by lone star ticks (Amblyomma americanum). With no widely available diagnostic test or cure, this mysterious tick-borne disease can spread unnoticed in the States. Scientists speculate that the virus could be more established than current case numbers imply. The findings have been published in the American Journal of Tropical Medicine.
Bourbon Virus is Hard to Spot
The virus is named after Bourbon County in Kansas, where it was first identified in 2014. The infected patient suffered multi-organ failure and died 11 days after symptom onset. Only a handful of cases have been documented since then, primarily in the central United States. However, lone star ticks have expanded into much of the Northeast, opening up new spaces for the virus to spread.
Bourbon virus, unlike several bacterial infections transmitted by ticks, does not respond to antibiotics. There are no vaccines or standard antiviral treatment for the infection. Doctors prescribe supportive care, such as rest and plenty of fluids, and manage symptoms as they arise. Patients generally develop fever, extreme fatigue, headaches, nausea, body aches, and rashes.
The lone star tick transmits ehrlichiosis and tularemia and is associated with Alpha-Gal Syndrome, which causes an allergic reaction on consuming red meat. Doctors often do not place Bourbon virus high on the list of plausible complications from a lone star tick bite, since most have never encountered it and cannot order a standard commercial test to confirm the diagnosis. As a result, the diagnosis goes off track, as doctors consider the better-known conditions when a patient becomes sick following a tick bite.
“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, they are similar to other tick-borne infections,” says Luis Marcos, MD, lead author, 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.”
Suspected samples in New York must be sent to the NYS Department of Health for analysis, which adds a hurdle to the limited awareness of the virus, making it difficult for clinicians to spot the infection.
Blood Tests Show Recent Infections
Marcos and his colleagues identified the virus in April 2026, while analyzing blood from 107 patients who had experienced fever and other signs of tick-borne illness between 2019 and 2024, confirming the first-ever case in the state.
Two people had antibodies against the Bourbon virus, implying that their immune systems had encountered it. Antibodies in one patient increased fourfold, suggesting acute or recent infection. The patient’s antibody levels swelled eightfold over one month. The patient showed severe symptoms and had to be hospitalized. Dr. Marcos confirmed that this one case was certainly a Bourbon virus infection.
Why is Lyme Treatment Failing?
The initial illness is similar to Lyme disease. Doctors prescribed doxycycline, an antibiotic often used to treat Lyme and several other bacterial infections that ticks carry. The patient did not respond to the treatment, and the symptoms only grew worse. The lack of response can be a major signal that the case is not one involving bacteria. Antibiotics fail to target viruses, meaning standard treatment for a suspected bacterial tick infection would be powerless against the Bourbon virus.
The infections are rare, but the disease itself can lead to serious and often quick deterioration. A second death associated with the virus was reported in 2026, the first one occurring in the Kansas case itself.
Dr. Marcos Suggests Better Surveillance
Marcos and his co-authors said that the findings highlight the need for better virus surveillance, improved clinical testing, and assays. They firmly believe that epidemiology and vector management sections should be informed and alert. Marcos believes that it is very important to fathom the true impact of the virus in high-risk areas before an effective treatment or standard clinical tests are developed.
Tick infections have surged over the years on US soil because of global warming. Shorter winters alongside a warmer autumn keep ticks active for longer. Once thought to be uninhabitable for ticks, northern areas and higher altitudes have seen a surge in their population. A warmer climate also allows animal hosts like deer and birds to expand their territory, carrying ticks into new ecosystems. The overall impact shows that the ticks stay active even in December instead of perishing in October.
The Centers for Disease Control and Prevention (CDC) predicts that there will be a record-breaking 500,000 cases of Lyme disease in 2026. CDC’s tick bite tracker shows an uptick of 53% in emergency room visits in April itself. The situation can definitely worsen if a viral infection comes into the mix.
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