Bourbon Virus Symptoms: What You Need to Know

Medically Reviewed and Compiled by Dr. Adam N. Khan, MD.

Quick Summary

• What it is: Bourbon virus is a very rare virus spread through tick bites, mainly by the lone star tick in the Midwestern, Eastern, and Southern United States.
• Primary Symptoms: Early symptoms feel like the flu—fever, extreme tired feeling (fatigue), body aches, rash, nausea, and headaches.
• Medical Care: There is no standard antiviral drug or vaccine. Doctors treat the illness with supportive care, such as hospital fluids and monitoring blood levels.

EMERGENCY WARNING:

If you or a loved one develops a sudden high fever, trouble breathing, confusion, severe fainting spells, uncontrollable vomiting, or unusual bruising or bleeding after spending time outdoors or receiving a tick bite, seek emergency medical care immediately or call 911. Rare tick-borne infections can progress rapidly and require urgent hospital evaluation.

What Is Bourbon Virus?

Bourbon virus is a rare germ that belongs to a group called Thogotovirus. Scientists first discovered this virus in 2014 in Bourbon County, Kansas, after a patient became severely ill following a tick bite.

Unlike many common infections caused by bacteria, Bourbon virus is an RNA virus. This means antibiotics like doxycycline or penicillin do not work against it. While infection from this virus is very uncommon, it can lead to severe health issues or even life-threatening complications.

Because the virus was identified fairly recently, researchers at the Centers for Disease Control and Prevention (CDC) and major medical universities continue to study how it affects the human body, how widely it has spread, and how doctors can best protect public health.

Recognizing Bourbon Virus Symptoms

Bourbon virus symptoms can closely mirror other common illnesses, such as the flu, COVID-19, or other tick-borne infections like Lyme disease and Ehrlichiosis [2]. Because symptoms often appear days after outdoor activity, paying close attention to changes in your body is critical.

Common Early Symptoms

After an infected tick bites a person, symptoms usually take a few days to develop. In the early stage, patients frequently experience systemic (whole-body) signs of illness:

1. Fever and Chills: A sudden spike in body temperature is often the first sign that the body is fighting off an infection.
2. Severe Fatigue: Patients often describe an overwhelming feeling of tiredness and weakness that makes simple daily tasks difficult.
3. Headache: Persistent, dull, or throbbing head pain is very common.
4. Body and Muscle Aches: Deep aches in the muscles and joints make movement uncomfortable.
5. Nausea and Vomiting: Stomach upset, loss of appetite, and throwing up often happen early in the illness.
6. Skin Rash: Some patients develop a mild rash on their body, though not everyone gets a visible mark or ring.

Advanced and Severe Symptoms

As the infection progresses over several days, the virus can affect organs and blood cells. Patients with severe infections may develop:

• Shortness of Breath: Difficulty catching one’s breath or rapid breathing.
• Confusion or Dizziness: Changes in mental clarity caused by high fever, severe dehydration, or systemic inflammation.
• Low Blood Cell Counts: Laboratory testing often reveals a sharp drop in white blood cells (leukopenia) and blood platelets (thrombocytopenia).
• Elevated Liver Enzymes: Blood tests may show that the liver is under stress or inflamed.
• Organ Stress: In extreme cases, heart, kidney, or lung function can decline, requiring intensive care unit (ICU) support.

Unique Clinical Takeaways

To help patients, caregivers, and primary care providers navigate this complex condition, here are three original, actionable clinical insights:

1. Antibiotic Non-Responsiveness in Suspected Tick-Borne Illness

When a person develops a fever, headache, and body aches after a tick bite, doctors often prescribe doxycycline—an antibiotic that effectively treats common tick-borne bacterial infections like Lyme disease, Rocky Mountain spotted fever, and Ehrlichiosis. Clinical Takeaway: If a patient’s symptoms fail to improve or continue to worsen after 48 to 72 hours of appropriate antibiotic therapy, healthcare providers should immediately suspect viral tick-borne pathogens such as Bourbon virus or Heartland virus. Recognizing this non-responsiveness early prevents dangerous delays in supportive hospital care.

2. Severe Cytopenias as an Early Diagnostic Flag

Bourbon virus has a strong tendency to affect bone marrow function early in the disease process. Clinical Takeaway: Standard complete blood count (CBC) panels often show a dramatic concurrent drop in both white blood cells (which fight infection) and blood platelets (which form clots). When a patient presents with flu-like symptoms and tick exposure, finding low white blood cells and low platelets should serve as a major red flag for viral tick-borne conditions, prompting immediate monitoring for bleeding, bruising, or secondary infections.

3. Differentiating Bourbon Virus from Heartland and Lyme Disease

While Lyme disease typically presents with a characteristic “bulls-eye” rash (erythema migrans) and responds well to oral antibiotics, Bourbon virus and Heartland virus present without classic localized rash patterns and cause deeper systemic weakness and lab abnormalities. Clinical Takeaway: Caregivers should maintain a detailed timeline of tick exposure, symptom onset, and rash appearance. Photos of any tick bites, ticks removed, or skin changes provide vital clues that help medical teams order specialized CDC viral tests rather than relying solely on standard bacterial panels.

How Bourbon Virus Spreads and Who Is at Risk

Understanding how the virus spreads helps families reduce their overall risk when spending time outdoors.

Transmission via the Lone Star Tick

Research indicates that the Lone Star tick (Amblyomma americanum) is the primary vector responsible for spreading Bourbon virus to humans. The Lone Star tick gets its name from a single silvery-white spot on the back of adult females.

Ticks contract the virus by feeding on infected animals (such as deer or small mammals) in the wild. When an infected tick attaches to a human skin surface to feed, the virus can pass into the bloodstream.

[Infected Wildlife / Mammals] ──> [Lone Star Tick Bites Animal] ──> [Tick Bites Human] ──> [Bourbon Virus Infection]

At this time, health officials have found no evidence that Bourbon virus spreads from person to person through casual contact, coughing, or touching.

Geographic Distribution and High-Risk Activities

Cases of Bourbon virus have been identified in the Midwestern, Southern, and Eastern regions of the United States. People who spend significant time outdoors in grassy, brushy, or wooded areas face a higher likelihood of encountering ticks. High-risk activities include:

• Hiking and trail running
• Camping and hunting
• Gardening and landscaping
• Clearing brush or chopping firewood
• Working outdoors in forestry or agriculture

How Doctors Diagnose Bourbon Virus

Because Bourbon virus is extremely rare, diagnosing it requires careful medical evaluation and specialized laboratory testing.

Medical History and Physical Examination

When you visit a medical center, your doctor will perform a complete physical assessment. They will ask detailed questions about:

• Recent outdoor activities, park visits, or travel history.
• Known tick bites or time spent in tall grass or timberland.
• The exact day your symptoms started and how quickly they changed.
• Your current medications and overall health history.

Specialized CDC Laboratory Testing

Standard blood tests performed at local clinics cannot directly identify the Bourbon virus. However, initial blood work like a Complete Blood Count (CBC) and a Comprehensive Metabolic Panel (CMP) can reveal suggestive clues:

• Low White Blood Count (Leukopenia): Indicates reduced immune cell activity.
• Low Platelet Count (Thrombocytopenia): Indicates reduced clotting capability.
• Elevated Liver Enzymes (AST/ALT): Points to liver inflammation.

If your doctor suspects Bourbon virus based on these findings and your travel history, they will consult state health departments and the CDC. Specialized testing, such as Reverse Transcription-Polymerase Chain Reaction (RT-PCR) or antibody assays, can confirm the presence of the virus or its genetic material.

Treatment and Care Options

Currently, there are no approved antiviral medications or vaccines specifically designed to cure or prevent Bourbon virus infection in humans. Medical treatment focuses on supportive care to help the body fight off the infection and recover safely.

Supportive Care and Hospitalization

For mild symptoms, patients may be advised to rest at home, stay well-hydrated, and use over-the-counter pain relievers or fever reducers (such as acetaminophen) under a doctor’s guidance.

For moderate to severe illness, hospitalization is required. Hospital-based supportive care includes:

• Intravenous (IV) Fluids: To prevent dehydration and support kidney function.
• Fever and Pain Control: Medications delivered safely to manage discomfort.
• Blood or Platelet Transfusions: Used if platelet levels drop dangerously low or if bleeding occurs.
• Respiratory Support: Supplemental oxygen or mechanical ventilation if breathing becomes difficult.

Experimental Treatments and Research Directions

Scientists are actively investigating potential therapies to combat Bourbon virus. Laboratory research at Washington University School of Medicine demonstrated that an experimental antiviral medication called favipiravir protected animal models against severe Bourbon virus disease. While these experimental findings are promising, further clinical research is required before any specific antiviral therapy can be approved for human use.

How to Prevent Tick Bites and Bourbon Virus

Because there is no vaccine available for Bourbon virus, preventing tick bites is your absolute best line of defense. Follow these straightforward strategies whenever you go outdoors.

Personal Protection Tactics

1. Use EPA-Registered Insect Repellents: Apply repellents containing DEET, picaridin, IR3535, or Oil of Lemon Eucalyptus (OLE) to exposed skin and clothing according to label instructions.
2. Treat Outdoor Gear with Permethrin: Spray boots, socks, pants, and tents with 0.5% permethrin spray, which kills ticks on contact.
3. Wear Protective Clothing: Wear light-colored clothing so ticks are easy to spot. Tuck your pant legs into your socks and your shirt into your pants when walking through woods or tall grass.
4. Perform Thorough Tick Checks: After coming indoors, check your full body for ticks. Use a mirror or ask a family member to check hidden areas such as the scalp, behind the ears, armpits, belly button, waist, groin, and behind the knees.
5. Shower Shortly After Being Outdoors: Showering within two hours of coming indoors helps wash off unattached ticks and provides a good opportunity to check your skin.

┌──────────────────────────────────────────────────────────┐
│              DAILY POST-OUTDOOR TICK CHECK LIST           │
├──────────────────────────────────────────────────────────┤
│  [ ] Scalp & Hairline         [ ] Armpits                │
│  [ ] In and Behind Ears       [ ] Around Waist & Navel   │
│  [ ] Back of Neck             [ ] Groin & Inner Thighs   │
│  [ ] Inside Belly Button      [ ] Behind Knees           │
└──────────────────────────────────────────────────────────┘

Environmental Control and Home Safety

• Maintain Your Yard: Keep lawn grass mowed short and remove leaf litter, tall weeds, and brush piles around your house.
• Create a Tick Barrier: Place a 3-foot wide barrier of wood chips or gravel between your lawn and wooded areas to restrict tick movement into play zones.
• Protect Pets: Speak with your veterinarian about effective tick prevention collars, topicals, or chewable treatments for dogs and cats. Ticks can ride into your living room on pet fur!

5 Frequently Asked Questions (FAQs)

References and Citations

1. Centers for Disease Control and Prevention (CDC). About Bourbon Virus. CDC Official Guidelines. /references/cdc-bourbon-virus-about
2. Passion Health Primary Care. What Are the Symptoms of Bourbon Virus After a Tick Bite? Patient Care Clinical Review. /references/passion-health-bourbon-virus-symptoms
3. Restored CDC Archives. Symptoms, Diagnosis, and Treatment of Bourbon Virus. /references/restored-cdc-bourbon-virus
4. Cameron D, MD. Bourbon Virus: Could a Flu Drug Treat This Tick-Borne Disease? Infectious Disease & Tick-Borne Illness Clinical Analysis. /references/cameron-md-bourbon-virus-treatment
5. Centers for Disease Control and Prevention (CDC). Preventing Tick Bites on People and Around the Home. /references/cdc-tick-prevention-guidelines

Medical Reviewer Bio & Disclosures

Dr. Adam N. Khan, MD is a board-certified internal medicine physician with over 15 years of clinical experience specializing in infectious diseases, preventive care, and epidemiology. He serves as a senior medical reviewer for MedLifeGuide and is affiliated with major academic medical centers in the United States.

Conflict of Interest Disclosure: Dr. Khan reports no financial disclosures, commercial affiliations, or conflicts of interest related to the pharmaceuticals, medical devices, or diagnostic tests discussed in this publication.

Standard Medical Disclaimer

Disclaimer: The information provided in this article is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. Always consult with a qualified physician or healthcare provider regarding any medical condition, unexplained fever, or tick bite. Never disregard professional medical advice or delay seeking it because of something you have read on MedLifeGuide. If you suspect a medical emergency, call 911 or visit an emergency room immediately.