Bourbon virus, a rare tick-borne illness with no known cure, has been confirmed for the first time in New York. The diagnosis in a 67-year-old Suffolk County man marks the seventh known case of the virus nationally. The patient was hospitalized, and while he recovered, two previous U.S. cases have been fatal.
Experts suggest that Bourbon virus may be more prevalent than currently recognized, partly because many healthcare providers are unaware of the illness and a commercial diagnostic test is unavailable. The confirmation process for the Suffolk County patient took five years. In parallel, testing of ticks and deer in New York has revealed evidence of the virus's presence across Long Island and in other parts of the state.
"The Bourbon virus is likely more prevalent than we think in our region and other cases are likely not being diagnosed," Dr. Luis Marcos, director of Stony Brook Medicine’s Tick-borne Disease Clinic, stated. Marcos treated the Suffolk County patient.
Symptoms and Diagnosis
Symptoms of Bourbon virus infection can appear two to seven days after a tick bite and may include headaches, fatigue, weakness, nausea, vomiting, muscle and joint pain, loss of appetite, and a maculopapular rash, which presents as a mix of flat and small raised red spots. The virus can also impact blood counts, leading to low white blood cell and platelet levels, which can compromise the body's ability to fight infection and stop bleeding.
Diagnosing Bourbon virus is challenging due to its rarity and the overlap of its symptoms with other tick-borne diseases such as Lyme disease, ehrlichiosis, and Heartland virus disease. Definitive diagnosis requires specialized pathogen-specific molecular or serologic testing, which often involves sending samples to state health departments or the Centers for Disease Control and Prevention (CDC). The Suffolk County patient's case was confirmed through serologic testing, which detects antibodies produced by the body in response to the virus.
Transmission and Prevalence
Bourbon virus is carried by the lone star tick, known for its aggressive biting behavior and activity from March through October. These ticks often attach to white-tailed deer, whose populations have increased in suburban areas. Research conducted in 2023 found evidence of active Bourbon virus transmission in Suffolk County since 2019. Additionally, evidence of the virus was found in deer in Ulster, Otsego, Wyoming, and Rensselaer counties, indicating its presence beyond Long Island.
Treatment and Prevention
There are currently no specific antiviral treatments for Bourbon virus. Medical care typically focuses on managing symptoms, which may include intravenous fluids for hydration and medications for fever and pain. Misdiagnosis as a bacterial tick-borne illness could lead to unnecessary antibiotic treatment, which is ineffective against viruses like Bourbon.
To minimize the risk of tick bites, public health officials recommend avoiding grassy, brushy, and wooded areas, and staying to the center of trails when hiking. Wearing long-sleeved shirts and pants, tucking pants into socks, and choosing lighter colored clothing can help in spotting ticks. Treating clothing with EPA-registered insect repellents containing permethrin or DEET is also advised. Thoroughly checking oneself for ticks after spending time outdoors is crucial for early detection and prevention of tick-borne diseases.