By Dr. Adolfo Alvino, MD

It’s a quiet Sunday afternoon and you decide to take a stroll through your backyard. Suddenly, you noticed a tiny, almost invisible hitchhiker hanging on to your skin. 

Ticks are more than just garden pests—they are vectors of potentially serious diseases. Throughout the United States, emergency room visits for tick bites have surged to their highest levels since 2017, making 2025 especially risky for anyone venturing outdoors

We've all heard the advice about Ticks: check your ankles, use repellent, and flick them off. But this year, a confluence of environmental shifts and biological mutations has created a new kind of threat that requires vigilance. If you've found a tick on you, or worse, if you’ve been bitten, this isn't a "wait and see" situation. It is time for you to act.

Although Lyme disease is rare in Texas—with only 27 cases reported in 2023—the Lone Star State faces real threats from diseases like Rocky Mountain spotted fever and ehrlichiosis, which can be swift and dangerous. 

Mark, a seasoned rancher who lives in the suburbs of Houston with his family, recently had a frightening experience with Ticks. "I've been working this land for forty years," he said as he shared his experience. "I've seen my share of Ticks. But this year it's different. I went out to check a fence line and came back with a dozen of them crawling on my boots. It's never been like this before."

Our goal today is to help you recognize the warning signs of Tick bites, avoid common mistakes, and, in the most urgent cases, understand when it is time to seek emergency care for a Tick bite.

More Than Just Lyme Disease

Usually, when we think of tick-borne illness, we think of Lyme disease. And while Lyme is still a major concern, this year, Ticks are carrying a new, more aggressive cocktail of pathogens. The Centers for Disease Control and Prevention (CDC) and Texas Department of State Health Services are now reporting a significant uptick in cases of a newly identified disease, colloquially called "Texas Fever."

Texas Fever isn't like the slow creep of Lyme disease, which can take weeks to show up as a bullseye rash. This new pathogen is a fast-acting, systemic attacker with a short incubation period, and the initial symptoms mimic a bad flu: fever, fatigue, and a pounding headache. The danger lies in how quickly it escalates, turning a seemingly minor illness into a life-threatening crisis in a short time.

Types of Ticks in Texas

In Texas, there are many different species of Ticks. The most common are - 

Lone Star Tick (Amblyomma americanum) – These can trigger alpha‑gal syndrome, an allergy to red meat, and transmit bacteria like Francisella tularensis and Ehrlichia species.

Dog (Wood) Tick, another Tick prevalent in Texas, can spread Rocky Mountain spotted fever, a condition that can escalate into a life-threatening emergency within days.

Black‑legged (Deer) Tick - Though less common in Texas, Black-legged (Deer) Ticks remain the carrier of Lyme disease, which may start with a bull’s‑eye rash and flu-like symptoms 

Should You Visit the Emergency Room for Tick Bites?

Yes, you should see a doctor if you find a Tick or have symptoms you suspect are from a Tick bite. You must go to a nearby emergency room immediately.

I know what you're thinking. "Isn't that an overreaction? Can't I just see my family doctor?" The aggressive nature of Texas Fever means that every hour counts. Your regular doctor's office may not be open at the time you find the Tick bite, or if they are open, they may not have the rapid-response diagnostics equipment or the specialized IV treatments required to stop the pathogen's swift progression. That is why you should go to a nearby emergency room.

Your local emergency room has the diagnostic equipment to diagnose Tick bites and the specialized IV treatment you need. They also have the resources and tools to handle a crisis in real time.

Emergency rooms will administer a specific, high-dose course of antibiotics that is designed to combat this new strain of pathogen. They will also monitor your vital signs and organ function, ensuring that the illness doesn't gain a foothold. This is not about being overly cautious; it's about making a strategic decision to protect your life or the life of your loved ones.

When to Go to the ER or See your Doctor for Tick Bites

You should go to the emergency room or see a doctor immediately if you experience any of the following.

• You can’t remove the tick despite careful attempts to do so
• You develop a widespread rash (especially a bull’s‑eye pattern) within 2–14 days of spending time outdoors
• You develop a fever or headache within 2–14 days of spending time outdoors 
• You notice spreading redness or signs of infection at the bite site (e.g., warmth, swelling, oozing) 

What to do After Spending Time Outdoors

Texans love to spend time outdoors as the weather permits, but if you live in a region with Tick infestation, you need to do the following.

Immediate Inspection - After any time spent outdoors, perform a thorough, full-body Tick check. Pay special attention to hidden areas like your scalp, armpits, behind your knees, and groin. Ticks are small and can be hard to see, so it is important that you thoroughly check to ensure you do not have any Ticks on you. 

Shower Promptly – This allows you to wash off wandering Ticks. Because Ticks are small and hard to identify, showering immediately after being outdoors is one thing you can do to ensure you are free of these pesky pests.

Examine Pets and Gear - Ticks can hitch a ride home on your pets and gear, and multiply there. Did you spend time outdoors with your four-legged friends? Check them, too. Don’t forget your gear, they are magnets for Ticks. Thoroughly checking your pets and gear ensures you do not have Ticks hanging around your home long after your outdoor adventure.

Other Things to Know about Ticks

• Lyme disease transmission generally requires a tick to be attached for at least 36–48 hours.
• Other infections like ehrlichiosis may develop within 5–14 days, and missed treatment can lead to organ failure or death 
• Prompt antibiotics can prevent complications—but delay can be devastating.
• In Texas, Rocky Mountain Spotted Fever may surface quickly with symptoms like nausea, fever, vomiting, muscle aches, and severe headache. Immediate medical attention is advised if you notice any of these conditions

What To Do If Bitten by Ticks

• Remove the tick promptly using fine-tipped tweezers, grasping as close to the skin surface as possible. Pull it straight upward with even pressure—don’t twist or squeeze 
• Dispose of it properly. Put it in a sealed container, wrap in tape, flush, or submerge in alcohol (don’t crush with your fingers) 
• Clean the area and wash your hands thoroughly with soap and water or alcohol 
• Take a picture of the tick and bite site, and consider keeping the tick in a container—for reference or testing (though testing often isn’t medically recommended) 
• See your doctor or visit a nearby emergency room
• Monitor Your Symptoms Closely. For the next 2–14 days, look for bull’s-eye rash or other unusual rashes, fever, headache, muscle aches, fatigue, spreading redness, and swollen glands 

How to Prevent Tick Bites

• Wear long-sleeved shirts, long pants, and light colors. This makes ticks easier to spot later
• Tuck shirt into pants and pants into socks. This seals off skin entry points to Ticks, preventing them from doing any damage to your system
• Use DEET-based repellents on exposed skin and permethrin-treated clothing or gear 

Summary

Every year, Texas sees sporadic but serious cases of tick-borne diseases. In 2025, the situation is worse, making awareness and urgency not just advisable but crucial. If you're bitten, treat it with urgency.

Tick bites may be small, but the potential consequences are not. Stay vigilant, know the red flags, and don’t wait. When in doubt, head straight to the nearest emergency room.

Remember to - 

• Remove the Tick correctly with fine-tipped tweezers.
• Clean the area and document the bite.
• Monitor for rash, fever, headache, and spreading redness for 2–14 days.
• Go to the emergency room immediately if you experience severe neurological or respiratory symptoms or heart palpitations.
• See a doctor urgently if you can't remove the Tick or develop fever, headache, rash, or swelling.
• Call your doctor fast if the tick has been attached long time or looks engorged.
• Keep prevention in mind always: wear protective clothing, use repellent and permethrin, and perform full-body checks (including pets).

Tick Bite Response Checklist

Click here to print this checklist and keep for reference when dealing with a tick bite. 

Take the following steps if you are bitten by a Tick.

Step 1: Remove the Tick

• Use fine-tipped tweezers
• Grasp tick close to skin
• Pull upward with steady, even pressure (do not twist or jerk)
• Clean bite area and hands with rubbing alcohol, iodine, or soap and water
• Dispose of a tick by placing it in a sealed bag/container OR flushing it down the toilet

Optional: Save Tick for Identification

• Place tick in a small container (e.g., pill bottle) or plastic bag
• Label with date and bite location on the body
• Store in freezer if needed for lab testing later

Step 2: Record Details

• Date and time of bite: ____________________
• Location on body: _______________________
• Location where exposure happened (e.g. hiking trail): _______________________
• Estimated time tick was attached (if known): _______________________

 Step 3: Clean and Observe

• Clean bite site daily and apply antibiotic ointment
• Mark the area with a pen to watch for rash development
• Avoid scratching

Step 4: Monitor for Symptoms

• Monitor for symptoms daily for 30 days
• Watch for rash, fever, fatigue, joint pain, or flu-like symptoms

Step 5: Seek Medical Advice If...

• Rash appears (especially bullseye-shaped)
• Fever or chills develop
• Muscle aches, fatigue, or headaches start
• Bite area becomes infected

• Symptoms worsen or persist

   

Tick Bites FAQ

We know you have questions about Ticks. Below, we answer the most frequently asked questions (FAQ) about Ticks in Texas.

Question 1: Are Texas Tick infestations among the worst in the U.S. this year?

Answer: Yes. Terminix’s first-ever breakdown of the 25 most tick-infested U.S. states for 2024 places Texas at #3, behind California and Florida.

Question 2: In what months are Texas Ticks more active?

Answer: Tick activity in Texas peaks during the warm months, typically from spring through late summer or early fall—most active April through September 

Question 3: What are the common types of Ticks in Texas?

Answer: Several species are prevalent in Texas, including:

• Lone Star Tick (Amblyomma americanum)
• American Dog Tick (Dermacentor variabilis)
• Black-legged (Deer) Tick (Ixodes scapularis)
• Brown Dog Tick (Rhipicephalus sanguineus)
• Gulf Coast Tick (Amblyomma maculatum)
• Cayenne Tick (southern areas)
• Other less common ticks include Winter Ticks, Cattle Fever Ticks, Soft Ticks (Ornithodoros), and Spinose Ear Ticks 

Question 4: What do Ticks need to survive?

Answer: Ticks are obligate blood feeders. They require vertebrate blood at each developmental stage and often rely on nutritional endosymbionts (e.g., Coxiella, Francisella) to obtain essential B vitamins absent in blood

Question 5: What do Ticks feed on?

Answer: Ticks feed on the blood of mammals, birds, and occasionally reptiles or amphibians. The Lone Star Tick is a generalist and feeds on a wide range, from small mammals and birds to livestock and humans.

Question 6: How do I identify Texas Ticks?

Answer: Identifying a tick can be crucial for determining the potential risk of disease. Key features to look for include the following - 

• Size: Adult Ticks are typically 3-5mm long, but they can swell to the size of a raisin after feeding.
• Color: Ticks are usually brown, reddish-brown, or black.
• Markings: The Lone Star Tick is recognizable by the single white spot on the female's back. The American Dog Tick has mottled white and brown markings.
• Number of legs: As arachnids, adult Ticks have eight legs, while larvae have six.

Question 7: What are the different stages of Tick development in Texas?

Answer: Most ticks in Texas go through four life stages:

1. Egg: The female Tick lays thousands of eggs on the ground.
2. Larva: The eggs hatch into a six-legged larva, which seeks a blood meal from a small host.
3. Nymph: After the first blood meal, the larva molts into an eight-legged nymph. The nymph seeks another blood meal, often from a slightly larger host. This is a common stage for human bites.
4. Adult: The nymph molts into an adult, which seeks a final blood meal to mate and reproduce.

Question 8: Where are you most likely to get bitten by a Tick in Texas?

Answer: You are most likely to encounter Ticks and get bitten in grassy, brushy, or wooded areas. This includes walking through fields, hiking on trails, gardening, or even in your own backyard. Ticks tend to hide in tall grass and on shrubs, waiting for a host to pass by.

When a tick attaches, it often moves to warm, protected areas of the body, such as:

• Under the arms
• Behind the knees
• In and around the hair
• In the groin area
• Inside the belly button

Question 9:  What illnesses can you contract from a Texas Tick?

Answer: Common tick-borne illnesses in Texas include the following - 

• Ehrlichiosis, STARI, Heartland/Bourbon viruses, Tularemia, Alpha-gal syndrome (Lone Star Tick) 
• Rocky Mountain Spotted Fever, Tularemia (American Dog Tick) 
• Lyme disease, Anaplasmosis, Babesiosis, Powassan virus (Black-legged Tick)—though Lyme is rare in Texas 
• Rickettsia Parkeri Rickettsiosis (Gulf Coast Tick), equine issues and paralysis (Cayenne Tick) 
• Tick paralysis, relapsing fever (Soft Ticks), and cattle fever in border areas 

Question 10: How do you prevent Tick bites?

Answer: Effective strategies for preventing Tick bites include the following - 

• Protective Clothing: Wear long sleeves, pants tucked into socks, and light-colored clothing.
• Use Repellents: EPA-approved products like DEET, Picaridin, Oil of Lemon Eucalyptus, or Permethrin-treated gear.
• Tick Checks: Inspect your body and pets after outdoor exposure, especially in hidden areas.
• Yard Maintenance: Keep grass mowed, remove brush and leaf litter, create barriers between yards and wooded areas.
• Pets: Use vet-recommended preventatives; check pets regularly and avoid tick-prone areas.

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Dr. Adolfo Alvino, MD, is a board-certified emergency medicine physician based in the Midland-Odessa area in Texas and the Medical Director of SignatureCare Emergency Center in Odessa, TX.  He graduated from the Albert Einstein College of Medicine of Yeshiva University in New York and has been in practice for over 10 years. Dr. Alvino specializes in emergency medicine.