North Carolina is home to several tick species that bite humans, and the state reports hundreds of tick-borne illness cases every year. The lone star tick dominates the landscape, but blacklegged ticks (deer ticks), American dog ticks, and a newer invasive species all pose risks depending on where you live and spend time outdoors. Ticks are found year-round in NC, though bites spike in late spring, summer, and fall.
Tick Species You’ll Encounter in NC
The lone star tick is by far the most common tick in North Carolina. In the Piedmont region, it makes up about 90% or more of ticks captured in field sampling, and roughly 65% of the ticks people find on themselves or their pets. Adult females are easy to spot: they’re reddish-brown with a single white dot on their back. Males are smaller with white streaks along the edges. Lone star ticks are aggressive biters found in wooded and brushy areas statewide.
The blacklegged tick (also called the deer tick) is the state’s primary carrier of Lyme disease. It’s smaller than the lone star tick, with a dark brown or black body and reddish-orange abdomen. These ticks are found throughout the state, though they tend to be more common in areas with dense leaf litter and forest understory where deer and rodents travel.
The American dog tick is a larger, rounder species with distinctive white or gray markings on its back. It prefers grassy fields, trails, and the edges where lawns meet woods. In North Carolina, it’s the most likely carrier of the bacteria that causes Rocky Mountain spotted fever.
The Asian Longhorned Tick
An invasive species, the Asian longhorned tick, has been spreading across the state since its introduction to the U.S. mainland in 2010. As of July 2024, it had been found in 30 North Carolina counties, mostly in the western and central parts of the state, including Mecklenburg (Charlotte), Wake (Raleigh), Buncombe (Asheville), and Guilford (Greensboro) counties. This tick reproduces rapidly and is a significant pest for livestock, showing up most often in pastures. Its role in transmitting diseases to humans in the U.S. is still being studied, but it does not appear to spread Lyme disease.
Tick-Borne Diseases Reported in NC
Five tick-borne diseases are officially tracked in North Carolina, and all five were reported in 2024. Most are bacterial infections that cause flu-like symptoms: fever, headache, muscle aches, and joint pain. They respond well to antibiotics when caught early but can lead to serious complications if left untreated.
Ehrlichiosis was the most frequently reported tick-borne disease in the state in 2024, with 278 confirmed and probable cases (2.5 per 100,000 residents). It’s transmitted by lone star ticks, which explains its prevalence given how common that tick is across NC.
Lyme disease followed closely with 247 cases reported statewide in 2024 (2.2 per 100,000 residents). Blacklegged ticks carry the bacteria responsible, and while Lyme is more strongly associated with the Northeast, North Carolina sees consistent case counts every year.
Spotted fever rickettsiosis, which includes Rocky Mountain spotted fever, accounted for 195 cases in 2024 (1.8 per 100,000). Rocky Mountain spotted fever is the most severe form and can be fatal without prompt treatment. The American dog tick is the primary carrier in NC.
Anaplasmosis and babesiosis are both transmitted by blacklegged ticks but remain uncommon. Only 13 anaplasmosis cases and a single babesiosis case were reported in 2024.
Southern Tick-Associated Rash Illness (STARI)
STARI is another condition linked to lone star tick bites. It produces a circular rash that looks similar to the Lyme disease “bull’s-eye” rash, but it’s caused by a different (and still poorly understood) mechanism. STARI is not one of the five officially reportable tick-borne diseases in North Carolina, so there are no reliable case counts, but it’s worth knowing about because the rash can easily be mistaken for Lyme disease.
Alpha-Gal Syndrome: The Red Meat Allergy
One of the more unusual consequences of a tick bite in North Carolina is alpha-gal syndrome, a condition where your immune system develops an allergy to a sugar molecule found in red meat and some dairy products. The lone star tick triggers it. When the tick feeds, its saliva introduces the alpha-gal sugar molecule into your body. Your immune system produces antibodies against it, and the next time you eat beef, pork, lamb, or certain dairy, those antibodies trigger an allergic reaction, sometimes severe.
North Carolina sits squarely in the epicenter for this condition, part of a belt of states stretching from Virginia to Oklahoma where the lone star tick is dominant. Among people who have been tested for alpha-gal antibodies, about 30% test positive, an extraordinarily high rate. Symptoms typically appear three to six hours after eating red meat, which is an unusual delay for a food allergy and makes it harder to identify without testing. Reactions range from hives and stomach pain to anaphylaxis.
When Ticks Are Most Active
Ticks are present in North Carolina all 12 months of the year, but your risk of being bitten is highest from late spring through fall. Different life stages peak at different times. Nymphs (the tiny, immature ticks that are hardest to spot and responsible for many disease transmissions) are most active in late spring and early summer. Adult ticks are more active in spring and fall. Even in winter, warm stretches can bring ticks out in a state with NC’s relatively mild climate.
How to Protect Yourself
Treating clothing and gear with permethrin is one of the most effective steps you can take. Permethrin-treated clothing kills ticks on contact and remains effective through multiple washes. For skin, use an EPA-registered insect repellent containing DEET, picaridin, or oil of lemon eucalyptus. Tuck pants into socks when walking through tall grass or brush, and stick to the center of trails when hiking.
After spending time outdoors, do a full-body tick check. Pay special attention to your scalp, behind your ears, your armpits, the backs of your knees, and your waistline. Ticks in the nymph stage can be as small as a poppy seed, so check carefully. Showering within two hours of coming indoors helps wash off unattached ticks and gives you a chance to spot ones that have started feeding.
Throw your outdoor clothes in the dryer on high heat for at least 10 minutes. The heat kills ticks more reliably than washing alone.
How to Remove a Tick Safely
If you find an attached tick, use fine-tipped tweezers. Grasp the tick as close to your skin’s surface as possible and pull upward with steady, even pressure. Don’t twist, jerk, or squeeze the tick’s body. If mouthparts break off and remain in the skin, try to remove them with the tweezers, but if you can’t get them out easily, leave them alone and let the skin heal. Clean the bite area with rubbing alcohol or soap and water afterward.
Skip the folklore remedies: nail polish, petroleum jelly, and heat from a match don’t work and may cause the tick to release more saliva into your skin. The goal is to get the tick off quickly and cleanly.
Symptoms to Watch For After a Bite
Most tick bites don’t result in illness, but if you develop a rash, fever, headache, muscle aches, or joint pain in the days or weeks after a bite, those are the hallmark signs of tick-borne disease in North Carolina. A circular or “bull’s-eye” rash is strongly associated with Lyme disease or STARI. Spotted fever rickettsiosis often produces a spotted rash on the wrists and ankles that spreads inward. Not all tick-borne illnesses produce a rash, though, so fever and flu-like symptoms after a known bite are worth taking seriously on their own. Early treatment with antibiotics is highly effective for the bacterial infections and prevents the more dangerous complications that come with delayed diagnosis.