This is the realm of the Lone Star tick and American dog tick, which means ehrlichiosis (for Lone Star tick) and Rocky Mountain spotted fever (for dog tick) are bigger concerns. States like North Carolina, Tennessee, Oklahoma, Arkansas, Missouri have historically high RMSF rates. The Carolinas, Virginia, Georgia – these have lots of Lone Star ticks, so ehrlichiosis is more common here. Lyme disease is actually less common in most of the deep South because the type of ticks and ecology aren’t as suitable (though parts of Virginia, Kentucky, and the NC mountains see some Lyme). Alpha-gal meat allergy syndrome from Lone Star tick bites is being recognized in the South (tick bites causing meat allergy – wild!). The South also has Tularemia in some areas (Arkansas, Missouri) and rare viruses like Heartland and Bourbon (found in a few patients in states like Missouri, Oklahoma, Kansas). In the Gulf Coast states, Rickettsia parkeri (a spotted fever from Gulf Coast ticks) causes a milder RMSF-like illness.