Tick-borne febrile illnesses lacking specific symptoms.

We report here one case of tularemia, one case of human monocytic ehrlichiosis, and one case of febrile illness most consistent with tularemia with titers suggestive of Rocky Mountain spotted fever in residents of three south-central Missouri counties. All three cases had with nonspecific symptoms of a febrile illness. All three patients had a history of a tick bite, common in south-central Missouri, but only two patients reported the tick bite when first seen. In these three cases, the severity of the illness provided a clue that led to a diagnosis of tick-borne febrile illnesses by confirmatory serology in two cases. It is very important that physicians be aware of these diseases in the spring and summer months.