We report a patient in North Carolina, USA, with Heartland virus infection whose diagnosis was complicated by previous Ehrlichia chaffeensis infection. We identified E. ewingii-infected and Bourbon virus-infected tick pools at the patient's residence. Healthcare providers should consider testing for tickborne viruses if ehrlichiosis is suspected.
Keywords: Amblyomma americanum; Bourbon virus; Ehrlichia chaffeensis; Ehrlichia ewingii; Heartland virus; North Carolina; United States; bacteria; co-infection; ehrlichiosis; ticks; vector-borne infections; viruses; zoonoses.