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Southern Tick-Associated Rash Illness
Southern Tick-Associated Rash Illness (STARI) was first recognized around the
early 1990s when people began to show symptoms similar to Lyme disease. Unlike
Lyme disease, these people did not have long-term problems, nor were they bitten
by the same kind of tick (Ixodes scapularis or the black-legged tick).
Studies have shown that the bacteria that causes Lyme disease, Borrelia
burgdorferi, does not cause STARI. STARI may also be called "Masters
disease" after the doctor who first identified the illness.
STARI Transmission
Much about STARI is still unknown. The Centers for Disease Control and
Prevention (CDC) have found that STARI usually occurs after a bite from an
infected lone star tick (Amblyomma americanum). The specific organism that an
infected lone star tick carries is not known. However, a bacterium called Borrelia lonestari has been discovered and may be a possible cause, but more
research is needed.
Lone star ticks live in the southeast and as far north as Maine. Adult females
have a white "lone star" on their backs. These ticks seek out and bite people
during any of their three life stages - larvae, nymph, or adult. Lone star
ticks can also transmit other diseases.
Photo of A. americanum courtesy of CDC
Symptoms and Treatment
The most obvious sign of a STARI infection is a rash called erythema migrans (EM),
which has
the shape of a "bull's eye". This symptom is often confused with Lyme
disease, which has a similar or identical rash. The rash can bee seen
about seven days after the tick bite, and expands outward from the site of the
bite. There may be a central area of clear skin. Other signs can include
tiredness, fever, headaches, muscle and joint pain. STARI differs from Lyme
disease in that arthritic, neurological, and recurring symptoms do not develop
as the disease gets worse. According to past and recent studies on STARI,
patients recover quickly from the rash and other symptoms after treatment with
oral antibiotics.
 Patient
with STARI; 1) site of tick bite,
2) red, radial, expanding edge of rash,
3) central clearing. Photo courtesy of CDC.
Map of A. americanum distribution,
courtesy of CDC.
STARI in Florida
STARI has been discovered in Florida and research on the occurrence of the
disease is underway. However, it may take some time before all the necessary
information can be collected since much is still unknown about STARI.
CDC Research on STARI
The Centers for Disease Control and Prevention (CDC) is requesting
participation in a study to ascertain if a Borrelia
organism other than B. burgdorferi is causing Lyme-like
disease, Southern Tick-Associated Rash Illness (STARI), in
southern states. Physicians are encouraged to contact the CDC if
a patient develops an expanding rash (5 cm or more in diameter) after a recent
lone star tick bite. Included below are the CDC letters of
explanation to physicians and their patients interested in
participating in this study.
Prevention of Tick-borne Diseases
Resources
1) Little, Susan.
Southern tick-associated rash illness: A newly recognized
tick-borne disease. DVM Newsmagazine: Best Practices 2003.
2) Centers for Disease Control and Prevention (CDC) Southern Tick-Associated Rash
Illness.
www.cdc.gov/ncidod/dvbid/stari/
3) Wilderness Medical Society (WMS) Southern Tick-Associated Rash Illness.
www.wms.org/Updates/STARI1.htm
4)
Purdue University Medical Entomology Department: STARI (Southern Tick-Associated
Rash Illness)
www.entm.perdue.edu/publichealth/diseases/tick/stari.html
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