Southern Tick-Associated Rash Illness (STARI)

An infection causing a rash similar to that produced by LYME DISEASE affecting residents in southeastern and south central United States. Southern tick-associated rash illness (STARI) is associated with the bite of the lone star tick (Amblyomma americanum). These ticks are found through the southeast and south central states. Even though spirochetes have been seen in A. americanum ticks, attempts to culture them in the laboratory have consistently failed. However, a spirochete has been detected in A. americanum by DNA analysis and was given the name Borrelia lonestari.

Symptoms
People who live or travel in the south and who develop a red, expanding rash with central clearing after the bite of a lone star tick should see a doctor. The Centers for Disease Control and Prevention is interested in obtaining samples from such patients under an Institutional Review Board-approved investigational protocol. In 2001 one patient with evidence of B. lonestari infection was reported in the medical literature. This patient had been exposed to ticks in Maryland and North Carolina and had developed a typical Lyme disease rash. DNA analysis indicated the presence of B. lonestari in a skin biopsy taken at the leading edge of the rash and in the tick removed by the doctor. Testing for Lyme disease was negative. The patient was treated with an oral antibiotic and recovered.

Lone star ticks can be found from central Texas and Oklahoma eastward across the southern states and along the Atlantic coast as far north as Maine. Although several studies have demonstrated that between 1 percent and 3 percent of these ticks are infected with a spirochete, a thorough assessment of risk of infection has not been conducted.

Treatment/Prevention
As with Lyme disease, prompt treatment with antibiotics cures the infection. Prevention measures similar to those for Lyme disease will reduce the exposure to infected ticks.