southern tick-associated rash illness

Image:STARI Rash.jpg

Diagnosis is based on a circular "bull's-eye" rash at the site of infection called erythema chronicum migrans, which is very similar to that seen in Lyme disease. However, the symptoms of STARI are mild, and resemble influenza, with fatigue, muscle pains, and headache.{{cite journal |author=Kirkland KB |title=Erythema migrans-like rash illness at a camp in North Carolina: a new tick-borne disease? |journal=Arch. Intern. Med. |volume=157 |issue=22 |pages=2635–41 |year=1997 |pmid=9531233 |doi=10.1001/archinte.1997.00440430117014 |author2=Klimko TB |author3=Meriwether RA |display-authors=3 |last4=Schriefer |first4=M |last5=Levin |first5=M |last6=Levine |first6=J |last7=Mac Kenzie |first7=WR |last8=Dennis |first8=DT}} Fever is sometimes seen, but is not characteristic.

As of 2018, most cases were from Southeastern Missouri, a few were from South Carolina, North Carolina, Georgia, and one case each in Mississippi and Long Island, New York.

The illness, first described in 1997, is a tick-borne disease carried by the lone star tick Amblyomma americanum. The tick had first been proposed as a possible vector of disease in 1984,{{cite journal |author=Schulze TL |title=Amblyomma americanum: a potential vector of Lyme disease in New Jersey |journal=Science |volume=224 |issue=4649 |pages=601–3 |date=May 1984 |pmid=6710158 |author2=Bowen GS |author3=Bosler EM |display-authors=3 |last4=Lakat |first4=MF |last5=Parkin |first5=WE |last6=Altman |first6=R |last7=Ormiston |first7=BG |last8=Shisler |first8=JK |doi=10.1126/science.6710158|bibcode=1984Sci...224..601S }} and the illnesses associated with the tick was called "Lyme-like disease",{{cite journal |vauthors=Masters EJ, Donnell HD |title=Lyme and/or Lyme-like disease in Missouri |journal=Missouri Medicine |volume=92 |issue=7 |pages=346–53 |date=July 1995 |pmid=7651314}} but it was not recognized to be distinct from Lyme disease until the late 1990s.{{cite journal |vauthors=Masters E, Granter S, Duray P, Cordes P |title=Physician-diagnosed erythema migrans and erythema migrans-like rashes following Lone Star tick bites |journal=Arch Dermatol |volume=134 |issue=8 |pages=955–60 |date=August 1998 |pmid=9722725 |doi=10.1001/archderm.134.8.955|doi-access= |s2cid=25606594 }}

In 2004, the disease was suggested to be caused by the related bacterium Borrelia lonestari,{{cite journal |vauthors=Masters EJ, Grigery CN, Masters RW |title=STARI, or Masters disease: Lone Star tick-vectored Lyme-like illness |journal=Infect. Dis. Clin. North Am. |volume=22 |issue=2 |pages=361–76, viii |date=June 2008 |pmid=18452807 |doi=10.1016/j.idc.2007.12.010}}{{cite journal |vauthors=James AM, Liveris D, Wormser GP, Schwartz I, Montecalvo MA, Johnson BJ |title=Borrelia lonestari infection after a bite by an Amblyomma americanum tick |journal=J. Infect. Dis. |volume=183 |issue=12 |pages=1810–4 |date=June 2001 |pmid=11372036 |doi=10.1086/320721|doi-access=free }} which is a spirochete first isolated in culture in 2004.{{cite journal |author=Varela AS |title=First Culture Isolation of Borrelia lonestari, Putative Agent of Southern Tick-Associated Rash Illness |journal=J. Clin. Microbiol. |volume=42 |issue=3 |pages=1163–9 |date=March 2004 |pmid=15004069 |pmc=356874 |doi=10.1128/JCM.42.3.1163-1169.2004 |author2=Luttrell MP |author3=Howerth EW |display-authors=3 |last4=Moore |first4=V. A. |last5=Davidson |first5=W. R. |last6=Stallknecht |first6=D. E. |last7=Little |first7=S. E.}} However, the conclusion has been controversial since the spirochete has not been detected in many cases of the syndrome,{{cite journal |author=Wormser GP |title=Microbiologic Evaluation of Patients from Missouri with Erythema Migrans |journal=Clin. Infect. Dis. |volume=40 |issue=3 |pages=423–8 |date=February 2005 |pmid=15668867 |doi=10.1086/427289 |pmc=2773674 |author2=Masters E |author3=Liveris D |display-authors=3 |last4=Nadelman |first4=R. B. |last5=Holmgren |first5=D. |last6=Bittker |first6=S. |last7=Cooper |first7=D. |last8=Wang |first8=G. |last9=Schwartz |first9=I.}} which has led some authors to argue that the illness is not caused by a bacterial pathogen.{{cite journal |author=Dennis DT. |title=Reply to Masters. "Lyme-Like Illness Currently Deserves Lyme-Like Treatment" |journal=Clinical Infectious Diseases |year=2006 |volume=42 |pages=581–582 |doi=10.1086/500018 |issue=4 |pmid=16421811|doi-access=free }} Several studies have failed to detect Borrelia burgdorferi, which is the causative agent of Lyme disease, in patients from the southern United States.{{cite journal |vauthors=Philipp MT, Masters E, Wormser GP, Hogrefe W, Martin D |title=Serologic Evaluation of Patients from Missouri with Erythema Migrans-Like Skin Lesions with the C6 Lyme Test |journal=Clin. Vaccine Immunol. |volume=13 |issue=10 |pages=1170–1 |date=October 2006 |pmid=17028220 |pmc=1595329 |doi=10.1128/CVI.00238-06}}

It has been suggested that tick salivary toxins may play a role, as the toxins are similar to spiders, scorpions and homologous to those found in snakes.{{Cite journal |last1=Kannangara |first1=Don Walter |last2=Patel |first2=Pritiben |date=December 2018 |title=Report of Non-Lyme, Erythema Migrans Rashes from New Jersey with a Review of Possible Role of Tick Salivary Toxins |url=https://pubmed.ncbi.nlm.nih.gov/30129909 |journal=Vector Borne and Zoonotic Diseases (Larchmont, N.Y.) |volume=18 |issue=12 |pages=641–652 |doi=10.1089/vbz.2018.2278 |issn=1557-7759 |pmid=30129909}}

Infections are treated with antibiotics, particularly doxycycline, and the acute symptoms appear to respond to these drugs.{{cite journal |vauthors=Blanton L, Keith B, Brzezinski W |title=Southern Tick-Associated Rash Illness: Erythema Migrans Is Not Always Lyme Disease |journal=South. Med. J. |volume=101 |issue=7 |pages=759–760 |date=June 2008 |pmid=18580719 |doi=10.1097/SMJ.0b013e31817a8b3f}}

No serious long-term effects are known for this disease, but preliminary evidence suggests, if such symptoms do occur, they are less severe than those associated with Lyme disease.

• Borrelia
• Zoonosis

{{Reflist}}

{{Medical resources

| DiseasesDB = 33924

| ICD9 = {{ICD9|088.89}}

}}

• [https://www.cdc.gov/stari/ Southern Tick-Associated Rash Illness (STARI) Home Page] Centers for Disease Control
• [https://web.archive.org/web/20070226164850/http://www.doh.state.fl.us/Disease_ctrl/epi/htopics/lyme/STARI_Fact_Sheet.pdf STARI Fact Sheet] Florida Department of Health
• [https://web.archive.org/web/20041028002147/http://www.uga.edu/scwds/topic_index/2003/Southern%20Tick.pdf Southern Tick-Associated Rash Illness (STARI)] SCWDS Briefs, January 2003, Vol.18, No.4

{{Tick-borne diseases}}

Category:Bacterial diseases

Category:Tick-borne diseases

Category:Lyme disease

Category:Spirochaetes