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Southern Tick-Associated Rash Illness

Southern Tick-Associated Rash Illness (STARI) or Masters disease is a Lyme-like illness that seems to be transmitted by the Lone star tick (Amblyomma americanum), which is the most common human-biting tick in Florida.  It was identified in people with a rash and other symptoms similar to those in Lyme disease that did not have evidence of infection with Borrelia burgdorferi and had been bitten by a different type of tick.  A related bacterium, Borrelia lonestari has been identified and may be the cause of the illness but is not confirmed.  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.

Amblyomma americanum and its distribution in the United States

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 chronic symptoms, such as arthritis and neurological symptoms are not likely to occur. 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.

 

 

Prevention of Tick-borne Diseases

Resources

Centers for Disease Control and Prevention (CDC) Southern Tick-Associated Rash Illness. www.cdc.gov/ncidod/dvbid/stari/

Little, Susan. Southern tick-associated rash illness: A newly recognized tick-borne disease. DVM Newsmagazine: Best Practices 2003.

Purdue University Medical Entomology Department: STARI (Southern Tick-Associated Rash Illness) www.entm.perdue.edu/publichealth/diseases/tick/stari.html

Masters E, Grigery C, Masters R.  STARI, or Masters Disease: Lone Star Tick-Vectored Lyme-like Illness. Infect Dis Clin N Am. 2008; 22:361-376.

Tick Bites and Erythema Migrans in Georgia: It Might Not Be Lyme Disease http://health.state.ga.us/pdfs/epi/gers/ger0801.pdf

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.

All files in this section are PDFs, open in a new window, and are under 30 KB.

• Physician Instructions for Collecting and Handling Clinical Specimens and Data from Patients with Suspected Tick Bite-Associated Rash Lesions of Unknown Etiology in the Southern United States
• Summary of Instructions - Study of Suspected Tick Bite-Associated Rash Lesions of Unknown Etiology in the Southern United States (STARI)
• Tick Associated Rash Study - Informed Consent Form
• Tick Associated Rash Study - Assent Form for Minors
• Laboratory Submission form for STARI Specimens (CDC)
• Shipping Instructions