Medicine:Southern tick-associated rash illness

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"STARI" redirects here. It is not to be confused with STAR 1.
Southern tick-associated rash illness
Other namesMasters' disease
Lone star ticks can be carriers of southern tick-associated rash illness.
SpecialtyInfectious disease

Southern tick-associated rash illness (STARI) is a tick-borne disease resembling a mild form of Lyme disease, which occurs in southeastern and south-central United States. It is spread by bites from the lone star tick Amblyomma americanum. The actual cause is still unknown.

Signs and symptoms

"Bull's-eye" STARI rash

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.[1] Fever is sometimes seen, but is not characteristic.

Geography

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.[2]

Cause

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,[3] and the illnesses associated with the tick was called "Lyme-like disease",[4] but it was not recognized to be distinct from Lyme disease until the late 1990s.[5][1]

In 2004, the disease was suggested to be caused by the related bacterium Borrelia lonestari,[6][7] which is a spirochete first isolated in culture in 2004.[8] However, the conclusion has been controversial since the spirochete has not been detected in many cases of the syndrome,[9] which has led some authors to argue that the illness is not caused by a bacterial pathogen.[10] Several studies have failed to detect Borrelia burgdorferi, which is the causative agent of Lyme disease, in patients from the southern United States.[11][9]

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.[2]

Treatment

Infections are treated with antibiotics, particularly doxycycline, and the acute symptoms appear to respond to these drugs.[7][12]

Prognosis

No serious long-term effects are known for this disease,[12] but preliminary evidence suggests, if such symptoms do occur, they are less severe than those associated with Lyme disease.[6]

See also

References

  1. ↑ 1.0 1.1 Kirkland KB; Klimko TB; Meriwether RA et al. (1997). "Erythema migrans-like rash illness at a camp in North Carolina: a new tick-borne disease?". Arch. Intern. Med. 157 (22): 2635–41. doi:10.1001/archinte.1997.00440430117014. PMID 9531233. 
  2. ↑ 2.0 2.1 Kannangara, Don Walter; Patel, Pritiben (December 2018). "Report of Non-Lyme, Erythema Migrans Rashes from New Jersey with a Review of Possible Role of Tick Salivary Toxins". Vector Borne and Zoonotic Diseases (Larchmont, N.Y.) 18 (12): 641–652. doi:10.1089/vbz.2018.2278. ISSN 1557-7759. PMID 30129909. 
  3. ↑ Schulze TL; Bowen GS; Bosler EM et al. (May 1984). "Amblyomma americanum: a potential vector of Lyme disease in New Jersey". Science 224 (4649): 601–3. doi:10.1126/science.6710158. PMID 6710158. Bibcode: 1984Sci...224..601S. 
  4. ↑ "Lyme and/or Lyme-like disease in Missouri". Missouri Medicine 92 (7): 346–53. July 1995. PMID 7651314. 
  5. ↑ "Physician-diagnosed erythema migrans and erythema migrans-like rashes following Lone Star tick bites". Arch Dermatol 134 (8): 955–60. August 1998. doi:10.1001/archderm.134.8.955. PMID 9722725. 
  6. ↑ 6.0 6.1 "STARI, or Masters disease: Lone Star tick-vectored Lyme-like illness". Infect. Dis. Clin. North Am. 22 (2): 361–76, viii. June 2008. doi:10.1016/j.idc.2007.12.010. PMID 18452807. 
  7. ↑ 7.0 7.1 "Borrelia lonestari infection after a bite by an Amblyomma americanum tick". J. Infect. Dis. 183 (12): 1810–4. June 2001. doi:10.1086/320721. PMID 11372036. 
  8. ↑ Varela AS; Luttrell MP; Howerth EW et al. (March 2004). "First Culture Isolation of Borrelia lonestari, Putative Agent of Southern Tick-Associated Rash Illness". J. Clin. Microbiol. 42 (3): 1163–9. doi:10.1128/JCM.42.3.1163-1169.2004. PMID 15004069. 
  9. ↑ 9.0 9.1 Wormser GP; Masters E; Liveris D et al. (February 2005). "Microbiologic Evaluation of Patients from Missouri with Erythema Migrans". Clin. Infect. Dis. 40 (3): 423–8. doi:10.1086/427289. PMID 15668867. 
  10. ↑ Dennis DT. (2006). "Reply to Masters. "Lyme-Like Illness Currently Deserves Lyme-Like Treatment"". Clinical Infectious Diseases 42 (4): 581–582. doi:10.1086/500018. PMID 16421811. 
  11. ↑ "Serologic Evaluation of Patients from Missouri with Erythema Migrans-Like Skin Lesions with the C6 Lyme Test". Clin. Vaccine Immunol. 13 (10): 1170–1. October 2006. doi:10.1128/CVI.00238-06. PMID 17028220. 
  12. ↑ 12.0 12.1 "Southern Tick-Associated Rash Illness: Erythema Migrans Is Not Always Lyme Disease". South. Med. J. 101 (7): 759–760. June 2008. doi:10.1097/SMJ.0b013e31817a8b3f. PMID 18580719. 
Classification



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