A rash similar to the rash of Lyme disease has been described in humans following bites of the lone star tick, Amblyomma americanum. The rash may be accompanied by fatigue, fever, headache, muscle and joint pains. This condition has been named southern tick-associated rash illness (STARI).
|Image: Patient with STARI; 1) site of tick bite, 2) red, radial, expanding edge of rash. 3) central clearing.
Photograph used with permission from the Journal of Infectious Diseases.
The rash of STARI is a red, expanding “bulls eye” lesion that develops around the site of a lone star tick bite. The rash usually appears within 7 days of tick bite and expands to a diameter of 8 centimeters (3 inches) or more. The rash should not be confused with much smaller areas of redness and discomfort that can occur commonly at tick bite sites. Unlike Lyme disease, STARI has not been linked to any arthritic, neurological, or chronic symptoms.
The cause of STARI is unknown. Studies have shown that is not caused by Borrelia burgdorferi, the bacterium that causes Lyme disease. Another spirochete, Borrelia lonestari, was detected in the skin of one patient and the lone star tick that bit him. However, subsequent study of over two dozen STARI patients has found no evidence of B. lonestari infection. In the cases of STARI studied to date, the rash and accompanying symptoms have resolved promptly following treatment with oral antibiotics.
STARI is specifically associated with bites of Amblyomma americanum, known commonly as the lone star tick. 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. The adult female is distinguished by a white dot or “lone star” on her back. All three life stages of A. americanum aggressively bite people.
In general, tick-borne illness may be prevented by avoiding tick habitat (dense woods and brushy areas), using insect repellents containing DEET or permethrin, wearing long pants and socks, and performing tick checks and promptly removing ticks after outdoor activity. Persons should monitor their health closely after any tick bite, and should consult a physician if they experience a rash, fever, headache, joint or muscle pains, or swollen lymph nodes within 30 days of a tick bite. In most circumstances, treating persons who only have a tick bite is not recommended.
The Centers for Disease Control and Prevention is interested in obtaining samples from STARI patients under an Institutional Review Board-approved investigational protocol. Physicians seeing patients with a recent lone star tick bite and an expanding rash at least 5 centimeters in diameter are encouraged to contact CDC at 970-221-6400 for more information. Patients must be at least 4 years old to participate.
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