STARI (Southern Tick-Associated Rash Illness)

STARI is the acronym for a recently recognized condition known as "southern tick-associated rash illness," which involves a rash indistinguishable from a Lyme disease EM lesion. The condition has been associated with a spirochete that has been isolated from skin lesions of patients and from ticks. Based on DNA analysis, it is not the same species as the spirochete that causes Lyme disease. Relatively little is known about STARI, which is apparent by the qualified details below.
Causative agent
  • A bacterium, specifically a spirochete tentatively identified as Borrelia lonestari.
Geographical distribution of cases
  • Documented cases have occurred in the southeastern and south central U.S.
Symptoms of infection
  • Similar to the initial flu-like symptoms of Lyme disease.
  • Reddish "bulls eye" rash at site of tick bite, indistinguishable from a Lyme disease EM lesion.
Reservoir host of Borrelia lonestari
  • Not documented, but thought to be white-tailed deer.
Vectors of Borrelia lonestari
  • Amblyomma americanum, the Lone Star tick.
Mode of Transmission of Borrelia lonestari
  • From infected lone star ticks (nymphs and adults) to humans via their bite.
  • NOTE: there is no known human-to-human transmission.
Diagnosis of infection
  • EM lesion at the feeding site of a Lone Star tick.
Treatment of infection
  • Antibiotic prescribed by a physician.
Prevention of infection
  • There is no vaccine.
  • Avoid tick habitat and contact with tick-infested vegetation (see E-243-W "The Biology of Indiana Ticks").
  • Wear clothing consisting of a long sleeved shirt, long pants, and boots.
  • Use a repellent recommended by CDC and treat clothing with permethrin.