Southern Tick Associated Rash Illness

Aka: Southern Tick Associated Rash Illness, Southern Tick-Associated Rash Illness, Southern Lyme Disease, STARI, Masters Disease

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II. Differential Diagnosis

  1. See Tick Borne Illness
  2. Lyme Disease

III. Pathophysiology

  1. Occurs after Lone Star Tick (Amblyomma Americanum) bite in southeastern and eastern states
  2. Unknown cause
    1. Borrelia lonestari association has been disproven

IV. Findings

  1. Viral-type prodromal symptoms (feve, Headache, Fatigue, myalgias)
  2. Circular or bullseye rash
    1. Similar to Erythema Migrans of Lyme Disease, but not caused by Borrelia Burgdorferi
    2. Rash onset from time of Tick Bite is typically by Day 6-7 on average (sooner than with Lyme Disease)
    3. STARI Lesions are typically smaller (6-10 cm) than for Lyme Disease (6-28 cm)
    4. STARI lesions are most often single (may be multiple in Lyme Disease)

V. Associated Conditions: Other Illnesses carried by Lone Star Tick

  1. Tularemia
  2. Ehrlichiosis
  3. Heartland Virus
  4. Bourbon Virus
  5. Alpha-Gal Syndrome

VI. Management

  1. Doxycycline
    1. STARI improves with Doxycycline (but known if Antibiotics modify course)
    2. However, STARI and Lyme Disease may be difficult to distinguish, and Doxycycline is critical for lymes

VII. Prognosis

  1. No association with longterm, chronic complications (e.g. Arthritis, neurologic deficits)

VIII. Resources

  1. STARI (CDC)
    1. https://www.cdc.gov/stari/disease/index.html

IX. References

  1. Abdelmaseih (2021) Cureus. 2021 13(5):e15306 +PMID: 34221760 [PubMed]

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