Erythema migrans-like rash illness at a camp in North Carolina: a new tick-borne disease?

Abstract

This investigation suggests the existence of a new tick-associated rash illness. We suspect that the disease agent is carried by A. americanum ticks. In the southern United States, EM-like rash illness should no longer be considered definitive evidence of early Lyme disease.

Retrospective Case Reports of Two Central North Carolina Residents

“…What is now termed STARI was first described in adolescents attending a summer camp in the North Carolina Piedmont [37]. As with several other studies on STARI, it is notable that some subjects had positive enzyme-linked immunosorbent assays and some positive bands on immunoblots for B. burgdorferi [32,[37][38][39]. Interestingly, the female subject in this report had a reactive IgM 23-kDa band following one episode of presumed STARI (illness 2).…”

“…After several papers in the early 2000s looked at whether the then recently discovered Borrelia lonestari was the cause of STARI [19,36], that possibility has been largely dropped [3,19], although more investigation has been suggested [2]. What is now termed STARI was first described in adolescents attending a summer camp in the North Carolina Piedmont [37]. As with several other studies on STARI, it is notable that some subjects had positive enzyme-linked immunosorbent assays and some positive bands on immunoblots for B. burgdorferi [32,[37][38][39].…”

“…Some of the medical records were destroyed either on purpose or accidentally by the treating medical providers, but the subjects had their own records of prescriptions and illness notes. While the resolution of EM-like rashes and symptoms following antibiotic treatment is associated with treatment [32,37], it does not prove a tick-related cause because resolution without treatment is known to occur in both Lyme disease and STARI.…”

Borrelia lonestariDNA in AdultAmblyomma americanumTicks, Alabama

“…Serum samples from these patients did not recognize B. burgdorferi antigens (4,5), and spirochetes from these cases have not been successfully cultured in BSK-H medium. Hence, these cases have been diagnosed as STARI.…”

“…However, a clinical condition similar to Lyme disease, termed southern tick-associated rash illness (STARI), has been described in humans in the southeastern region of the United States associated with the bite of Amblyomma americanum ticks (1,4,5). Moreover, a new spirochete, B. lonestari, was described from A. americanum on the basis of polymerase chain reaction (PCR) amplification of the flagellin and 16s rRNA genes (6,7).…”