Southern Tick-Associated Rash Illness: Erythema Migrans Is Not Always Lyme Disease

Abstract

Southern tick-associated rash illness (STARI) is a rash occurring after a tick bite. It is a form of erythema migrans, an annular rash with central clearing that is almost identical with the erythema migrans seen in Lyme disease. The etiologic agent is not known but may be a Borrelia species. The tick vector is different in the two diseases. Serious systemic complications are not currently recognized with STARI but treatment with doxycycline is prudent. Differentiating STARI from Lyme disease is discussed.

Surveillance for Lyme Disease — United States, 2008–2015

“…Although probable cases from states with high incidence still occurred more commonly among males, probable cases from neighboring states and states with low incidence occurred more commonly among females. Demographic differences among cases reported from states with high and low incidence have been previously documented ( 16 , 17 ) and might reflect lack of specificity of erythema migrans in locations where southern tick-associated rash illness occurs ( 18 ) as well as higher potential for false positive serologic results stemming from lower positive predictive value of those tests in settings with low incidence ( 19 , 20 ). Many confirmed cases in states with low incidence likely reflect travel to states with high incidence ( 16 ) .…”

The Biological Survey of Canada: A Personal History

“…Although the exact etiologic agent is unclear, Borrelia burgdorferi sensu stricto is not the causative agent (Masters et al 2008). Serious systemic complications are not currently recognised with STARI but treatment with doxycycline is recommended (Blanton et al 2008;Masters et al 2008).…”

Retrospective Case Reports of Two Central North Carolina Residents

“…Due to today's progressive standards for informed consent, such studies may be difficult or impossible to conduct since they would require a cohort of patients agreeing to no treatment over time in the face of existing evidence of Lyme-like symptoms associated with STARI [33]. Most reports support treating these patients as for Lyme disease [41][42][43], though some question whether treatment is needed in spite of the condition's Lyme-like symptoms [44]. A recent study suggests that in the South, some cases of Lyme disease-like illnesses may be attributable to lone star tick-vectored infections with previously undetected B. burgdorferi sensu lato [45], but more research is needed to confirm these findings.…”