STARI, or Masters Disease: Lone Star Tick–Vectored Lyme-like Illness

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).…”

“…americanum is also well-known as the tick-vector associated with STARI, sometimes called Masters disease [32]. Data on its incidence are entirely lacking, in part because there is no test or diagnostic code [33,34], and the public has not been trained to keep attached ticks.…”

“…Interestingly, the female subject in this report had a reactive IgM 23-kDa band following one episode of presumed STARI (illness 2). The CDC states that STARI has not been linked to arthritis, neurologic disease, or chronic symptoms [19]; however, Masters and colleagues have published evidence that sequelae do occur [32,38].…”

“…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.…”

The Biological Survey of Canada: A Personal History

“…This spirochaete has been detected in lone star ticks removed from humans and has been cultured from A. americanum (Varela et al 2004); however, attempts to detect this agent by polymerase chain reaction (PCR) or culture from skin biopsies from patients have not been successful, except for detection of B. lonestari by PCR in one patient (James et al 2001;Wormser et al 2005), suggesting that other agents may be involved in the etiology of STARI. 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).…”