STARI, or Southern tick-associated rash illness, is a tick-borne disease that was first described by physicians in Missouri in 1984. It wasn’t considered distinct from Lyme disease until the 1990s. Cases of STARI first appeared in the South and Southeast of the United States, but it now extends up into the mid-Atlantic states and into the Northeast.  

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Signs and Symptoms 

 

Symptoms of STARI are very similar to those of Lyme disease. Patients with STARI will also develop a “bull’s eye” rash near the site of the tick bite. Skin lesions that appear near the bite are also often accompanied by fatigue. Other signs of STARI include flu-like symptoms such as fever, chills, and headache.  

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The rash that develops with STARI, although similar to the erythema migrans rash with Lyme disease, differs subtly. Lesions in STARI patients have reported being smaller and taking on the bull’s eye appearance more frequently than in Lyme disease patients. 

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The CDC cautions automatically concluding that a rash at the site of a tick bite is STARI, as the saliva from a lone star tick can cause redness and irritation as well. So a rash may not necessarily be a sign of STARI infection. Furthermore, a STARI rash may appear within 7 days of being bitten by an infected tick. 

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 What is the Bacterium that Causes STARI? 

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Researchers believed that STARI was caused by Borellia lonestari, but have been unable to conclude this for certain. They were able to rule out the bacterium B. burgdorferi, the agent for Lyme disease, as a cause of STARI, though. STARI has been traced to lone star ticks, and this tick species is not a vector for Lyme disease. 

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It was thought that B. lonestari was the bacterium that causes STARI because it was found in one case of the disease. But there hasn’t been enough further evidence support this idea. Some dissenters even think that the STARI may not be a bacterial infection. 

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The CDC differentiates STARI from Lyme disease, saying that patients with STARI generally develop a rash sooner than Lyme disease, that they’re less likely to have additional symptoms than with Lyme disease, and that recovery after antibiotics was more rapid in STARI cases. For more about the differences between these 2 diseases, see this info from the CDC. https://www.cdc.gov/stari/disease/index.html 

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 Which Types of Tick Carry STARI? 

 

STARI has been traced to the lonestar tick, Amblyomma americanum. The distribution of the lone star tick ranges from the South and Southeast and into the Northeast. Populations of the lone star tick were found in Connecticut as recently as 2018. 

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Lone star ticks can be aggressive, feeding on both humans and domestic pets in any of their life stages. In addition, patients bitten by a lone star tick and later infected with STARI were more likely to have remembered being bitten by a tick than patients who contracted Lyme disease from an infected tick bite.  

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Cures and Treatments 

 

Since STARI symptoms resemble those of Lyme disease, doctors usually treat STARI patients with antibiotics. In most cases, patients fully recovered as a result of the medication. The acute recovery from antibiotics casts doubt on the idea that STARI isn’t a bacterial infection. However, since the cause of the disease is still officially unknown, it cannot be ruled out. 

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As the cause has still not been discovered, there is no diagnostic test for doctors to give patients for STARI. There is also no link between STARI and arthritis, neurologic problems, or other chronic symptoms. It’s unknown if STARI causes red meat allergy, or alpha-gal syndrome, but the lone star tick is known to be a vector for alpha-gal. 

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Areas in Danger of Being Bitten 

 

As mentioned, the lone star tick is prevalent in most of the Southeast and into the Northeast. This tick likes wooded areas, so venturing into woodlands with significant amounts of underbrush puts you and your pets at risk of being bitten. Lone star ticks are very likely to attack humans, dogs, and cats. 

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Is STARI dangerous? So far, the disease seems milder than Lyme disease and other tick-borne diseases. Symptoms appear less severe and it has been successfully treated with antibiotics. It’s not known, however, how the disease develops if left untreated. 

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Lone star ticks are vectors for several other tick-borne diseases, such as ehrlichiosis and tularemia. Prevention of tick bites it the number-one recommendation from the CDC for avoiding these diseases. Stay away from areas that are likely to be tick habitats if possible. If you plan to go hiking or camping, wear long sleeves and pants, socks, and closed-toe shoes. In addition, treat your clothes with a permethrin solution before heading to wooded areas. always check yourself and your pets for ticks before going back inside as well. For more info from the CDC on tick bite prevention, see here. https://www.cdc.gov/ticks/avoid/on_people.html

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With the right precautions, you can protect yourself from tick-borne diseases like STARI.