Southern tick–associated rash illness
ABBR: STARI
A rash resembling erythema migrans that develops in someone bitten by the Lone Star tick (Amblyomma americanum).
Causes: STARI is believed to be caused by infection with Borrelia species, spirochetes known to cause both relapsing recurring fever and Lyme disease although it may result from some other infectious agent.
Symptoms and Signs: The rash of erythema migrans (EM) is red and often has an open or clear center. The rash spreads from a central point outward like the expand ing wave that forms when a stone is dropped into water. The rash is often accompanied by nonspecific and relatively systemic symptoms, including fevers, malaise, muscle and joint pains, and fatigue.
Diagnosis: The diagnosis is made when the rash identified on a person from the South Central or Southeastern U.S.
Prevention: People who spend time outdoors in tick-infested areas should use insect repellents, e.g., pyrethrins, to impregnate their clothing. The period of greatest risk for tick exposure is between the beginning of spring and the end of fall. DEET should be applied to bare skin to limit tick attachment and feeding. Clothes worn outdoors should be laundered promptly. Surveying the skin for the presence of ticks or nymphs may lead to early identification and removal (before the disease is acquired).
Treatment: Oral doxycycline, amoxicillin or cefuroxime is used to treat STARI.
Patient Care: Patients with STARI or related tick-borne illnesses should be educated about the use of insect repellents whenever they go outside. Patients who contract the disease should learn about the antibiotics they are prescribed, their potential side effects, and the necessity of completing a full course of therapy once antibiotic therapy begins. STARI has no known long-term side effects.
SYN: Masters disease.