STARI and Lyme Disease: Similarities and Differences
STARI and Lyme disease can appear very similar after a tick bite, making diagnosis challenging. Both conditions may cause an erythema migrans–type rash and flu-like symptoms.
Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron discusses the case of a 63-year-old woman diagnosed with Southern Tick-Associated Rash Illness (STARI).
STARI and Lyme disease share many similarities. In their article
“Southern Tick-Associated Rash Illness: Florida’s Lyme Disease”
, Abdelmaseih and colleagues describe a patient case highlighting these similarities and differences.1
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Case Presentation
The patient was bitten by a lone-star tick on her right leg while camping in Gainesville, Florida. After removing the tick she noticed a pruritic target-like erythematous lesion.
Two weeks later she developed persistent fever, headache, and diffuse myalgias for four days following the tick bite.
On presentation she had a fever of 100.5°F and tachycardia of 127 BPM. Laboratory testing revealed a low white blood cell count, anemia, thrombocytopenia, and elevated liver function tests.
Fortunately, the patient’s symptoms resolved with a 14-day course of doxycycline.
STARI and Lyme Disease: Similarities and Differences
The authors discussed several similarities between STARI and Lyme disease.
- “The associated rash is similar if not indistinguishable from Lyme disease erythema migrans, with lymphocytic dermal infiltrate.”
- Both STARI and Lyme disease diagnoses are based largely on clinical evidence.
- “At the present time there is no approved diagnostic modality to identify STARI; therefore diagnosis must rely on clinical evidence including erythema migrans and tick exposure.”
Geographic Clues in Diagnosis
The diagnosis of STARI and Lyme disease often relies on geographic exposure.
“Diagnosis usually relies on geographic association (STARI from central Texas and Oklahoma eastward across the southern states and along the Atlantic coast as far north as Maine, versus Lyme disease in the Northeast, Mid-Atlantic, and Upper Midwest).”
However, the authors did not address reports documenting the presence of lone-star ticks in the Northeast, Mid-Atlantic, and Upper Midwest, or the presence of deer ticks in parts of the South.
Long-Term Consequences Remain Uncertain
It has been widely assumed that STARI does not cause long-term complications. However, much about the illness remains unknown.
“A recent study has suggested that STARI is transmitted by the lone-star tick Amblyomma americanum; however, much is still unknown about STARI.”
Treatment Considerations
The treatment of STARI is also uncertain.
“STARI is often treated as Lyme disease with doxycycline twice daily for 14 days; however, there is no approved treatment yet.”
The authors concluded that STARI is an emerging Lyme-like illness producing erythema migrans rash, although its true incidence remains unknown because it is not nationally reportable.
Questions Addressed in This Podcast
- What is STARI?
- Are there differences between STARI and Lyme disease rashes?
- Are there differences in the ticks responsible for infection?
- How is STARI diagnosed compared with Lyme disease?
- What clinical evidence is needed to diagnose STARI?
- What are the consequences if Lyme disease or co-infections are overlooked?
- What do we know about ticks in the southern United States?
Thanks for listening to another Inside Lyme Podcast. Please remember that the advice given is general and not intended as specific advice to any particular patient. If you require specific advice, please seek that advice from an experienced professional.
Frequently Asked Questions
What is STARI?
STARI (Southern Tick-Associated Rash Illness) is a Lyme-like illness transmitted by the lone-star tick that produces an erythema migrans rash similar to Lyme disease.
How is STARI different from Lyme disease?
STARI and Lyme disease share similar rashes and symptoms, but they are transmitted by different ticks. STARI is associated with lone-star ticks, while Lyme disease is transmitted by black-legged (deer) ticks.
How is STARI diagnosed?
There is no approved diagnostic test for STARI. Diagnosis is based on clinical findings, including rash appearance and tick exposure in endemic regions.
How is STARI treated?
STARI is commonly treated with doxycycline for 14 days, similar to Lyme disease, although standardized treatment guidelines have not been established.
Related Articles:
Lyme Disease Co-infections
Borrelia miyamotoi
Powassan Virus
Babesia
References:
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Abdelmaseih R, Ashraf B, Abdelmasih R, Dunn S, Nasser H.
Southern Tick-Associated Rash Illness: Florida’s Lyme Disease Variant.
Cureus. 2021;13(5):e15306.
About the Author
Dr. Daniel Cameron is a board-certified physician with more than 37 years of clinical experience treating Lyme disease and other tick-borne illnesses.
Dr. Cameron is the past president of the International Lyme and Associated Diseases Society (ILADS) and the lead author of the ILADS Lyme disease treatment guidelines.
Through his Inside Lyme Podcast and clinical commentary, he reviews research and case reports to help clinicians and patients better understand Lyme disease, co-infections, and Lyme-like illnesses such as STARI.
Emerging? I had multiple tick bites as a child during summer trips to Kentucky, in the early to mid 1970s.
I has taken a while for doctors and researchers to document ticks and tick borne diseases in new areas. Until someone writes it up, the typical answer might be we don’t have tick or we don’t have tick borne diseases in this area.
I have been ill since the spring of 1987 . I lived in a wooded area near a lake . I saw several Possums and Raccoons when I lived there . I had not lived there long and I was clearing brush and taking it into the woods . When I finished and was cleaning up . I found a Tick embedded in my left arm . I removed it with tweezers and flushed it .It wasn’t long before subtle changes began .Visual problems ,fatique and and a strange sensation in my left foot and left arm . Several months later I was diagnosed with Hemianopsia . I started having memory problems .Nobody seemed to know what was wrong . It wasn’t until 1999 and my mother was watching a show about Lyme Disease and she called me to tell me how the rash shown on the show looked the same as the one I developed after the Tick bite .I contacted a Infectious disease Doctor and he did treat me with iv antibiotics . I did get better after being bed ridden and having to use a walker while undergoing