Southern tick-associated rash illness

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Southern tick-associated rash illness
Amblyomma americanum tick.jpg
Lone star ticks can be carriers of southern tick-associated rash illness.
Classification and external resources
ICD-9-CM 088.89
DiseasesDB 33924

Southern tick-associated rash illness (STARI) or Masters' disease is an emerging infectious disease related to Lyme disease that occurs in southeastern and south-central United States. It is spread by tick bites, but the organism that causes the infection is unknown.


This illness is a tick-borne disease carried by the lone star tick Amblyomma americanum. This tick was first proposed as a possible vector of disease in 1984,[1] and the illnesses associated with the tick called "Lyme-like disease",[2] but it was not recognized to be distinct from Lyme disease until the late 1990s.[3][4]

Several studies have failed to detect Borrelia burgdorferi, which is the causative agent of Lyme disease, in patients from the southern United States.[5][6] This disease may be caused by the related bacterium Borrelia lonestari,[7][8] which is a spirochete first isolated in culture in 2004.[9] However, this conclusion is controversial since the spirochete is not detected in all cases of the syndrome,[6] which has led some authors to argue that the illness is not caused by a bacterial pathogen.[10]


"Bull's-eye" STARI rash

Diagnosis is based on a circular "bull's-eye" rash at the site of infection called erythema chronicum migrans, which is very similar to that seen in Lyme disease. However, the symptoms of STARI are mild, and resemble influenza, with fatigue, muscle pains, and headache.[4] Fever is sometimes seen, but is not characteristic.


Infections are treated with antibiotics, particularly doxycycline, and the acute symptoms appear to respond to these drugs.[8][11]


No serious long-term effects are known for this disease,[11] but preliminary evidence suggests, if such symptoms do occur, they are less severe than those associated with Lyme disease.[7]

See also[edit]


  1. ^ Schulze TL, Bowen GS, Bosler EM, et al. (May 1984). "Amblyomma americanum: a potential vector of Lyme disease in New Jersey". Science. 224 (4649): 601–3. doi:10.1126/science.6710158. PMID 6710158. 
  2. ^ Masters EJ, Donnell HD (July 1995). "Lyme and/or Lyme-like disease in Missouri". Mo Med. 92 (7): 346–53. PMID 7651314. 
  3. ^ Masters E, Granter S, Duray P, Cordes P (August 1998). "Physician-diagnosed erythema migrans and erythema migrans-like rashes following Lone Star tick bites". Arch Dermatol. 134 (8): 955–60. doi:10.1001/archderm.134.8.955. PMID 9722725. 
  4. ^ a b Kirkland KB, Klimko TB, Meriwether RA, et al. (1997). "Erythema migrans-like rash illness at a camp in North Carolina: a new tick-borne disease?". Arch. Intern. Med. 157 (22): 2635–41. doi:10.1001/archinte.157.22.2635. PMID 9531233. 
  5. ^ Philipp MT, Masters E, Wormser GP, Hogrefe W, Martin D (October 2006). "Serologic Evaluation of Patients from Missouri with Erythema Migrans-Like Skin Lesions with the C6 Lyme Test". Clin. Vaccine Immunol. 13 (10): 1170–1. doi:10.1128/CVI.00238-06. PMC 1595329Freely accessible. PMID 17028220. 
  6. ^ a b Wormser GP, Masters E, Liveris D, et al. (February 2005). "Microbiologic Evaluation of Patients from Missouri with Erythema Migrans". Clin. Infect. Dis. 40 (3): 423–8. doi:10.1086/427289. PMC 2773674Freely accessible. PMID 15668867. 
  7. ^ a b Masters EJ, Grigery CN, Masters RW (June 2008). "STARI, or Masters disease: Lone Star tick-vectored Lyme-like illness". Infect. Dis. Clin. North Am. 22 (2): 361–76, viii. doi:10.1016/j.idc.2007.12.010. PMID 18452807. 
  8. ^ a b James AM, Liveris D, Wormser GP, Schwartz I, Montecalvo MA, Johnson BJ (June 2001). "Borrelia lonestari infection after a bite by an Amblyomma americanum tick". J. Infect. Dis. 183 (12): 1810–4. doi:10.1086/320721. PMID 11372036. 
  9. ^ Varela AS, Luttrell MP, Howerth EW, et al. (March 2004). "First Culture Isolation of Borrelia lonestari, Putative Agent of Southern Tick-Associated Rash Illness". J. Clin. Microbiol. 42 (3): 1163–9. doi:10.1128/JCM.42.3.1163-1169.2004. PMC 356874Freely accessible. PMID 15004069. 
  10. ^ Dennis DT. (2006). "Reply to Masters. "Lyme-Like Illness Currently Deserves Lyme-Like Treatment"". Clinical Infectious Diseases. 42 (4): 581–582. doi:10.1086/500018. PMID 16421811. 
  11. ^ a b Blanton L, Keith B, Brzezinski W (June 2008). "Southern Tick-Associated Rash Illness: Erythema Migrans Is Not Always Lyme Disease". South. Med. J. 101 (7): 759–760. doi:10.1097/SMJ.0b013e31817a8b3f. PMID 18580719. 

External links[edit]