How does a person get STARI?
Unlike Lyme disease, which is transmitted by the bite of Ixodes scapularis (blacklegged tick, also known as the “deer tick"), STARI is associated with the bite of the lone star tick,
Amblyomma americanum. The lone star tick is common in the southeast and south-central United States, the same geographic location where most cases of STARI occur. Spiral-shaped bacteria known as spirochetes have been detected in a small percentage (1-5%) of the
A. americanum ticks collected from this region. DNA analysis of the spirochetes has indicated that they are not
Borrelia burgdorferi, the agent of Lyme disease, but are a different, newly recognized species, Borrelia lonestari. You may get STARI if you are bitten by a lone star tick that is infected with
B. lonestari.
Is there any compelling evidence that B. lonestari causes STARI or that lone star ticks transmit it?
In 2001, a patient from New York developed a rash indistinguishable from erythema migrans (the hallmark rash of Lyme disease) at the site of a lone star tick bite. The patient had been traveling in both Maryland and North Carolina prior to noticing the attached tick. Blood testing for Lyme disease was negative. DNA testing of both the tick and a biopsy of the rash showed evidence of B. lonestari. This is a strong indication that
B. lonestari causes STARI, and that
A. americanum is a capable vector (transmitter) of the pathogen.
How prevalent is STARI? 
The current incidence of STARI is unknown. A case definition has not yet been developed, so the disease is not nationally reportable. The CDC is continuing to study the illness in order to more clearly define it.
What are the symptoms of STARI?
Persons experiencing an expanding red, ring-like rash with central clearing (erythema migrans) following the bite of a lone star tick,
Amblyomma americanum, or following exposure to ticks even if there is not a known tick bite, especially those living or traveling in southeastern or south-central states, should see a physician. A mild illness characterized by symptoms such as fatigue, headache, stiff neck, and occasionally fever, or other generalized symptoms may accompany the rash.
How is STARI diagnosed?
There is currently no specific diagnostic test for STARI. The CDC is interested in obtaining samples from patients who have suspected STARI so that further research can be conducted. Evidence to support a clinical suspicion of STARI include rash, other suggestive symptoms, recent travel history to the southeast or south-central United States, known lone star tick bite, activities they may have resulted in tick exposure, and diagnostic tests that rule out traditional Lyme disease. In addition, DNA tests of skin and/or blood specimens may be possible if submitted to the CDC.
What is the treatment for STARI?
There are currently no specific recommendations for treating STARI. However, in most published case reports to date, the rash and other accompanying symptoms resolved quickly after the initiation of doxycycline therapy.
What can I do to reduce my risk of becoming infected with STARI?
-
Wear proper clothing as a physical barrier against ticks – long pants tucked into boots or tightly-woven socks; long sleeve shirt; shirt tucked into pants; and light-colored clothing so as to more easily spot ticks. - Check your skin and clothing periodically for ticks.
- Use both skin and clothing repellents that have been approved by the Environmental Protection Agency (EPA). They are safe and effective.
DOD Insect Repellent System
The
DOD Insect Repellent System is an effective way to protect military personnel from pests and insect-borne diseases. The systems incorporates:
- An insect repellent treated uniform
- Wearing the uniform properly
- Applying insect repellent containing DEET, Picaridin, or IR3535 to exposed skin
- Sleeping inside an insect repellent treated bed net
What should I do if I find a tick attached to my skin?
Remove attached ticks as soon as they are found. Use tweezers to firmly grasp the tick's mouthparts up against the skin, and pull back firmly and steadily. Be patient – the tick's central mouthpart called the hypostome is covered with sharp barbs, sometimes making removal difficult. Don't pull back sharply, as this may tear the mouthparts from the body, leaving them embedded in the skin. If the mouthparts do break off, don't panic – the mouthparts alone cannot transmit disease because the infective body of the tick is no longer attached. However, to prevent secondary infection, remove the mouthparts as you would a splinter. Never squeeze the body of the tick or use such things as petroleum jelly, fingernail polish remover, or a lighted match: these methods could force more infective fluid into the skin. After removal, wash the wound site, and apply an antiseptic. Preserve the tick by placing it in a clean, dry jar, or other well-sealed container, and keeping it in your freezer. Should you develop disease symptoms, take the tick with you to the physician's office; identification of the tick species may assist the physician with your diagnosis and treatment. Discard the tick after a month; all known tick-borne diseases will generally display symptoms within this time period.
