Southern Tick-Associated Rash Illness (STARI) in the North

STARI Following a Tick Bite in Long Island, New York

Feder, Henry M. Jr
Hoss, Diane M.
Zemel, Lawrence
Telford, Sam R. III
Dias, Feliciano
Wormser, Gary P.

¹Departments of Pediatrics and Family Medicine, Connecticut Children’s Medical Center, Hartford
²University of Connecticut Health Center, Farmington
³Caris Diagnostics, Newton, Massachusetts
⁴Connecticut Children’s Medical Center, Hartford
⁵Division of Infectious Diseases, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
⁶Department of Microbiology, University of Connecticut Health Center, Farmington
⁷Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla

Correspondence: Henry M. Feder Jr, MD, Departments of Family Medicine and Pediatrics, University of Connecticut Health Center, Farmington, Connecticut 06030 ([email protected]).

Received May 2, 2011

Accepted July 19, 2011

Clinical Infectious Diseases 53(10):p e142-e146, November 15, 2011. | DOI: 10.1093/cid/cir553

The most common clinical manifestation of Lyme disease is the characteristic rash, erythema migrans (EM). In the 1980s EM-like eruptions were reported in Missouri and other southeastern states. The EM-like eruptions, which were of unknown etiology, often followed the bite of the Lone Star tick (Amblyomma americanum) and the rash is called STARI (southern tick-associated rash illness). Although the Lone Star tick is found in the Lyme disease–endemic areas of New England and Mid-Atlantic regions of the United States, STARI has been reported only once from the Northeast and Mid-Atlantic regions. We report a child from Connecticut who visited Long Island, New York, and developed a rash that was thought to be EM. Because the patient failed to respond to antibiotics used to treat Lyme disease, an investigation ensued, and the diagnosis of STARI was established.