Southern Tick-Associated Rash Illness (STARI)

Southern Tick-Associated Rash Illness is not a reportable disease in Oklahoma.  Persons in the southeastern and south-central states, including Oklahoma, have reported an illness indistinguishable from the early stages of Lyme disease. These symptoms include the “bull’s-eye” rash, also called an erythema migrans (EM) rash, usually associated with Lyme disease. However, testing for the bacteria that causes Lyme disease in these persons is negative. This Lyme-like disease has been named “STARI”, or Southern Tick-Associated Rash Illness. Although the cause of this disease is not fully understood, it appears to be associated with the bite of the lone star tick (Amblyomma americanum). This is a different tick than the deer tick (Ixodes scapularis) which transmits Lyme disease. Lone star ticks are commonly found in Oklahoma, and are known to aggressively bite humans. Researchers have identified a bacterium that is thought to be the cause of STARI and named it Borrelia lonestari (B. lonestari).

Until recently, it remained unclear whether the lone star tick could transmit B. lonestari to humans or whether B. lonestari was the actual cause of STARI. In 2001, researchers at the Centers for Disease Control and Prevention confirmed the presence of B. lonestari in a patient with an EM rash, and from the lone star tick that had bitten her. These scientists are continuing their efforts to develop tests for B. lonestari. There is currently no commercially available test for B. lonestari. The treatment and prevention measures for STARI are similar to other tickborne illnesses. Contact your physician if you think you might have STARI, or any symptoms of illness that develop within two weeks of tick exposure. Your physician may prescribe antibiotics to treat an illness suspected to be STARI.

The Oklahoma State Department of Health continues to investigate tickborne diseases in Oklahoma. To further advance our knowledge of STARI in Oklahoma, we encourage health care providers to report patients who present with an EM rash to the Acute Disease Service (ADS) at (405) 271-4060. From 2001-2005, the ADS has investigated seven possible cases of STARI in residents of eastern Oklahoma. Each of these persons presented with an EM rash and each tested negative for Lyme disease. Three of these persons recalled being bitten by a lone star tick. These case reports, in addition to the known distribution of the lone star tick, indicate the likely presence of STARI in Oklahoma.

STARI Fact Sheets and Information:
STARI Fact Sheet (43k.pdf) 
   STARI Hoja Informativa (45k.pdf)
Lyme Disease
Tickborne Disease Prevention

External STARI Resources:
CDC STARI
CDC Lyme Disease