Southern Tick-Associated Rash Illness

Southern tick-associated rash illness (STARI) is clinically indistinguishable from Lyme disease (LD) in its early stages. In some cases a skin lesion (or rash) that looks like a Lyme disease erythema migrans (EM) appears at the site of the tick bite. Treatment with an antibiotic regimen similar to that used for LD helps resolve STARI. In some patients, STARI resolves on its own without antibiotic treatment. It has been suggested that STARI is caused by the spirochete B. lonestari that is transmitted by lone star ticks. Serologic testing for LD antibodies in STARI patients is not helpful because STARI is not caused by B. burgdorferi (the causative agent of LD).

The Centers for Disease Control and Prevention recommends that patients with an expanding rash and recent history of exposure to the lone star tick see a physician. Because of its similarity to Lyme disease, the extent to which STARI occurs in New Jersey has not been determined. However, studies in New Jersey have shown that the infection prevalence of B. lonestari in lone star ticks is 4% to 9%.

Southern Tick-Associated Rash Illness Fact Sheet

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