Southern tick-associated rash illness differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: : Vishnu Vardhan Serla M.B.B.S. [2]

Differentiating Southern tick-associated rash illness from other Diseases

Many people, even health care providers, can be confused about whether the lone star tick causes Lyme disease. It does not. Patients bitten by lone star ticks will occasionally develop a circular rash similar to the rash of early Lyme disease. The cause of this rash has not been determined; however, studies have shown that the rash is not caused by Borrelia burgdorferi, the bacterium that causes Lyme disease.

Distinctions between STARI and Lyme disease symptoms

In a study that compared physical findings from STARI patients in Missouri with Lyme disease patients in New York (Wormser et al, 2005), several key differences were noted:

• Patients with STARI were more likely to recall a tick bite than were patients with Lyme disease.
• The time period from tick bite to onset of the skin lesion was shorter among patients with STARI (6 days, on average).
• STARI patients with an erythema migrans rash were less likely to have other symptoms than were Lyme disease patients with erythema migrans rash.
• STARI patients were less likely to have multiple skin lesions, had lesions that were smaller in size than Lyme disease patients (6-10 cm for STARI vs. 6-28 cm for Lyme disease), and had lesions that were more circular in shape and with more central clearing.
• After antibiotic treatment, STARI patients recovered more rapidly than did Lyme disease patients.