Southern Tick-Associated Rash Illness (STARI) in the North: STARI following a tick bite in Long Island, New York

Clin Infect Dis. 2011 Nov;53(10):e142-6. doi: 10.1093/cid/cir553. Epub 2011 Sep 21.


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.

Publication types

  • Case Reports

MeSH terms

  • Amoxicillin / therapeutic use
  • Animals
  • Bites and Stings*
  • Child, Preschool
  • Exanthema / diagnosis*
  • Exanthema / etiology
  • Exanthema / pathology
  • Female
  • Humans
  • Ixodidae*
  • New York City
  • Tick Infestations / diagnosis*
  • Tick Infestations / drug therapy
  • Tick Infestations / pathology
  • Ticks*


  • Amoxicillin