Image: Adobe Stock.<\/em>
\n <\/figcaption>
\n <\/figure>\nThe similar-looking rashes can make diagnosing Lyme disease trickier; however, STARI is less severe than Lyme disease, often self-resolving, and lacks long-term neurological and arthritic symptoms.<\/p>\n
For an explanation on the impact of the migrating ticks, Healio spoke to Ray<\/b>mond<\/b> J. <\/b>Dattwyler<\/b>, <\/b>MD<\/b>, <\/b>professor of microbiology\/immunology and medicine at New York Medical College, who coauthored the correspondence.<\/p>\n
He<\/b>a<\/b>lio<\/b>:<\/b> How and why has the distribution of the <\/b>l<\/b>one <\/b>s<\/b>tar tick (<\/b>Amblyomma<\/b> americanum<\/b>) changed, and where are they overlapping now with ticks that cause Lyme disease?<\/b> <\/p>\n
Dattwyler<\/b>: <\/b>We don\u2019t know what\u2019s causing the overlapping. They\u2019re overlapping throughout the Mid-Atlantic and into southern New England. The trouble is they\u2019re shifting and could spread in northern parts of New England.<\/p>\n
He<\/b>a<\/b>lio<\/b>: How <\/b>is<\/b> the changing epidemiology <\/b>complicating<\/b> the diagnosis of Lyme disease and STARI? <\/b> <\/p>\n
Dattwyler<\/b>: The certainty that the rash (Erythema migrans) is diagnostic of Lyme disease is significantly diminished. So, what we need are better diagnostic tests, which are being developed.<\/p>\n
He<\/b>a<\/b>lio<\/b>: What are the clinical implications of these changes, and how should clinicians in these areas alter current practices?<\/b> <\/p>\n
Dattwyler<\/b>:<\/b> It makes the diagnosis of Lyme disease tougher. I\u2019ve seen thousands of Lyme disease cases, and I can\u2019t tell the difference between Erythema migrans and STARI. You can no longer say you definitely have Lyme disease. For the average physician, treat them as if they had Lyme disease. You still follow them up and still do appropriate testing. If I were a PCP and saw the lesion, I would treat it with doxycycline, even though you can no longer definitely say it\u2019s Lyme. It\u2019s safer to treat than not to treat. The risk of missing Lyme is greater than the risk of giving someone doxycycline or amoxicillin who doesn\u2019t need it. <\/p>\n
He<\/b>a<\/b>lio<\/b>: Do we know to what extent STARI occurs in the Mid-Atlantic states? <\/b> <\/p>\n
Dattwyler<\/b>:<\/b> It\u2019s fairly common in the Mid-Atlantic states but we don\u2019t have exact numbers.<\/p>\n
Healio<\/b>: Does STARI resolve on its own without antibiotic treatment? And, if it does, what percentage of cases are resolved without treatment?<\/b> <\/p>\n
Dattwyler<\/b>:<\/b> Yes, it resolves on its own. We\u2019re not even sure what\u2019s even causing it. People have looked for bacteria and viruses and have not come to a definite conclusion.<\/p>\n
Healio<\/b>: Is it expected that STARI will surpass Lyme disease in cases in the Mid-Atlantic?<\/b> <\/p>\n
Dattwyler<\/b>:<\/b> Unknown.<\/p>\n
Healio<\/b>: Are there emerging tools or technologies that may simplify the distinction between Lyme disease and STARI?<\/b> <\/p>\n
Dattwyler<\/b>:<\/b> We have the PCR that can diagnosis Lyme disease but the biggest problem with it is you must do a skin biopsy, and the average physician and the patient don\u2019t want to do a skin biopsy. We\u2019re essentially working on a workaround. When will we develop diagnostic tools? One will never know. <\/p>\n
Healio<\/b>: Because medical guidance of STARI is based on similarity to Lyme disease, do you expect guidance to become more specific to STARI?<\/b> <\/p>\n
Dattwyler<\/b>:<\/b> Right now, no. I can\u2019t predict the future.<\/p>\n
Healio<\/b>: Other than the indistinguishable rash, are there any other problems caused by the migrating tick?<\/b> <\/p>\n
Dattwyler<\/b>:<\/b> The biggest problem is the meat-allergy question. For whatever reason, lone star tick bites can cause an allergy to alpha-gal, which is in beef and pork. You could get delayed anaphylaxis that can happen up to 6 or more hours after eating meat. There\u2019s one anaphylaxis death that I\u2019m aware of. [Editor\u2019s note: The death, which was <\/i>described recently in a journal<\/i>, occurred in 2024.]<\/i><\/p>\n
Healio<\/b>: Do you expect STARI to impact other regions beyond the Mid-Atlantic, perhaps into areas farther north?<\/b> <\/p>\n
Dattwyler<\/b>:<\/b> That\u2019s a definite maybe. I would expect that it would. When and to what degree, I don\u2019t know. I know it\u2019s not around Boston yet.<\/p>\nFor more information:<\/h2>\n
Raymond J. <\/b>Dattwyler<\/b>, MD,<\/b> can be reached at infectiousdisease@healio.com.<\/p>\n\n
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