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Updated: May 10, 2026
07:20
Detecting the Lyme Disease Spirochete, Borrelia Burgdorferi, in Ticks Using Nested PCR
Published on: February 4, 2018
Hitting the target: Lyme or STARI?
Ian M Goldstein1, Marissa A Black, Brian Leydet
1Tulane University School of Medicine, New Orleans, USA.
Summary
Erythema migrans (EM) rashes in the Southeastern US may indicate Southern Tick-Associated Rash Illness (STARI), not Lyme disease (LD). Distinguishing between STARI and LD is crucial for appropriate treatment and preventing long-term LD complications.
Area of Science:
- Infectious Diseases
- Dermatology
- Epidemiology
Background:
- Erythema migrans (EM) is a hallmark rash of Lyme disease (LD), prevalent in the northeastern and north central US.
- EM rashes in the Southeastern US are typically diagnosed as Southern Tick-Associated Rash Illness (STARI).
- Accurate differentiation is essential as untreated LD can result in severe, long-term health issues.
Observation:
- A case of EM rash in a 3-year-old female from central Louisiana presented with findings suggestive of LD.
- The patient's geographic location and rash characteristics initially raised diagnostic questions.
- Clinical and laboratory data prompted a closer examination of potential etiologies.
Findings:
- The presented case underscores the diagnostic challenge of EM in regions where STARI is more common.
- While clinically resembling LD, the specific diagnosis requires careful consideration of geographic and epidemiological factors.
- This case highlights the need for robust diagnostic criteria to differentiate EM presentations.
Implications:
- Misdiagnosis of EM rash can lead to delayed or incorrect treatment, particularly concerning the distinction between STARI and LD.
- Early and accurate diagnosis of LD is critical to prevent chronic complications.
- This case emphasizes the importance of considering regional variations in tick-borne illnesses and their presentations.
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